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We have evaluated the incidence, long term evolution and pathogenesis of posttransplant hyperlipidaemia (HL) in 88 transplanted patients without nephrotic syndrome followed for 2 to 13 years by the same staff. Incidence of HL decreased strikingly over the years from 51% at 2 years to 25% at 10 years. This fall was due solely to the return to normal of the lipid profile in 13 patients between 2 and 8 years after transplantation. This progressive decrease should be taken into account when the frequency of posttransplantation dyslipaemia is assessed. The incidence of hyperlipidaemia increases with age. Above 40 years, hyperlipidaemia is more frequent in females than in males. Obesity and reduced renal function are both associated with a higher incidence of dyslipaemia. No relationship was found between lipid disorders and either steroid dosage or fasting blood glucose levels. Dyslipaemia appears thus to be due to the interplay of several factors. Normalisation of the lipid profile occurred in 13 patients without significant decrease in bodyweight, serum creatinine or prednisone dosage. At 8 years atheromatous lesions were not more frequent in dyslipaemic than in normolipaemic subjects.
Proc Eur Dial Transplant Assoc 1979
PMID:The evolution of hyperlipidaemia late after renal transplantation. 39 4

In recent decades, non-insulin dependent diabetes mellitus (NIDDM) has become a major public health problem in several parts of the world. A complex disorder, NIDDM is associated with an increased risk of blindness, coronary heart disease, peripheral vascular disease, and kidney failure (1). The epidemiology of NIDDM is providing new insights into many aspects of this disease, including prevalence, incidence, morbidity, and mortality (2). My objective is to explain the high prevalence of a NIDDM susceptible genotype(s) in several distinct populations: American Indians, Australian Aborigines, and Pacific Islanders. The susceptible genotype may have been selected into these populations because of unusually frequent food shortages that occurred during the initial colonization of 'new worlds'. NIDDM has been shown to have a strong genetic component (3) that may include a 'thrifty' genotype(s) (4,5). The 'thrifty' genotype(s) may have once allowed founding populations to survive feast' and 'famine' conditions for several generations. With an assured food supply and a sedentary lifestyle, however, the 'thrifty' genotype(s) becomes disadvantageous, leading to obesity, increased insulin resistance, beta cell decompensation, and NIDDM (3,6).
Adv Perit Dial 1992
PMID:Archaeology and the "thrifty" non insulin dependent diabetes mellitus (NIDDM) genotype. 136 87

We hypothesize that the swan neck catheter for peritoneal dialysis with exit in the presternal area will have better exit site healing and a decreased incidence of exit site infection than currently used peritoneal dialysis catheters with the exit located on the abdomen. The chest is a very stable structure, with minimal wall motion, especially of the upper chest and over the sternum. Hence, a catheter exit located on the chest will be subjected to only minimal movement. Decreased piston like movement of the catheter at the exit site reduces inward transfer of outer microbial flora. Moreover, a tight garment is usually not worn on the chest and there is less pressure on the exit. Based on this rationale a new catheter (swan neck presternal) has been designed. The presternal peritoneal dialysis catheter is composed of two flexible (silicon rubber) tubes joined through a titanium connector at the time of implantation. The device has been dubbed as a "bath tube" catheter because, with the exit on the chest, a patient may take a tub bath without the risk of exit contamination due to submersion. Two such catheters were implanted in two patients. One patient had multiple problems (including chronic exit site infection) with a previously implanted swan neck Missouri 2 catheter, the other patient was originally rejected as a peritoneal dialysis candidate due to extreme obesity. Both catheters healed well in 6 weeks and the exits have not become infected during the first 8 months. These preliminary experiences with 2 catheters support the rationale of their design.
Adv Perit Dial 1992
PMID:Swan neck presternal ("bath tub") catheter for peritoneal dialysis. 136 15

Advantages of CAPD in diabetic uremic patients may offer better control of visual and neurological disease. There remain some undesired side effects, i.e: obesity, blood lipid imbalance and loss of appetite due to glucose absorption. In February 1988 four diabetic uremic CAPD patients (2 males and 2 females with an average age of 62.25 +/- 11.32, range 52-76) began treatment substituting one of the usual glucose exchanges with 1% aminoacid solution. Treatment time averaged 52 months (range 9-17). Each month the patients were examined clinically and via blood chemistries. Every 3 months clearances, residual renal function, ocular fundus and motor nerve conductance velocity were measured. Plasma nitrogen increased, while triglycerides, cholesterol and total protein remained unchanged; bicarbonate decreased causing slight acidosis. There were no significant variations of either clearances or ultrafiltration and the quantity of insulin administered decreased. Results confirm that a 1% aminoacid solution can be used as an osmotic agent in peritoneal dialysis to prevent some of the complications such as blood lipid imbalance. The slight acidosis can be corrected by increasing the buffer content of the bag.
Adv Perit Dial 1990
PMID:CAPD in diabetics: use of aminoacids. 198 40

Glucose has several disadvantages such as low pH, high osmolality and hyperglycemia. Rapid glucose absorption contributes to hyperlipidemia, obesity and ultrafiltration failure in peritoneal dialysis patients. Two commercially available plasma substitutes 10% hydroxyethylstarch (HES) and 6% dextran were studied for ultrafiltration and absorption patterns. 18 ml of each solution were instilled into the peritoneal cavity of 6 non-uremic rats. HES yielded a significantly (p less than 0.02) greater ultrafiltration after 6 h of dwell, whereas 2.3% glucose solution showed the typical ultrafiltration pattern of an easily absorbable osmotic agent. With 6% dextran ultrafiltration was markedly lower. At the end of cycle time the mean absorption rates for HES were 62.7% and 41.5% for dextran. It is concluded that HES is a potent osmotic agent due to sustained colloidal ultrafiltration. However, despite their high molecular weights both solutions were markedly absorbed probably by lymphatics. However, accumulation in tissues and undefined metabolic pathways might prove disadvantageous in patients with ESRD.
Adv Perit Dial 1989
PMID:Ultrafiltration and absorption characteristics of hydroxyethylstarch and dextran during long dwell peritoneal dialysis exchanges in rats. 248 83

This retrospective study examined whether alternate day steroid therapy decreased the incidence or severity of side effects of prednisone without decreasing renal function. We conclude that alternate day steroid therapy is indicated in adult renal transplant recipients to treat steroid-induced diabetes, hypertension and minor prednisone side effects, but is not useful for obesity. Further, alternate day steroid therapy can be used safely without compromising renal function or graft survival.
Proc Clin Dial Transplant Forum 1980
PMID:Comparison of alternate day steroids and daily steroids in renal transplant recipients. 705 Sep 77

The subclavian vein has provided a useful vascular access for hemodialysis, both in acute as well as chronic renal failure. We were prompted to do 58 two catheter single lumen subclavian hemodialyses for the following reasons: (A) Marked obesity. (B) Patients with pre-existing aortic iliac synthetic vascular grafts. (C) Use of pre-existing hemodialysis equipment. (D) Decrease in recirculation and lack of high obligatory ultrafiltration as compared to single-needle hemodialysis.
Clin Exp Dial Apheresis 1982
PMID:Subclavian hemodialysis using the two catheter single lumen approach. 715 23

We review our experience with hypertonic saline compress therapy in 17 patients with complicated peritoneal dialysis catheter exit-site infections (ESIs). Compresses consisted of exit-site application of 4-5 gauze pads soaked with warm 3% saline for 5-10 minutes, three times daily, for 2-4 weeks, followed by once-daily use thereafter. The mechanism of action involves inhibition of bacterial growth by a hypertonic medium. Eleven patients with cultures positive for Staphylococcus aureus or Pseudomonas were treated with local exist-site measures (cleansers, antiseptics, antibiotic ointments). Therapy, which included multiple courses of systemic antibiotics, failed in 8 patients; in 3 patients, who were intolerant to antibiotics, ESI remained unresolved after local care only. Six patients with culture-negative ESIs received no systemic antibiotics and were unimproved following local therapy. Factors associated with therapy failure included malnutrition, diabetes, obesity, and dermal sensitization and injury associated with prolonged topical agent use. Following hypertonic saline compress therapy, we observed resolution of ESI in all patients without recurrence for follow-up intervals of 3-12 months (mean 6.5 months). Advantages of this therapy include excellent patient acceptance, ease of use, lack of adverse effects on exit site, adjacent skin, catheter or systemic reaction, and minimal expense. Future potential applications include routine daily use for infection prophylaxis and as therapy combined with antibiotics for established ESIs.
Adv Perit Dial 1993
PMID:Hypertonic saline compresses: therapy for complicated exit-site infections. 810 36

Exit-site infection (ESI) in children on continuous ambulatory peritoneal dialysis (CAPD) is a complication observed mainly in obese patients and patients wearing diapers. From 15 December 1991 to 28 February 1993, five Swan neck presternal catheters (SNPCs) were implanted in 5 children aged 2-11 years. The criteria for insertion of a SNPC were the following: young age in 1 child, obesity in 2, recurrent ESI in 2, and the use of diapers in 2. In some patients there was more than one criterion. The observation period ranged from 1-10 months, and the time on CAPD with the SNPC was 1-9 months. During this period, we did not observe any catheter-related problems. The potential advantages of the chest location of the catheter exit site are the following: 1. easy exit-site care; 2. decreased risk of ESI in small children because of greater distance from wet diapers; 3. avoidance of trauma with crawling/creeping; and 4. better healing and decreased risk of ESI in the area with less fat thickness.
Adv Perit Dial 1993
PMID:Preliminary results with the Swan neck presternal catheter for CAPD in children. 810 54

Atherosclerosis and thrombosis, two major causes of morbidity and mortality in renal transplant recipients, share the same clinical risk factors including decreased fibrinolysis and lipid disturbances. In a cross-sectional study we have determined parameters of fibrinolysis in control subjects (n = 23) and stable renal allograft recipients without cyclosporin (CsA) (n = 10) and with CsA (n = 87) in their immunosuppressive treatment. In CsA-treated patients, tissue-type plasminogen activator was moderately increased compared to patients without CsA (8.4+/-3.3 vs 5.5+/-2.8 ng/ml). The plasminogen activator inhibitor (PAI) activity in plasma was clearly increased in CsA-treated patients: 14.5+/-8.8 vs 7.2+/-3.2 in normal controls and 8.5+/-2.4 AU/ml in patients without CsA. Total cholesterol and LDL cholesterol levels were higher in CsA-treated patients (256+/-62 and 169+/-60 mg/dl) than in patients without CsA (209+/-45 and 136+/-44 mg/dl). The two groups did not differ in HDL cholesterol, triglycerides, and lipoprotein(a). Hypercholesterolaemia, obesity, and steroid-induced diabetes could be identified as risk factors for elevated plasma PAI activity in CsA-treated patients. Hypofibrinolysis induced by elevated PAI levels and increased LDL cholesterol may contribute to the increased thrombogenicity and accelerated atherosclerosis observed in cyclosporin-treated patients.
Nephrol Dial Transplant 1996 Feb
PMID:Elevated plasminogen activator inhibitor levels in cyclosporin-treated renal allograft recipients. 867 91


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