No abstract

Malnutrition negatively influences the response to the hepatitis B virus vaccine in haemodialysis patients. Non-responders have higher morbidity and mortality than responders, and therefore the absence of response to the hepatitis B vaccine can be considered as a risk factor in the haemodialysis population.

Carpal tunnel syndrome, peripheral arthropathy, erosive spondiloarthropathy and lytic bone lesions have all been associated with dialysis amyloidosis. Recent studies indicate that β₂-microglobulin is the major constituent protein in this new form of amyloidosis. Dialysis amyloidosis was reported to have a local rather than a systemic involvement, although its full extent is yet to be determined. We investigated 3 patients on maintenance hemodialysis with bilateral caφal tunnel syndrome and amyloid arthropathy and found amyloid depositions in several organs. These findings suggest that, in contrast to what had been thought previously, dialysis amyloidosis could have systemic as well as visceral distribution. The amyloid deposits found were resistant against potassium permanganate treatment and reacted with anti-human β₂-microglobulin antibody.

Fifty-three consecutive subclavian or jugular hemodialysis catheters inserted into 41 patients were prospectively studied over a period of 8 months in order to determine the incidence of infection and its mechanisms. The intravascular, intradermal and the Y catheter segments as well as both connections were cultured using a quantitative technique for the intraluminal surface. In addition, the intravascular and intradermal portions of the catheter were cultured using a semiquantitative technique for the external surface. Skin smears of the catheter entry site were also cultured, and blood cultures were similarly obtained if fewer developed. Twenty-nine of the 53 catheters (55%) were significantly colonized by one (19 cases) or more (10 cases) microorganisms. The source of the colonizing microorganisms was the skin in 17 cases (58 %), intraluminal in 5 (17 %), both routes in 5 (17 %) and others in 2 (6.8%). Staphylococcus epidermidis (22 cases) and Staphylococcus aureus (4 cases) were the bacteria most frequently isolated. Nine of the 53 catheterizations (17%) were complicated by catheter-related septicemia due to S. aureus in 4 cases, S. epidermidis in 3 cases, Streptococcus faecalis in 1 and Proteus vulgaris in 1. Catheter-related bacteremia contributed to a patient’s death in 1 case. Suppurative local infections of the catheter entry site developed in 3 cases, 2 of them with septicemia. We conclude that the rate of infection due to subclavian or jugular hemodialysis catheters is very high and that the skin is the most frequent origin of the microorganisms.