The ten-year graft survival rate was similar in patients with IgAGN or other renal diseases. At least 35% IgAGN patients had biopsy-proven recurrence, and younger patients were more prone to the risk of recurrence. Recurrence did not affect the ten-year graft survival.

The aim of the present study was transmembrane pressure (TMP) modulation in high-volume mixed hemodiafiltration (HDF) to optimize efficiency and minimize protein loss. The optimal flow/pressure conditions in on-line mixed HDF assisted with a feedback control of TMP were defined in this prospective randomized study in order to obtain maximal efficiency in solute removal while minimizing potential side effects. Two different TMP profiles in mixed HDF were compared in 12 unselected patients who underwent two study periods of 2 weeks each in cross-over randomized sequence: (A) constant TMP at around 300 mmHg and (B) profiled TMP, in which TMP was slowly increased from a low initial value to the maximal value. In both procedures, the mean volume exchange was 10.6+/-1.4 l/h. Mean filtration fraction was 53%. Instantaneous beta2-microglobulin (beta2-m) clearance was higher at the start of the session with profiled TMP (207+/-35 vs 194+/-28 ml/min, P<0.005), whereas no differences were found at the end (135+/-19 vs 132+/-19 ml/min). Profiled TMP resulted in a higher mean beta2-m clearance of the session (97.0+/-15.4 vs 87.8+/-18.3 ml/min, P<0.01), in lower albumin loss in the first 30 min (0.62+/-0.14 vs 0.98+/-0.18 g, P<0.0001), and, in the whole session (3.98+/-1.19 vs 5.24+/-0.77 g, P<0.001), in higher dialyzer ultrafiltration coefficients and lower resistance indexes. This study showed that the TMP feedback modulation in mixed HDF was highly effective in maintaining very high ultrafiltration rates and filtration fractions, and minimized potential side effects as a result of the improved preservation of membrane permeability and more favorable dialyzer pressure regimen.

Mixed HDF was the most efficient technique in the highest range of safe operating conditions. In mid-dilution HDF, high pressures generated inside the dialyser compromised membrane permeability and limited the total infusion rate, resulting in an overall reduction in solute removal.

Background: An elevated Ca×PO₄ product and C-reactive protein (CRP) have been associated with coronary artery calcification and increased cardiovascular mortality in hemodialysis (HD) patients. However, it has not been defined, so far, whether and how both parameters are related to each other. For this reason we have evaluated in a cross-sectional and in an interventional study the possible correlation between Ca×PO₄ and CRP and the effect of the correction of a high Ca×PO₄ on CRP levels. Methods: 47 uremic patients (age 65 ± 16 years) on regular chronic HD were selected from a total population of 125 prevalent patients treated at our Institution. Patients had no clinical evidence of either acute infectious or inflammatory diseases for at least 4 weeks before the study. They were on regular bicarbonate HD for 6–329 months (median 42). CRP, hemoglobin (Hb), serum albumin (sAlb), protein catabolic rate (PCRn), serum calcium (Ca), serum phosphorus (PO₄), Ca×PO₄, intact PTH, Kt/V, presence of ischemic heart disease (IHD) and/or peripheral vascular disease (PVD) were recorded. CRP was Ln-transformed in all statistical analyses because of positive skewness. Results: The main findings were: LnCRP 2.17 ± 0.77 mg/l, Ca 10.1 ± 0.4 mg/dl, PO₄ 5.8 ± 0.6 mg/dl, Ca×PO₄ 59 ± 6 mg²/dl², andPTHint 218 ± 195 ng/ml. 18/47 had IHD, 18/47 PVD. A significant hyperbolic correlation between Ca×PO₄ and CRP was observed. A piecewise linear regression model analysis identified a break-point for Ca×PO₄ at 55 mg²/dl². Comparison of CRP levels after the division of the patients into two groups according to Ca×PO₄ break-point (group A, Ca×PO₄ ≤55 mg²/dl², n = 16 patients; group B, Ca×PO₄ >55 mg²/dl², n = 31 patients) showed that CRP levels were significantly lower in patients in group A (LnCRP 1.43 ± 0.22 mg/l) than in group B (LnCRP 2.55 ± 0.67 mg/l, p < 0.0001). Multiple regression analysis bearing LnCRP as dependent variable confirmed Ca×PO₄ as the most significant variable among the other variables examined. In 22 patients with Ca×PO₄ ≧60 mg²/dl², we performed intensive lowering of the Ca×PO₄ product in order to reach and maintain a Ca×PO₄ ≤55 mg²/dl² for 3 months. At the end of observation, a significant reduction in Ca×PO₄ and LnCRP was observed (Ca×PO₄ pre 62.8 ± 1.9 vs. post 46.3 ± 6.2 mg²/dl²: p < 0.0001; LnCRP pre 2.32 ± 0.36 vs. post 1.83 ± 0.14 mg/l: p < 0.0001). No significant variation in the other biochemical parameters was observed. Conclusions: Our data show that in chronic HD patients in steady clinical conditions with no clinical evidence of either infectious or inflammatory diseases, a high Ca×PO₄ is associated with high CRP concentrations. Intensive lowering of Ca×PO...