Optimum Calcium Concentration of Dialysis Fluid for Maintenance Haemodialysis

To define the minimum and maximum levels for calcium concentration of dialysis fluid a combination of acute and long-term observations was carried outIn acute experiments the external calcium balance during dialysis was dependent on the gradient between plasma ultrafilterable calcium and dialysis fluid calcium concentration. Changes in plasma calcium during dialysis did not correlate with measured external balance.In long-term studies it was found that raising the dialysis fluid calcium concentration from 5.0 to 6.0 mg./ 100 ml. both arrested biochemical and radiological changes of hyperparathyroidism, and, by causing a progressive fall in plasma phosphates, made metastatic calcification less likely. Raising the concentration to 6.5 mg./lOO ml. in an attempt to compensate for negative alimentary calcium balance caused nausea and vomiting in some patients.A concentration of 6.0±0.2 mg./100 ml. is recommended.     

Treatment of Muscle Cramps during Maintenance Haemodialysis

The effect of a slowly released oral preparation of sodium chloride (Slow Sodium) on the frequency and severity of muscle cramps, on blood pressure, and on body weight was compared with that of placebo in a double-blind cross-over trial in 19 patients on maintenance haemodialysis for end-stage renal failure. A significant reduction in both the frequency and severity of cramps was found while the patients were receiving the sodium chloride preparation and no significant alteration in blood pressure or body weight was detected.     

Reproductive Potential of Patients Treated by Maintenance Haemodialysis

Three of the wives of 25 men undergoing maintenance haemodialysis for terminal renal failure became pregnant. This suggests that fertility is not necessarily impaired in these patients and that contraceptive methods should be used by women patients at risk.     

Cephaloridine Serum Levels in Patients on Maintenance Haemodialysis

Cephaloridine serum half-life was determined in 11 patients undergoing maintenance haemodialysis. Three of them were anephric. The mean cephaloridine half-life was 10·4 hours. There was an inverse correlation between cephaloridine half-life and the duration of maintenance haemodialysis treatment. Reasons for this are discussed.The effect of haemodialysis with the Kiil dialyser on cephaloridine half-life was studied in three patients.Dosage recommendations for patients on maintenance haemodialysis are suggested.     

Transient and Persistent Hypercalcaemia in Patients Treated by Maintenance Haemodialysis

In a group of 32 patients with terminal renal failure the initial hypocalcaemia was corrected after two months'' adequate maintenance haemodialysis. In seven patients hypercalcaemia occurred with a peak incidence after about six months'' treatment. In six of these patients hypercalcaemia was transient and the plasma calcium became normal with haemodialysis alone. In one patient the hypercalcaemia was persistent and the plasma calcium reverted to normal only after subtotal parathyroidectomy. This patient had no radiological bone disease, a normal alkaline phosphatase, and no metastatic calcification of the soft tissues.It is concluded that in some patients with terminal renal failure treated with maintenance haemodialysis autonomy of the parathyroids becomes evident in the absence of bone disease or a raised plasma alkaline phosphatase, and that subsequently with continued dialysis there is a spontaneous involution towards normal parathyroid function.     

Significance of High Plasma Renin Activity in Patients on Maintenance Haemodialysis Therapy

Blood pressure and plasma renin activity were remeasured after an interval of 8 to 17 months in 16 patients on maintenance haemodialysis previously found to have high renin activity. Continuing intermittent haemodialysis changed the plasma renin activity and blood pressure but no consistent pattern was seen. This confirmed our previous finding that adequate dialysis can control blood pressure in the presence of high renin activity. We therefore conclude that bilateral nephrectomy should be approached with renewed caution.     

Plasma Renin Activity and Blood Pressure in 89 Patients Receiving Maintenance Haemodialysis Therapy

Blood pressure, plasma renin activity, plasma sodium concentration, plasma potassium concentration, dietary sodium intake, and duration of dialysis have been measured under standard conditions in 89 patients on maintenance haemodialysis. No significant relation was found between plasma renin activity and blood pressure. Statistically significant correlations were found between plasma renin activity and plasma sodium concentration and between plasma renin activity and dietary sodium intake.Only one patient was found to have uncontrollable hypertension associated with a markedly raised plasma renin activity. Reasons are given for not performing bilateral nephrectomy in this patient. We believe the low incidence of uncontrollable hypertension and hyperreninaemia in our patients to be due to their slow introduction to haemodialysis, thus preventing violent swings in body weight, blood pressure, and renin secretion.Although plasma renin activity did fall with duration of dialysis, all 15 patients who have been on maintenance dialysis for longer than five years have normal levels.     

Anticoagulation by Ancrod for Haemodialysis

The defibrinating agent ancrod (Arvin) was used instead of heparin for intermittent haemodialysis. It was an effective, and apparently safe, anticoagulant and reduced the deposition of fibrin and leucocytes on the Cellophane membrane. Administration was more complicated and urea dialysance was less with ancrod than with heparin.     

Side-to-side Antecubital Arteriovenous Fistulae for Haemodialysis

Initial experience with side-to-side anastomosis of the brachial artery to the median cubital vein is reported in 11 patients in whom it was impossible to use or continue using the more normal sites. Eleven patients have so far been dialysed for a total of 80 fistula months. There was one early failure and no late ones. The appreciable morbidity was considered acceptable in these otherwise difficult patients.     

血液透析血压及其变异性与患者预后的相关性分析

目的:探讨血液透析前后和血液透析过程中血压及其变异性与患者预后的相关性。方法:选取沈阳军区总医院血液透析中心2010年1月1日至2013年12月31日收治的维持性血液透析患者,收集并对比随访期内生存及死亡患者的自然信息及临床资料,评估血液透析过程中患者血压及其变异程度与患者预后的关系。结果:共有269例患者纳入研究,经过4年随访共死亡83(30.86%)例。死亡组年龄显著大于存活组(64.92±13.24岁比49.89±12.86岁,P=0.000),而透析年限显著短于存活组(2.60±2.56年比7.25±4.14年,P=0.000)。死亡组透析前SBP(P=0.001)、DBP(P=0.000)、MAP(P=0.000)均显著高于存活组。两组间透析后SBP、DBP、MAP比较均无显著差异。死亡组△SBP(P=0.026)、△DBP(P=0.001)、△MAP(P=0.001)幅度显著大于存活组。死亡组透析前SBP变异率显著高于存活组(P=0.001);死亡组透析后SBP变异率(P=0.000)、DBP变异率(P=0.014)、MAP变异率(P=0.005)均高于存活组。死亡组每次透析前各时间点间SBP变异率(0.12±0.04 mm Hg比0.09±0.03 mm Hg,P=0.000)与MAP变异率(0.10±0.03mm Hg比0.09±0.03 mm Hg,P=0.001)显著高于非死亡组。结论:维持性血液透析患者透析前血压、透析前后血压改变幅度、透析前后血压变异率、每次透析各时间点间血压变异率等与全因死亡相关。