Changgi D. Hong

Anthropometric Norms for the Dialysis Population

Although norms are available for healthy subjects, it is preferable, when interpreting anthropometry in individual dialysis patients, to compare measurements with norms for the stable dialysis population. The purpose of this study was to develop these reference anthropometric norms for dialysis patients. Triceps skinfold (TSF), subscapular skinfold (SSF), and mid-upper arm circumference (MUAC) measurements were made in 925 patients with no major illness, who were being treated by chronic maintenance dialysis in 27 dialysis facilities. Of these, 609 patients treated by hemodialysis (HD) were in subgroups large enough to compare with those from the National Health and Nutrition Examination Survey (NHANES) II. Diabetic patients were significantly different from nondiabetic patients; therefore, the two groups were analyzed separately. Male HD patients (diabetic and nondiabetic) did not differ significantly from the NHANES II data. Diabetic HD females did not differ significantly from the NHANES II data, except for the TSF of black women older than 55 years. Measurements of nondiabetic HD females (black and white) were significantly below the NHANES II data. In 138 continuous ambulatory peritoneal dialysis (CAPD) patients, measurements were similar to those of HD patients.

Effect of recombinant human erythropoietin on muscle energy metabolism in patients with end-stage renal disease: a 31P-nuclear magnetic resonance spectroscopic study.

To evaluate the effects of recombinant human erythropoietin (r-HuEPO) on muscle energy metabolism in patients with end-stage renal disease (ESRD), 10 patients receiving maintenance hemodialysis were given r-HuEPO (3,000 U three times a week for 8 weeks). Intracellular phosphocreatine to inorganic phosphate ratios and pH were measured with 31P-nuclear magnetic resonance spectroscopy before and after all-out handgrip exercise, before treatment and at 4 and 8 weeks after r-HuEPO treatment. The same measurements, from 14 normal individuals also were studied for comparison. The hematocrit increased significantly with r-HuEPO treatment, although the dose of r-HuEPO did not correct it to the normal level. The exercise capacity improved significantly. Intracellular pH was not different between the ESRD patients and controls or between before and after r-HuEPO treatment. The phosphocreatine to inorganic phosphate ratio at the resting state improved significantly with r-HuEPO treatment, reaching the same level as the normal subjects even before the low hematocrit normalized. The measurements immediately after exercise were the lowest levels obtained (the nadir state) and were not different between groups. In the state of maximum recovery, a pattern was noted that was similar to that found in the resting state. These results showed that r-HuEPO treatment improved the phosphorylation potential during the resting state and the maximum phosphorylation potential during the postexercise recovery phase, and suggest that the treatment improved the rate of oxidative phosphorylation in ESRD patients receiving hemodialysis.

Antibody to Tamm-Horsfall protein after acute tubular necrosis.

Histological examination of a renal biopsy specimen from a patient with acute renal failure showed the localization of Tamm-Horsfall protein in the renal interstitium. Measurement for serum anti-Tamm-

Comparison of Buffering Capacity in Patients on Hemodialysis and Continuous Ambulatory Peritoneal Dialysis

A standard acid loading test was used to assess the buffering capacity in 9 hemodialysis (HD) and 25 continuous ambulatory peritoneal dialysis (CAPD) patients. There was a significant increase in H+ concentration and a decrease in plasma bicarbonate levels after the acid loading in all patients; however, PaCO2 did not change significantly. CAPD patients tolerated the acid load better, at least in the first 2 h, than HD patients. The brief duration of experiments did not allow us to observe differences, if any, in the recovery rates between HD and CAPD patients. CAPD patients tolerated the acid load equally, whether studied with or without fresh dialysate in the peritoneal cavity. Their tolerance to the acid load did not change with an increasing duration of the CAPD therapy. Baseline values and acid tolerance curves were similar in CAPD patients on regular Dianeal (lactate 35 mEq/l) and Dianeal PD2 (lactate 40 mEq/l). It is concluded that the buffering capacity is marginally higher in CAPD than in HD patients, although the baseline acid-base parameters were essentially identical.

The Rat as an Animal Model of Lead Nephropathy

Nephropathy is only one of a number of toxic effects of lead observed in humans. Others include anemia, peripheral neuropathy, and an array of signs and symptoms attributed to deranged function of the central nervous system. These effects have been reported principally in children of pre-school age and in adults occupationally exposed to lead. The frequency of occurrence and severity of adverse effects in these two populations has diminished over the years. There is still cause for concern, however, particularly in regard to occupational lead nephropathy. The death rate due to chronic nephritis among male lead workers in the first quarter of this century was twice as high as among non-lead-exposed males of the same social class (Lane, 1964). Even among men employed from 1947 to 1970 excess mortality due to nephritis appears to have occurred (Cooper and Gaffey, 1975). Recent studies of renal function in workers indicate that occupational lead nephropathy is still a major problem (Wedeen et al., 1979; Hong et al., 1980).