Serum C-reactive protein (CRP) levels were measured by nephelometry in 30 healthy subjects (controls) and in 99 patients with uncomplicated terminal uremia on conservative therapy (group 1, n = 30) or chronic hemodialysis (group 2, n = 69). Whereas there was no difference between controls and group 1, both the mean concentration of CRP and the incidence of elevated levels were significantly higher in group 2 in comparison with both controls and group 1. Moreover, the degree of increase in these patients was directly correlated with the duration of hemodialysis. The abnormality, therefore, is somehow related to chronic hemodialysis per se. From a practical standpoint, we concluded that this test cannot be recommended as an acute-phase reactant in this clinical setting.

The immunogenicity of a recombinant hepatitis B vaccine was evaluated in 35 hemodialysis patients who received a standard dose (20 μg) of the vaccine at 0,1, 2 and 6 months. After the full vaccination course (month 7), 60% (21/35) of the patients had seroconverted (anti-HBs titer ≥10 mlU/ml). The duration of protection lasted up to 18 months after the start of vaccination in 85.7% (18/21) of the responders. At that time, an additional dose was given to all the patients: 1-2 months later, the overall immunization rate had increased to 65.7% (23/35); lastly, in month 24 (i.e., 6 months after the booster dose), 62.5% (15/24) of the patients available for evaluation were still maintaining protective levels of anti-HBs antibodies. Comparable results had previously been obtained in 21 well-matched patients on our dialysis program who were vaccinated with a plasma-derived vaccine according to the recommended schedule.

We measured the serum concentrations of a variety of lipid constituents – total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, apolipoproteins A1 and B, and lipoprotein(a) – in well-matched uremic patients undergoing chronic hemodialysis with either cuprophane (n = 13) or polysulfone (n = 13) membranes. We found that the patients on polysulfone membrane dialysis had significantly higher mean HDL cholesterol and apolipoprotein A1 concentrations than the patients on cuprophane membrane dialysis. There were no significant differences in the other variables studied. Moreover, polysulfone membrane dialysis was associated with a lower prevalence of potentially atherogenic lipid abnormalities such as low HDL cholesterol levels and high total cholesterol/HDL cholesterol rations. We concluded that the use of more physiological dialysis procedure may improve, in the long term, lipid and lipoprotein profiles in hemodialysis patients, though the exact mechanism(s) remains unknown.

A 65-year-old man presented proteinuria in the nephrotic range that occurs in the setting ofhigh renin hypertension. Proteinuria persisted after normalizing blood pressure by nifedipine. In contrast, treatment with an ACE-inhibitor (enalapril) resulted in the prompt resolution of the proteinuria. Interestingly, proteinuria relapsed after removing the ACE-inhibition. These observations suggest a causal relation between the overactivity of the renin-angiotensin system in this patient and his proteinuria.

A 20-microgram dose of a recombinant hepatitis B vaccine was given at 0, 1, 2 and 6 months to 24 hemodialysis patients. From month 7 (i.e., 1 month after the fourth injection), 58.3% (14/24) of the patients had developed protective levels of antibodies against hepatitis B surface antigen (anti-HBs). In patients responding to vaccination, the fourth injection led to an abrupt rise of the anti-HBs titres which reached their maximum 2 months later, that is, in month 8. At that time, the geometric mean titre of anti-HBs was 145.79 mlU/ml. Eighteen months after the start of vaccination, 50% (12/24) of the patients were maintaining protective levels of anti-HBs antibodies. It is noteworthy that these results could be obtained with a considerably lower dosage than previously recommended.