Cardiac diseases are well known among patients on maintenance hemodialysis (HD), and carnitine deficiency may be an important factor in cardiac morbidity. We studied the effects of low-dose L-carnitine treatment (500 mg/day) on chest symptoms (dyspnea on exertion, chest pain, palpitation), cardiac function, and left ventricular (LV) mass in 9 HD patients with reduced ejection fraction (EF). After 6 months of L-carnitine treatment, most patients had at least some improvement in chest symptoms, while LVEF was increased and LV mass was decreased. Carnitine fractions increased and reached plateaus at 2-3 times the baseline levels. These results suggest that prolonged low-dose L-carnitine treatment can improve the cardiac morbidity by restoring decreased carnitine tissue levels and impaired oxidation of FFA.

Administration, Oral↗

PubMedDate not supplied

Development of alumina ceramic transcutaneous connector to prevent skin exit site infections around CAPD catheters.

It is very important to prevent skin exit site infections in order to continue continuous ambulatory peritoneal dialysis (CAPD) safely over the long-term. The silicon material conventionally used can result in sinus formation between the skin and the catheter, and may trigger exit site infections. To resolve this problem, we employed a bioinert, rigid, and nonporous transcutaneous connector made of alumina ceramic. Earlier long-term animal experiments with alumina ceramic placed in soft tissue demonstrated the outstanding biocompatibility of this material. The transcutaneous connector was designed with a simple cylindrical configuration; in order to make sufficient contact between this connector and the patient, a silicon tube was made into a swan neck catheter with a disk-shaped Dacron cuff at the upper position in order to reinforce adhesion to soft tissue. Ten CAPD patients (maximum time on dialysis of 14 months) have used the new CAPD catheter system with no exit site infections to date. Furthermore, there has been virtually no downgrowth of the skin around the connector, while the connector and tissue have remained in very close contact.

Aluminum↗

PubMedDate not supplied

External peritoneo-venous shunt for intractable ascites.

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Aged↗

PubMedDate not supplied

Accumulation of a disopyramide metabolite in renal failure.

Ten hemodialysis (HD) patients with normal liver function received disopyramide (DP) therapy in the steady state. DP, mono-N-dealkyldisopyramide (MND) and alpha-1-acid glycoprotein (AAG) were measured before and after HD. Ten patients with normal renal and liver function were selected as controls. The DP concentration was 2.08 +/- 0.39 micrograms/ml (mean +/- SD) in the control group, and the pre and post HD levels were 2.40 +/- 1.08 micrograms/ml and 1.73 +/- 0.87 micrograms/ml, respectively, in the HD group. The MND concentration was 0.42 +/- 0.23 microgram/ml in controls, 1.53 +/- 0.52 micrograms/ml in pre HD and 1.08 +/- 0.32 microgram/ml in post-HD. Although DP and MND are both classified as small molecular weight substances, the average decrease in plasma concentration from pre to post HD was under 30% with both agents. The MND/DP ratio in the HD group was higher than in controls, but there was no significant difference between pre and post HD. The AAG level was 75 +/- 5 mg/dl in controls and 109 +/- 11 mg/dL before HD in the HD group (p < 0.001). In conclusion, an MND accumulation was observed in HD patients receiving DP therapy. Because the anticholinergic effect of MND is 24 times that of DP, MND is thought to contribute in some way to the hypoglycemia induced by DP in renal failure.

Adult↗