We compared the survival of 842 patients on centre haemodialysis to 272 patients on continuous ambulatory peritoneal dialysis (CAPD). All patients selected had begun treatment between 1 January 1984 and 30 June 1988 and were from six centres which participate in a regional renal patients registry. Patients on CAPD were older and had a greater proportion of diabetes and other associated diseases. Age, diabetes, and cardiovascular diseases were associated with a shorter survival on treatment in all the patients studied. Without adjustment for risk factors, patient 3-year survival was higher in centre haemodialysis than in CAPD, 80% versus 64% respectively. However, no significant differences could be shown in the survival rates of the two treatment modalities after accounting for the heterogeneity of the patients in the two groups, either by stratification or by multivariate analysis (Cox). Age was the main predictive factor for CAPD patient survival, while the influence of diabetes and cardiovascular diseases was less clear. Technique survival was much better in centre haemodialysis (94% versus 56% in CAPD, 3-year survival). Older age and diabetes mellitus were associated with a greater risk of switching from centre haemodialysis to CAPD and a trend to retain those patients on CAPD.

No abstract

Cardiac output (CO), total peripheral resistance (TPR), renal blood flow (RBF), renal vascular resistance (RVR) and intrarenal blood flow distribution have been measured 48 h after unilateral (right) nephrectomy (UNX) and in sham-operated rats (SO). Glomerular filtration rate (GFR) and renal plasma flow (RPF) were determined using standard inulin and PAH clearances. Superficial single nephron GFR (SNGFR) was measured by free-flow micropuncture techniques. Extracellular fluid volume (ECV) and plasma volume (PV) were also determined. UNX rats showed increases of 17.4% in remnant kidney GFR and 34.5 % in RPF. Filtration fraction was decreased to 0.27 ± 0.01 (control value 0.31 ± 0.01; p < 0.0025). SNGFR was 45% higher in UNX rats and the ratio SNGFR/GFR increased by 28%. Cardiac output also increased (33.6 ± 1.0 for UNX rats; 28.0 ± 1.2 ml/min/100g BW for SO rats; p < 0.0025) accompanied by a corresponding fall (20%) in TPR. Left kidney RBF increased by 22%, whereas RVR decreased by 21%. Blood flow through individual glomer-uli increased in the outer and inner cortex and was unchanged in the midcortex. In conclusion, 48 h after unilateral nephrectomy, rats showed a hyperdynamic circulatory state with increased CO and decreased TPR; this could be involved in the acute adaptive functional and renal changes reported after uninephrectomy.

Experiments have been carried out in order to clarify to what extent the absence of PRL renal catabolism in experimental renal insufficiency is responsible for the high PRL circulating levels. Furthermore, the relative contribution of the glomerular filtration rate and peritubular degradation to PRL renal clearance have been assessed. Circulating PRL basal levels were measured by RIA in sham-operated and intact control rats and in three uremic rat models: urine autoinfusion, bilateral ureteral ligation, and bilateral nephrectomy. Plasma PRL basal levels (nanograms per ml; mean +/- SEM) were increased in sham-operated rats (30.3 +/- 5.1) with respect to control animals (18.5 +/- 2.7; P less than 0.05). Bilaterally nephrectomized animals (66.4 +/- 16.4) and those with bilateral ureteral ligation (69.3 +/- 15.9) developed similar hyperprolactinemia, in contrast to urine-autoinfused rats (20.2 +/- 2.1; P less than 0.005) whose hormone levels were similar to those of control animals. Creatinine levels were markedly elevated and comparable in the three uremic rat groups. The results suggest that: 1) hyperprolactinemia in rats in acute renal insufficiency is due primarily to reduced renal function; 2) PRL renal catabolism in the rat requires a certain rate of glomerular filtration; and 3) PRL peritubular degradation does not seem to be relevant in PRL catabolism by rat kidney.

In eight years with 127 continuous ambulatory peritoneal dialysis (CAPD) patients, peritonitis due to Acinetobacter calcoacetlcus accounted for 1.6% of total peritonitis episodes. These were serious episodes, showing severe pain with fever. paralytic ileus, and leukocytosis, and appeared following peritonitis due to other organisms. An 80% relapse rate led to catheter removal.

Systemic and renal hemodynamics and body fluid volumes were evaluated in 48-hour uninephrectomized (UNX) and sham-operated (SO) rats, 3 h after glycerol-induced acute renal failure (ARF). UNX rats showed a 20% increase in cardiac output (CO) and renal blood flow (RBF) and a 20% decrease in total peripheric resistance (TPR) and renal vascular resistance (RVR) with respect to the control rats. There was no difference in body fluid volumes. 3 h after ARF induction UNX rats showed a minor decrease in RBF and GFR and a minor increase in RVR when compared with the control rats. CO decreased to similar levels in both UNX and SO rats. Mean arterial pressure and TPR increases were observed in UNX and SO rats but these increases were higher in the UNX than in the SO rats. Plasma and extracellular volumes were reduced in both groups of rats. The partial protection afforded by the renal mass reduction against the glycerol-induced ARF seem to be explained by the minor decrease in RBF and the lesser increase in RVR exhibited by the UNX rats after ARF induction.

Based on the above results, we recommend titration of the vancomycin dose in this group of patients and the administration of a loading dose of 20 mg/kg during the last hour of the hemodialysis session, followed by a maintenance dose of 7 mg/kg after each session, as well as the monitoring of the drug levels in this group of patients.

No abstract