Kidney involvement is a frequent extraglandular manifestation of primary Sjögren's syndrome. It is rarely overt and may precede the onset of subjective sicca syndrome.

To clarify the role of chronic anaemia in the pathogenesis of the left ventricular hypertrophy (LVH) of chronic uraemia, nine normotensive dialysed patients were studied before and 3 and 6 months after start of intravenous treatment with recombinant human erythropoietin (rHuEpo). M-Mode echocardiographic estimations of left ventricular mass indices (LVMi) and plasma noradrenaline determinations were made at 3 and 6 months, and total blood volume (TBV) only at 6 months. Resting haemoglobin values were 5.9 +/- 1.3 (SD) g/dl, increased within 3 months to 10.2 +/- 1.2 (P less than 0.001), then remained unchanged. Baseline LVMi was 115 +/- 18 g/m2 body surface area (b.s.a.) and decreased significantly (P less than 0.0025) over the entire period to a final value of 78 +/- 13 g, which did not differ from the average value for 19 healthy controls. Resting plasma noradrenaline was 1.45 +/- 0.44 pmol/ml and did not change significantly, although values were reduced at the 3rd month, when decreased heart rates and slightly and non-significantly increased blood pressures were recorded. TBV did not vary because the increased erythrocyte mass was compensated for by parallel decreases in plasma volume. These data demonstrate the existence of a cause-effect relationship between uraemic anaemia and LVH, although the precise mechanism remains unknown. Amelioration of anaemia with rHuEpo, by allowing recovery from the attendant LVH, might improve long-term cardiovascular prognosis in some dialysed uraemic patients.

Aluminium (Al) overload has been recognised as a frequent complication in uraemic patients on regular dialysis treatment. We report how acute visual disorders occurred after performing a desferrioxamine (DFO) test in patients on regular dialysis treatment suspected of having aluminium overload. Fifteen patients on regular dialysis treatment for 132 +/- 73 (range 17-250) months, aged 61 +/- 10 (range 47-79) years were given DFO as a test at standard dosage. In the 13 patients who complained of visual disorders, we performed ophthalmologic examinations soon after DFO administration, and again 5 months later in 11 of them. A decrease in visual acuity and/or dyschromatopsia, transient or permanent, were present in ten patients. Four had permanent maculopathy and three also had a permanent alteration of VEP (visual evoked potential). Visual fields were normal in all patients except one who presented a permanent central scotoma. The EOG (electro-oculogram) was permanently impaired in five patients and some of them had fluoroangiographic alterations due to damage of the pigmented epithelium. Six to eight months after the DFO test four patients still complained of visual acuity reduction. We conclude that there is a high rate of visual disorders after giving DFO at the standard doses; therefore we stress the need to modify the doses commonly used and/or the mode of infusion.

Although there are only 10 years of clinical experience with CAPD, compared to about 30 years of clinical practice with haemodialysis, it is time to compare the results obtained from the two methods. In this review, after briefly summarising the state of the art for some worrisome aspects of CAPD (peritonitis, loss of ultrafiltration and peritoneal clearance, malnutritional status), the ability of CAPD and haemodialysis to control the uraemic abnormalities are compared. Anaemia, blood pressure, cardiac function, renal bone disease, beta 2-microglobulin, and uraemic neuropathy are examined in the light of our personal experience and the literature; data so far published seem to indicate that the two methods are roughly similar for controlling these conditions. A survey of the studies comparing patient and method survival is also included. Patient survival on CAPD or on haemodialysis does not differ by more than 6 years. Method survival is better for haemodialysis; this is primarily due to the high drop-out rate from CAPD because of peritonitis, and the difference is very much reduced in CAPD centres with a low incidence of peritonitis. On the whole, CAPD seems to be able to compete, sometimes favourably, with haemodialysis. However, in our opinion the two methods are not in competition; each has its preferential indications, limits and complications, and both should be offered to uraemic patients in accordance with their medical or social needs. One should be ready to shift the patient from one method to the other when necessary, either for short periods of time or indefinitely.

On 578 unselected new patients followed from 1981 through 1993, 51% on CAPD and 49% on HD, long-term patient and method survivals, cause of death, and drop-out in the two methods were compared. Survival, adjusted for patient selection biases, was not different on CAPD and HD up to 10 years. 50% of the patients were still in their first treatment after 3.5 years on CAPD and after 7 years on HD, and 5 and 28% respectively, after 10 years. Patient survival on CAPD was not falsely improved by drop-outs. Drop-out is increasing for CAPD, mainly due to patient/partner burn-out, which should be relieved by a more liberal application of automated PD. Malnutrition is more frequent on CAPD than on HD but not for the elderly. In a 3 year prospective study on 60 CAPD and 34 HD patients serum albumin, nPCR and nutritional status, as assessed by SGA did not influence survival in each modality. Survival was similar with K(p,r)t/V > or = 1.7/week on CAPD and Kt/V > or = 1/treatment on HD, and worse below these values. On CAPD, a Kp,rt/V > or = 1.96 gave better survivals.