Gabriel Morduchowicz

Compliance in Hemodialysis Patients: A Multivariate Regression Analysis

Successful treatment of patients with end-stage renal failure requires, in addition to dialysis, strict control of dietary, fluid and medication intake. In the present study we measured, in 50 chronic hemodialysis patients, serum potassium (K), serum phosphate (PO4) and interdialytic weight gain as indices of diet, medication and fluid compliance, respectively. Dietary compliance did not correlate with fluid or medication compliance, whereas fluid intake and medication compliance were related (p = 0.01). Age, time on dialysis, place of birth and whether the patient came accompanied or not to the dialysis unit were the main variables affecting serum K levels. Sex, ethnic origin and education significantly affected serum PO4. Sex, place of birth, marital status, number of children and years of education affected fluid intake. The compliance of the hemodialysis patient with different aspects of his regimen is thus multifactorial. Attempts to improve compliance and thus reduce morbidity and mortality should be aimed at identifying the population with low compliance and exposing them to educational programs.

Adequacy of Dialysis and Nutritional Status in Hemodialysis Patients

Twenty-three nondiabetic end-stage renal failure patients on hemodialysis were studied for adequacy of dialysis and nutritional status. Midweek predialysis blood urea nitrogen was 27.1 +/- 6.4 mmol/l of urea, KT/V, according to urea kinetic modelling, was 1.21 +/- 0.22 and mean normalized protein catabolic rate (nPCR) was 1.15 +/- 0.23 g/kg/day. Only 1 patient had a KT/V less than 1 and 4 patients had an nPCR less than 1 g/kg/day. No correlation was found between the different nutritional parameters. All patients had normal serum albumin. However, some of the patients could be classified as severely malnourished when parameters such as body weight (2 patients), triceps skinfold (5) and total lymphocyte count (3) were taken into account. No correlation was found between adequacy of dialysis and the different nutritional parameters. Furthermore, when patients were divided into low and normal KT/V, no differences were found in their nPCR. We conclude that a global assessment of the nutritional status is required in hemodialysis patients, and at least in patients with an acceptable KT/V, nPCR is not dependent on the adequacy of dialysis.

Bacteremia Complicating Peritonitis in Peritoneal Dialysis Patients

Bacteremia is a rare complication of peritonitis in end-stage renal failure (ESRF) patients treated by peritoneal dialysis. Three of our ESRF patients on peritoneal dialysis developed bacteremia during a peritonitis episode (1/19 peritonitis episodes). In 2 cases, the responsible organism was Escherichia coli and peritonitis was most likely associated with infection of the biliary tract. The 3rd patient had a perforation of the colon and Klebsiella spp. was the infective organism. Only the last patient survived but had to be transferred to hemodialysis. Bacteremia during peritonitis is infrequent in peritoneal dialysis patients and it appears to be related to other intra-abdominal events.

Prostanoids and thromboxane production by renal brush border membrane

It has been estimated that proximal tubule are responsible for about 7.5% of total kidney prostaglandin PGE2 production. In the present report we investigated the production of prostanoids and thromboxane by rabbit renal proximal tubule brush border membrane. PGF2 alpha was the major endogenous prostaglandin produced under basal condition. The addition of exogenous arachidonic acid increased only PGE2 production. No PGE2 production was found when vesicles were incubated with indomethacin or at 4 degrees C, suggesting the involvement of the PGH2 synthase and PGE2 isomerase enzymes. Addition of angiotensin II at 10(-6) and 10(-9) mol l-1 did not affect the endogenous PGE2 production by brush border membrane. Thus, results of our study demonstrates that the renal proximal tubule brush border membrane has the capacity to produce prostanoids and thromboxane.

Renal replacement therapy in the ninth decade of life

We reviewed our experience with seventeen end-stage renal failure (ESRF) patients aged 80 years or older, chronically dialyzed at our institution, during a seven year period. They represented 7% of the total dialysis population. The male:female ratio increased from 1.7:1 before age of 80 to 3.25:1 after 80. The main reason for ESRF was renal hypertensive disease (41% vs 6.6% before 80). Fourteen patients were treated initially with peritoneal dialysis and three with hemodialysis. The one and two year survival were 50 and 7% respectively. The main cause of death was infectious diseases (50% vs 25% before 80). Patients were hospitalized for a mean of 6.2% of treatment time. No patient asked for discontinuation of therapy. Dialysis therapy is feasible even in the very old, even though the overall survival is relatively short.