Biomedical subjects
Publications and source records attributed to S Shaldon.
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The effect of an angiotensin II antagonist (saralasin) on arterial pressure, plasma renin activity (PRA) and plasma aldosterone concentration (PAC) was assessed in seven dialysis-resistant hypertensive patients. During saralasin infusion performed before hemodialysis, mean arterial pressure fell by 8 to 18.3% in six out of the seven subjects; arterial pressure was normalized in three of them. After hemodialysis (6 subjects), a normal arterial pressure was achieved in five patients. One patient was resistant to saralasin before and after dialysis. A negative correlation (r = 0.62) was obtained between pre-infusion PRA and the change in mean arterial pressure induced by saralasin. Post-infusion PRA increased in saralasin responsive patients, the change in PRA being correlated (r = 0.82) with the pre-infusion PRA. Plasma aldosterone concentration was variably affected by saralasin; a negative correlation between pre-infusion PAC and the absolute change in PAC during saralasin was obtained (r = 0.72). The role of angiotensin II in the maintenance of a high arterial pressure in chronic dialysis patients was demonstrated. In saralasin-resistant patients, more vigorous ultrafiltration is proposed.
A sorbent system (Redy D11 cartridge) capable of 'in line' regeneration of ultrafiltrate during haemofiltration (Amicon 0.5 m2) has been developed and applied on 3 X 4 hr/week schedule to 3 patients with end stage renal failure previously treated for up to 6 months with haemodialysis. Total experience, to date, is 8 patient months. Tolerance to fluid removal improved with the new system. Patient well being and rehabilitation has been maintained. The system offers the potential of haemofiltration without sterile replacement fluid or expensive fluid balancing machines.
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Clinical data and therapy of all male home dialysis patients of two centres were compared in order to establish predisposing factors to priapism. One centre (Frankfurt) had nine priapisms in 96 patients, whereas the other centre (Montpellier) had none in 59 patients. The only difference found were higher haematocrits in Frankfurt than in Montpellier. The highest haematocrits were found in the priapism patients. Further evaluation of the Frankfurt data showed that androgen therapy, high haematocrits and hypovolemia increase the risk of dialysis priapism. It is recommended to withdraw androgen therapy when the haematocrit is consistantly above 25%.
Two matched groups of patients were dialysed either thrice weekly on a double re-used Gambro (2m2) for four and a half hours per dialysis (Group A) or thrice weekly five hours per dialysis on a single non re-used Gambro (1m2) (Group B). There was no significant differences in measured parameters of nitrogen retention between the groups, nor did the mean motor nerve conduction velocity alter significantly in any patient. Both groups preferred short dialysis. No manifestations of inadequate dialysis appeared up to 18 months even in bilateral nephrectomised patients of whom there were 2 in each group. Group B experienced significantly fewer hypovolaemic symptoms during dialysis and the single system in thus preferred. The mean dialysis index in Group A was 1.0 and 0.9 in Group B. These results suggest that a dialysis index of 1.0 overestimates dialysis needs.
1. A P113 Saralasin infusion test was performed in 10 patients on long-term regular hemodialysis. Six patients were considered to have hypertension resistant to dialysis treatment and 4 had their arterial pressure controlled by dialysis. 2. Five out of 6 resistant and 3 out of 4 responsive patients had a positive response to Saralasin associated with a normalization of diastolic arterial pressure. 3. The value of the Saralasin infusion test to pre-select the patients for bilateral nephrectomy is discussed and it is felt that a negative test may be of more value in encouraging more aggressive ultrafiltration in hypertension apparently resistant to dialysis therapy.
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Intramuscular testosterone 250-500 mg weekly given to 25 patients on long-term haemodialysis produced a significant rise in haemoglobin level in all patients. The response was reversible when the drug was stopped. Treatment was effective in bilaterally nephrectomized patients and those with intact kidney tissue. The use of intramuscular testosterone is recommended for all adult patients on long-term haemodialysis in order to eliminate the need for routine blood transfusions.
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