Christina M. Comty

Pericarditis in Chronic Uremia and Its Sequels

Abstract Uremic pericarditis occurred in 25 of 152 patients treated by chronic dialysis. Pyrexia was associated with pericarditis in 96% of the patients. A friction rub was not heard at any time in...

Coronary-Artery Surgery in Patients with End-Stage Renal Disease

Between 1975 and 1979 we performed coronary arteriography on 15 patients with end-stage renal failure and clinical evidence of severe ischemic heart disease. One patient died after the procedure of severe pump failure. Ten patients subsequently received coronary-artery bypass grafts, and two of these patients also received mitral-valve replacement. One patient, a diabetic, died of sepsis after surgery. Eight of the nine surviving patients, including the two patients who had undergone mitral-valve replacement, are markedly improved as a result of surgery. Our experience indicates that these patients can undergo angiography and coronary-artery bypass surgery at an increased but acceptable risk, provided dialysis is done before and after cardiac catheterization and surgery to control extracellular volume overload and hyperkalemia. The operation benefits patients with end-stage renal failure and severe ischemic heart disease by relieving angina and improving their level of activity. It is unclear whether survival is improved for these patients.

Peritoneal Transport of Vancomycin in 4 Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

The pharmacokinetics of vancomycin have been studied in 4 chronic renal failure patients undergoing continuous ambulatory peritoneal dialysis. Patients received 1 g of vancomycin in 2 liters of dialysate during an initial phase, and serum and dialysate samples were collected for vancomycin determination. 54% of the amount introduced into the peritoneal cavity were absorbed systemically during a 6-hour cycle. Peak serum concentrations averaged 23.7 microgram/ml. Mean elimination half-life was calculated to be 66.9 h, and dialysis clearance averaged 2.4 ml/min.

Protein metabolism in renal failure.

Abstract The concept of severe protein restriction in chronic renal failure is a familiar one. This is a review of some aspects of protein metabolism with particular reference to the use of low-protein diets in undialized patients and some of the problems associated with the management of patients on dialysis or after transplantation.

Cardiac Complications of Regular Dialysis Therapy

Since the introduction of regular hemodialysis treatment in 1960 (1), prolongation of useful life has been achieved for many thousands of patients. Long term hemodialysis, however, does not prevent cardiovascular disease. Indeed, cardiac complications on the basis of atherosclerosis are considered to be the commonest cause of death of long term dialysis patients. A recent report from Seattle indicates that 60% of deaths at the end of 13 years could be attributed to arteriosclerotic complications (myocardial infarction, stroke, congestive heart failure), occurring in patients who initially were selected because of the absence of vascular disease (2).

Digoxin Pharmacokinetics in Continuous Peritoneal Dialysis

Excerpt To the editor: The weekly clearance of small and middle molecules in patients undergoing continuous ambulatory peritoneal dialysis has been shown to be higher than that in chronic intermitt...

Cardiac Complications of Regular Dialysis Treatment

Since the introduction of regular hemodialysis in 1960 (1), prolongation of a useful life has been achieved for many thousands of patients, but long term hemodialysis does not prevent cardiovascular disease. Cardiac complications, on the basis of atherosclerosis, are considered to be the commonest cause of death. A recent report from Seattle indicates that 60% of deaths at the end of thirteen years could be attributed to arteriosclerotic complications (myocardial infarction, stroke, congestive heart failure) occurring in patients who initially were selected because of the absence of vascular disease (2).

Pretreatment and Preparation of City Water for Hemodialysis

In the early years of chronic hemodialysis, water used for dialysis was rarely treated. Because average patient survival was short, there was a general unawareness of acute or chronic complications from exposure to tap water contaminants. Since the late 1960’s, however, nephrologists have become increasingly aware of both acute and chronic problems resulting from exposure to untreated water. Contaminants present in both tap water and concentrate used for dialysate preparation, may enter patient’s blood stream across the dialyzer membrane in large amounts because of the large volume of fluid to which the patient is exposed during treatment (140 to 240 1). Trace amounts of contaminants especially the metals, present in dialysate may result in considerable into the blood stream (1). Such accumulation is worsened as a result of a longer biological half-life because of the absence of urinary excretion. There is evidence that pediatric patients may be more susceptible to trace metal-induced complications than adults.