From April 2000 to April 2001, a total of 108 chronic stable haemodialysed patients (34 males aged 57.76 +/- 12.68 years under haemodialysis treatment for 31.41 +/- 24.71 months and 74 females aged 54.99 +/- 12.87 years under haemodialysis for 41.47 +/- 33.47 months) were studied for signs of clinical depression. Depression was measured by using 'The Taiwanese Depression Questionnaire (TDQ)'. After analysing various possible factors, we chose to study three dimensions: affective change, somatic complaint and cognitive disturbance. Thirty-six (33.4%) of the patients were found to have TDQ scores above 19; our cut-off value. Diabetic patients were also found to have higher depression scores and affective change scores than those without diabetes. The elderly suffered more from somatic complaints, and patients without jobs also tended to have higher depression scores. We compared the nutrition indexes and uraemic toxin removal indexes of those with higher depression scores (score> or =19) with those with normal scores (score <19), and we found no differences between the two groups. We found that an underlying disease and job status were the major differences found in the two groups. Therefore, our findings suggest that the depression found in our chronic haemodialysed patients was not a result of the physical conditions, but a result of psychosocial problems indicating a need for psychosocial support for these patients.

We prospectively evaluated the antihypertensive effect and tolerability of three different antihypertensive agents, losartan (angiotensin II receptor blocker), amlodipine (calcium channel blocker), and lisinopril (angiotensin-coverting enzyme inhibitor), in patients with mild-to-moderate hypertension. After a 2-week washout period, 121 patients were randomly allocated to three different groups for 12 weeks. Medications were titrated upward as necessary to achieve the goal office-recorded sitting diastolic blood pressure (SiDBP) (defined as SiDBP <90 mmHg or SiDBP > or = 900 mmHg but with a > or = 10 mmHg drop from baseline). Efficacy and tolerability were assessed after 4, 8, and 12 weeks of therapy with each regimen. At 12 weeks, significant differences in SiDBP compared with data of baseline were noted in all three groups ( P < 0.001 in all comparisons). Similarly, significant differences in the sitting systolic blood pressure compared with baseline data were also seen for all three groups ( P < 0.001 in all comparisons). The number of patients reaching goal SiDBP were comparable for the three groups: 25 patients (62.5%) in the losartan group, 27 patients (67.5%) in the amlodipine group, and 22 patients (59.5%) in the lisinopril group (not significant). Amlodipine produced a more pronounced reduction in SiDBP than the other two medications, although without statistical significance. Patients receiving lisinopril showed a high incidence of coughing (31.7%). Low leg edema was noted only in the amlodipine group (7.5%). Compared with the amlodipine and lisinopril groups, the losartan group seemed to have relatively fewer episodes (7.5%), and fewer patients (three cases) experienced adverse effects. In conclusion, this study demonstrates that losartan has the same antihypertensive effect, but has superior tolerability compared with the other two drugs. Coughing was a common side effect of lisinopril therapy in our population.

SUMMARY: Interdialytic weight gain (IDWG) has been reported to contribute to cardiovascular mortality in haemodialysis patients. In order to determine the relationship of IDWG to the pre‐dialysis blood pressure and left ventricular hypertrophy, 168 patients on maintenance haemodialysis were initially evaluated. The IDWG was estimated as the current pre‐dialysis weight minus the preceding post‐dialytic weight and expressed as a proportion (%) of the current dry weight. Patients were divided into two groups: group I consisted of patients with a mean IDWG > 5% each month for 6 months and group II consisted of patients with a mean IDWG < 5% each month for 6 months. As 51 patients had increased IDWG > 5% on more than one occasion, but fewer than six times, they were not included in the above two groups. Thus, 117 patients (33 men, 84 women) were enrolled in this study. All patients received haemodialysis three times a week, with a duration of 4.6 ± 0.5 h per dialysis session. Pre‐dialysis systolic and diastolic blood pressure (SBP, DBP) and left ventricular mass index (LVMI), as determined by echocardiography, were studied regularly. The results demonstrated that the IDWG correlated significantly with age (r = −0.209, P = 0.024) and solute removal index (Kt/V) (r = 0.254, P = 0.006), but did not correlate with pre‐dialysis systolic or diastolic blood pressure. In contrast, LVMI correlated with SBP (r = 0.816, P < 0.001), DBP (r = 0.377, P < 0.001) and age (r = 0.458, P < 0.001). Left ventricular hypertrophy presented in 18 group I subjects (81%) and 68 group II subjects (72%) respectively (P < 0.001). In conclusion, this study shows that excessive IDWG in patients maintained on haemodialysis does not correlate with pre‐dialysis blood pressure, emphasizing that additional factors other than fluid volume may play a role in the control of blood pressure in uraemic patients.

In patients with advanced uremia, rhuEPO therapy may result in improved gonadotropic hormone levels and sexual function. Good dialysis quality may contribute to the increase in the incidence of patients with better sexual function.