No abstract

Objective To determine the effect of peritoneal dialysis modalities such as nightly intermittent peritoneal dialysis (NIPD), continuous cyclic peritoneal dialysis (CCPD), and continuous ambulatory peritoneal dialysis (CAPD) on residual renal function. Design A six-month prospective, nonrandomized comparison study. Setting Outpatient CAPD unit of a university hospital. Participants Eighteen end-stage renal disease patients treated by peritoneal dialysis (8 by NIPD, 5 by CCPD, and 5 by CAPD). Interventions Samples from the total dialysate, blood, and 24hour urine collection were obtained monthly. Measurements Urea, creatinine, and beta2-microglobulin concentrations were measured. Renal and peritoneal clearances of each substance and KT/V urea were calculated. Residual renal function (RRF) was estimated by renal creatinine clearance (RCcr). Results No significant differences in age, sex, and primary renal disease among the three groups were noted. In all groups, anemic and hypertensive states were controlled identically, and mean weekly total (renal + peritoneal) KT/V urea (over 2.1/wk) and total creatinine clearance (over 60 L/wk/1.73 m2) were maintained during the whole experimental period. Starting mean RCcr was near 4.0 mL/min/1.73 m2 in all groups. Thereafter, a rapid and significant decline in RRF was demonstrated on NIPD and CCPD. The declining rates of RCcr values at 6 months after starting NIPD and CCPD were -0.29 and -0.34 mL/min/month, respectively, which were much greater than those of CAPD (+0.01 mL/min/month). Conclusion Because of a possibly characteristic progressive loss of RRF in automated peritoneal dialysis (APD), strict regular assessment of RRF should be performed from the start of APD.

Mid-systolic deceleration of pulmonary flow wave is likely to be related to reflection.

The sensitivity of the baroreceptor reflex in nine patients with borderline hypertension (mean age 19.1 + 0.2 years) was compared to that in six normal subjects of comparable age (mean 18.8 ± 0.3 years) and that in 14 patients with established hypertension (mean age 48.3 ± 3.1 years). The sensitivity of the baroreceptor reflex was assessed by determining the slope of the regression line relating the rise of systolic pressure to the prolongation of the R-R interval during the transient rise of arterial pressure induced by an intravenous injection of phenylephrine. The average baroreceptor slope in nine patients with borderline hypertension was 9.1 ± 0.8 msec/mm Hg, which was significantly less than that in six normal subjects (16.0 ± 2.0; P < 0.01), but was greater than that in 14 patients with established hypertension (4.9 ± 0.7; P < 0.01). The significant negative correlation was found as the baroreceptor slope was related to the mean arterial pressure in patients with borderline hypertension and normal subjects, all of whom were 20 years old or less. Attenuation of the baroreceptor sensitivity may influence the maintenance of raised arterial pressure in borderline hypertension. Material and Methods The study was undertaken on 29 subjects. They were divided into three groups. Group A included nine patients with borderline hypertension. All patients but one were sent from the siudent clinic of the university for an evaluation of high blood pressure which was found on a routine student physical examination. These students were selected on the basis of blood pressure readings higher than 150 mm Hg systolic or 90 mm Hg diastolic at least three times out of five checks on five successive days. All patients were asymptomatic. Their age was 19.1 ± 0.2 (mean ± SEM) years old. Additional Indexing WordsGroup B was composed of 14 patients with established hypertension. Their age ranged from 32 to 68 years old (mean age 48.1 ± 2.8). All of them had the history of hypertension for at least a few years and their diastolic blood pressures were consistently higher than 95 mm Hg at the outpatient clinic, although some of them showed a reduction of blood pressure after admission without drug treatment. Most of them had evidence of cardiovascular diseases on the fundoscopic examination, ECG, or chest X-ray. No patient had symptoms or signs of congestive heart failure. All medications including antihypertensive drugs were discontinued at least two weeks prior to the study.Secondary hypertension was ruled out on all patients in groups A and B. The studies undertaken on these patients included complete blood counts, urinalysis, urine culture, serum and urine electrolytes, intravenous pyelography, creatinine clearance, plasma renin activity at rest and after one hour of upright posture, and 24 hours urine for VMA, 17KS and 170HCS, and aldosterone.Six normal volunteer students of comparable ages were included as controls (group C).