The purpose of our study was to investigate whether continuous venovenous hemodiafiltration (CVVHDF) concomitant with radiological procedures (RxP) was feasible, well tolerated and could significantly remove iodi nated contrast media (CM). Methods: 26 patients with various degrees of renal insufficiency who were submitted to RxP were included in the study. The CVVHDF session was started immediately before CM administration. All the patients were evaluated for feasibility and tolerability; furthermore a pharmacokinetic study was done on 12 patients to calculate the amount of CM eliminated. The baseline incidence of CM nephropathy was studied in 25 consecutive historical controls.
Results: The CM administered was 208 +/- 146 g; the fractional removal of CM was 9. 2 +/- 4. 9% during RxP and 30. 9 +/- 20. 7% during the whole CVVHDF session. Hemodynamic tolerance was excellent.
The incidence of CM nephropathy in the experimental and control groups was 37 and 24%, respectively. Conclusions: CVVHDF during RxP is feasible and well tolerated but ioversol removal is modest. This fact together with the high incidence of renal function impairment, the complexity of the procedure and its intrinsic risks, and the large amount of resources needed discourage the routine use of CVVHDF as a prophylactic tool to avoid CM nephropathy. Patients on chronic hemodialysis (HD) suffer from general immune incompetence, resulting in a high incidence of infectious complications, impaired response to vaccinations and a high incidence of malignancy.
Although various abnormalities in T cell function of HD patients have been described, it remains unclear whether this is due to an intrinsic T cell defect. Aim: In the present study we tested the capacity of T cells to proliferate upon stimulation with antigen-presenting cell and T-cell-derived cytokines. Methods: The proliferation capacity of lymphocytes obtained from patients on HD and healthy controls was determined by measuring the proliferation of peripheral blood mononuclear cells (PBMC) after stimulation with rhIL-2, rhIL-15, rh TNF-, or combination of those cytokines. In all samples the percentage of / TCR-positive T cells was measured. Results: After isolation of PBMC the percentage of T cells varied from 70% (before stimulation) to 80% (after stimulation).
IL-2, IL-15 and TNF- all induced PBMC proliferation, while the combination TNF- plus IL-2 or TNF- plus IL-15 appeared to be additive. No difference between PBMC from HD patients and controls was found. Conclusion: We conclude that lymphocytes from HD patients have no intrinsic defects in their proliferation capacity after stimulation with IL-2, IL-15 or TNF-, in vitro, as the increase in counts per minute is predominant. To identify factors contributing to the development and progression of left ventricular hypertrophy (LVH) in patients on high-flux hemodialysis.
Method: Fifty patients without clinical cardiac disease underwent baseline echocardiography, related measurements and follow-up studies 6-12 months later. Results: Residual urea clearance was lower (0. 7 +/- 1. 1 vs. 2. 2 +/- 2.
4 ml / min ; p = 0. 034) while systolic blood pressure (162 +/- 21 vs. 147 +/- 11 mm Hg; p = 0. 003), duration of dialysis dependence (38 +/- 37 vs.
17 +/- 13 months; p = 0. 004) and interdialytic weight gain (1. 98 + 0. 84 vs. 1. 32 + 1.
08 kg; p = 0. 026) were higher in those with LVH. Parathyroid hormone changed less in those whose LVH regressed (186 +/- 89 vs. 303 +/- 280 pg / ml ; p = 0.
032). Regression did not occur when parathyroid hormone was >300 pg / ml . ACE gene polymorphism did not affect LVH development or progression. Conclusion: Systolic hypertension, duration of dialysis dependence and high interdialytic weight gains promote LVH. Hyperparathyroidism retards LVH regression. van Riemsdijk IC, Baan CC, Loosen EHM, Zie tse R, Weimar W: Patients on Chronic Hemodialysis Have No Intrinsic Lymphocyte Defect upon Stimulation with Interleukin-2, Interleukin-15 or Tumor Necrosis Factor-Alpha.
Blood Pur if 2003; 21: 158-162 (DOI: 10. 1159/000069154).