Several clinical observations suggest the superiority of icodextrin compared with 4.25% dextrose in optimizing peritoneal ultrafiltration (UF), but no rigorous controlled evaluation has hitherto been performed. For comparing icodextrin and 4.25% dextrose during the long dwell of automated peritoneal dialysis, a multicenter, randomized, double-blind trial was conducted in 92 patients (control, 45; icodextrin, 47) with 4-h dialysate to plasma ratio creatinine >0.70 and D/D 0 glucose <0.34. Long-dwell net UF and the UF efficiency ratio (net UF volume per gram of dialysate carbohydrate absorbed) were determined at baseline, week 1, and week 2. The control and treatment groups were comparable at baseline (all patients using 4.25% dextrose for the long dwell) with regard to mean (؎SEM) net UF (201.7 ؎ 103.1 versus 141.6 ؎ 75.4 ml, respectively; P ‫؍‬ 0.637) and the percentage of patients with negative net UF (control, 37.8%; treatment, 42.6%; P ‫؍‬ 0.641). During the study period, net UF was unchanged from baseline in the control group but increased significantly (P < 0.001) in the icodextrin group from 141.6 ؎ 75.4 to 505.8 ؎ 46.8 ml at week 1 and 540.2 ؎ 46.8 ml at week 2. In the icodextrin group, the incidence of negative net UF was significantly lower (P < 0.0001) than in the control group. Findings were similar for UF efficiency ratio. Rash was reported significantly more often in the icodextrin group. This study showed that in high-average and high transporters, icodextrin is superior to 4.25% dextrose for long-dwell fluid and solute removal.

This study provides an overview of prescription practices in a cohort of CKD patients. Substantial underutilization of certain classes of cardioprotective medications is apparent, and systematic educational efforts in this direction may well prove worthwhile to impact outcomes.

The clinical course was reviewed of 102 renal allograft recipients between December 1967 and December 1973. Only 4 of 21 patients (19 per cent) who had 2 or more episodes of rejection during the first 2 months had a functioning graft at the end of 1 year, compared to 24 of 30 patients (83 per cent) who had no rejection episodes. A similar trend was seen 2 to 6 months after transplantation. During the first 2 years vigorous immunosuppressive therapy for rejection in the first few months resulted in 12 deaths (44 per cent) of 27 patients. Subsequent to this immunosuppressive therapy was modified and grafts were removed if there was not a prompt recovery of function after treatment, which resulted in a significant decrease in mortality rate to 16 per cent. There also was improvement in the over-all survival of patients with functioning grafts from 37 to 56 per cent. Serious complications and mortality could be related to high dosage of steroids and severe leukopenia. A white blood count of less than 1,000 mm.3 on 3 successive days was associated with a mortality rate of 52 per cent, compared to 15 per cent in those without leukopenia. Serious consideration should be given to early graft removal in patients who have 2 or more episodes of rejection in the first few months after transplantation, particularly when there is not a prompt improvement in renal function after immunosuppressive therapy. High doses of steroids (greater than 1 mg. per kg. for more than 26 days during the first 60 days) should be avoided to decrease morbidity and mortality rates from serious infections. The results of histocompatibility (HL-A) matching in 72 donor-recipient pairs indicated an improved graft survival when there was a match of 2 or more antigens, which is supported by the results recently reported by the Transplant Registry. The results of mixed lymphocyte reactions in 20 live donor-recipient pairs showed a marked improvement in graft survival when there was less than 20 per cent stimulation and it appeared that this reaction was of more important prognostic significance than the results of histocompatibility (HL-A) matching in these patients.