Long-Term Administration of Calcium Acetate Efficiently Controls Severe Hyperphosphataemia in Haemodialysis Patients

In order to avoid aluminium toxicity, calciumcontaining phosphate binders have been used increasingly. Unfortunately, calcium carbonate and calcium citrate produce hypercalcaemia in a number of patients. New studies have shown that calcium acetate is promising in that it binds more phosphate than calcium carbonate at comparable doses. We tested calcium acetate in eight severely hyperphosphataemic patients (2.25 ± 0.08 mmol/l) on maintenance haemodialysis over 5 months. Serum phosphate decreased to 1.86 ± 0.06 mmol/l, but at the cost of an increase in serum calcium. However, the increment of serum calcium was always less than the respective decrease of serum phosphate, and hypercalcaemia—immediately reversible after dose reduction—only occurred once in two patient

Stimulation of erythropoietin in renal insufficiency by hypobaric hypoxia

Patients with renal anaemia show inadequate levels of immunoreactive erythropoietin (Epo) related to the degree of anaemia. The purpose of our study is to compare the degree of stimulation of Epo by means of hypobaric hypoxia in normal controls and patients with renal anaemia. Baseline Epo concentrations were found to be 11.1±2.0 U/l in 10 healthy volunteers and 11.4±4.6 U/l in six patients with renal anaemia. After exposure to hypobaric hypoxia equivalent to 4560 m above sea level for a duration of 3.5 h, we observed a significant increase in serum Epo in healthy volunteers to 22.8±9.1 U/l (P<0.005), while there was no increase in patients with renal anaemia: 12.3±5.2 U/l (P<0.2). Our results show that in patients with renal anaemia serum Epo concentrations are comparable to those of normal controls, but inadequate in view of the concomitant degree of anaemia. Stimulation by acute hypobaric hypoxia was not possible in patients with renal insufficiency as opposed to normal controls. From these data it can be concluded that either Epo production is working at maximum capacity under baseline conditions, or an additional hybobaric stimulus is not able to influence a disturbed set point of the oxygen sensor regulating Epo synthesi

Intravenous 1,25(OH)2 Vitamin D3 Therapy in Haemodialysis Patients: Evaluation of Direct and Calcium-Mediated Short-Term Effects on Serum Parathyroid Hormone Concentration

Eleven patients on chronic haemodialysis treatment thrice weekly received 1 μg 1,25(OH)2D3 i.v. after each dialysis for 3 weeks. Phosphate binders were mainly CaCO3, supplemented in a few patients by moderate amounts of A1(OH)3. Ionised calcium was measured by ion-selective electrode, normal values being 1.28-1.42mmol/l. PTH was estimated by an N-terminalsensitive assay; normal values are <0.25μg/ml. Results before and after 1,25(OH)2D3 were: ionised calcium before haemodialysis, 1.19±0.12and 1.17±0.14; ionised calcium after haemodialysis, 1.33±0.07 and 1.30±0.09; PTH before haemodialysis, 1.39±0.71 and 1.38±0.69; PTH after haemodialysis, 0.64±0.22 and 0.60 ±0.17; Phosphate before haemodialysis, 1.85±0.48 and 2.18±0.43 (P<0.05). No change of PTH concentration and ionised calcium before and after haemodialysis treatment could be documented after i.v. 1,25(OH)2D3 treatment. Mild and severe hyperparathyroidism were indistinguishable. Increased serum calcium concentrations therefore appear to be required for the suppression of PTH secretion by i.v. 1,25(OH)2D3 therap

Post-Transplant Diabetes Mellitus in Renal Allograft Recipients: A Matched-Pair Control Study

The incidence of post-transplant diabetes mellitus was evaluated retrospectively in 901 consecutive renal transplant recipients. Thirty-two (3.6%) patients developed diabetes mellitus requiring drug therapy. 18 of 32 became hyperglycaemic within 3 months of transplantation. Post-transplant diabetes mellitus occurred in 24 of 628 (3.8%) patients treated with conventional therapy consisting in azathioprine and prednisone, and in 8 of 273 (2.9%) patients receiving cyclosporin A (CsA) in addition (triple therapy). To identify predisposing factors 32 nondiabetic patients matched for age, sex, number of graft, immunosuppressive protocol, and graft function at onset of diabetes were used as case controls. Thirteen of 32 patients with diabetes mellitus and 5 of 32 control patients had abnormal glucose tolerance pretransplant (P<0.025). HLA-B8 was significantly more frequent in patients with post-transplant diabetes mellitus than in control patients (9 of 29 vs 2 of 31, (P<0.02). Twelve (38%) patients became diabetic during or immediately after anti-rejection therapy with intravenous pulse prednisone. Four diabetic patients experienced chronic pancreatitis pre-transplant. Family history of diabetes mellitus, bodyweight, number of rejection episodes, and immunosuppressive drug doses were similar in both groups. Actuarial patient and graft survival was not significantly different in diabetic patients and controls, although 10-year data tended to be better in controls. Thus, post-transplant diabetes mellitus was not a frequent complication in patients sometimes predisposed by an impaired glucose tolerance pre-transplant and was triggered by pulse prednisone therapy in 38

Effect of Human Exogenous Leukocyte Interferon in Cytomegalovirus Infections

Human leukocyte interferon was injected into nine patients with cytomegalovirus infections; four of these patients were congenitally infected, and five had acquired infections. In three patients viruria was completely inhibited. In five patients viral excretion in the urine was only transiently inhibited. Viremia was not significantly suppressed. The lymphocyte response to phytohemagglutinin was suppressed in two patient