Prescribing medication in long-term dialysis units.

Little information is available regarding the current patterns of medication use in long-term dialysis centers. Therefore, we surveyed the medication records of 1,023 patients undergoing long-term dialysis therapy in 27 dialysis centers. The mean number of medications prescribed per patient was 7.7 +/- 0.54, increasing patient age, increasing duration of dialysis, in-center dialysis, and the presence of underlying diabetic and hypertensive nephropathy were associated with increased frequency of medication use. The use of multiple pharmacologic agents was associated with a high frequency of drug duplication (12%), potential dosage error (9%), potential significant drug interaction (15%), and use of contraindicated drugs (2.5%). A lack of individualization of the use of several pharmacologic agents was apparent. An extreme degree of center variability in drug use was also apparent. Periodic review of medication use should be undertaken in the long-term dialysis setting.

Hyporeninemic hypoaldosteronism--case report and observation of dissociated renin and erythropoietin activity.

A case is reported of hyporeninemic hypoaldosteronism, diagnosed during an evaluation of hyperkalemia. Urine and plasma aldosterone concentrations were depressed despite hyperkalemia and were not responsive to ACTH, cosyntropin, and angiotensin 2. Adrenal glucocorticoid function was normal. Plasma renin activity also was low, and was hyporesponsive to stimulation, including intravascular volume contraction and potassium depletion. Autonomic nervous function was intact. Of the 32 previously reported cases of selective hypoaldosteronism, plasma renin activity was low in the majority of cases in which it was measured. A classification of the types of selective hypoaldosteronism is presented. It is of interest that the serum erythropoietin activity in this case was increased while plasma renin activity was markedly depressed.