A remarkable rise in intraocular pressure occurs during hemodialysis in eyes with an impaired aqueous outflow, when serum osmolality decreases rapidly.

These results suggest that the addition of Lixelle to the high-flux dialyzer is associated with a significant clinical improvement in DRA patients.

Plasma exchange (PE) is often performed in combination with hemodialysis (HD) or hemodiafiltration. However, most methods were developed for the treatment of renal failure, so various problems may arise during treatment of liver failure (LF). In this study, we investigated the impact of PE alone and in combination with HD, and we assessed the complications of using PE + HD for the treatment of LF. After the exchange of 1 L of fresh frozen plasma (FFP), we measured serum electrolytes, HCO(3) (-), citrate, and acetate at 3 points in the circuit: A) the plasma separator inflow; B) after mixing of FFP/the dialyzer inflow; and C) the dialyzer outflow. Serum levels of human hepatocyte growth factor (HGF), acetate, and citrate were also measured before and after PE + HD. The levels of K(+), Ca(++), HCO(3) (-), and acetate were significantly decreased, and citrate was increased, between A and B. K(+) and citrate were decreased, while Ca(++), HCO(3) (-), and acetate showed an increase between B and C. Comparison of A with C revealed insufficient correction of the Ca(++) and citrate levels by HD. After PE + HD, serum levels of acetate and citrate were increased, while HGF was decreased. We concluded that i) when PE is performed, HD is also necessary for correction, but achieves insufficient correction of Ca(++) and citrate, ii) PE is non-selective and not only removes toxins but also beneficial substances such as HGF, iii) accumulation of acetate occurred, even with bicarbonate dialysate, since it also contains acetate for acidification.

BackgroundHemodialysis is essential for the survival of patients suffering from chronic renal failure. However, in diabetics the incidence of dry eye disease is higher than in non-diabetic individuals. Accordingly, we evaluated if this difference is attributable to different effects of hemodialysis on basal tear fluid secretion.MethodsA modified Schirmer´s eye test determined if hemodialysis improved basal tear secretion rates in 36 diabetic and non-diabetic patients undergoing hemodialysis.ResultsBasal tear secretion was invariant in diabetic patients whereas in non-diabetic individuals this process increased.ConclusionIn non-diabetic patients, autonomic neuropathy appears to be less severe and somewhat reversible since only in these individuals hemodialysis improved basal tear fluid secretion. This difference may be a factor contributing to the lower incidence of dry eye disease in non-diabetic patients.

A 71-year-old woman was admitted to the Wakayama Medical University Hospital with dizziness and loss of body balance. She had started hemodialysis at the age of 70. During the 33 days before admission, she received oral tizanidine hydrochloride at 3 mg/day for leg cramps. An admission electrocardiogram (ECG) demonstrated sinus bradycardia of 47 bpm. A 24-h ECG showed a total number of heartbeats of 68,779 and an average heart rate of 48 bpm. The maximum RR interval was 3720 msec. The electrophysiology test demonstrated slight sinus node dysfunction. There was no major organic heart disease. We suspected that tizanidine was the cause of bradycardia and stopped administration of this drug. After discontinuation symptoms gradually disappeared. The serum concentration of the tizanidine showed a higher trough of 1.78 ng/mL. In conclusion, because there was a disappearance of symptoms and a lightening of bradycardia due to the discontinuation of this medication, tizanidine was strongly suspected as the cause of severe bradycardia.