While CMB is nearly neutral when using 1.25 DCa, the use of 1.5 DCa results in a gain of Ca during HD. The risks associated with Ca load should be considered in the choice of DCa prescription for HD but need also be weighed against the risk of worse haemodynamic dialysis tolerance.
To evaluate the immunological state in chronic renal insufficiency, the Authors studied cellular and humoral immunity in 292 patients with chronic renal failure. They were divided into 3 groups: 1) 37 with creatinine clearance between 50 and 20 ml/min; 2) 57 with creatinine clearance between 20 and 8 ml/min; 3) 178 treated by hemodialysis. In vivo and in vitro tests, that is DNCB, PPD skin tests, spontaneous, active and EAC rosettes, surface membrane immunoglobulin test, complement (C3, C4) and serum immunoglobulins were taken as markers of the immune response. Cell-mediated immunity was found to be significantly impaired in patients with terminal renal insufficiency or on hemodialysis and also markedly reduced in patients with non-terminal renal insufficiency. Humoral immunity produced less significant results: the B lymphocyte count and serum immunoglobulins were normal; only C3 levels were found below normal range. Thus it would seem that cell-mediated immunodeficiency appears in an early stage of chronic renal failure and that hemodialysis does not improve this deficiency.
From a review of the literature regarding kinetic models used for assessing the adequacy of hemodialysis, no definite conclusions can be drawn as to whether the classical urea kinetic model (UKM) or modified direct dialysis quantification (mDDQ) is more reliable. We compared mDDQ with classical UKM and with a modified UKM that employs an equilibrated urea value. From the theoretical viewpoint, no substantial conflict is found between the two models as regards the dialysis dose, if urea rebound is considered. From the practical viewpoint, in our opinion direct quantification lends itself better for experimental purposes whereas for routine Kt/V evaluation UKM is easier and accurate enough, provided that rebound is taken into account.
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