Objective To examine the effect of a reduced calcium/magnesium dialysis fluid (1.25/0.25 mmol/L, respectively) on calcium and magnesium mass transfer in both 1.36% and 3.86% glucose solutions. Design Each patient underwent four test exchanges, two with a standard dialysis fluid containing 1.36% and 3.86% glucose, and two with a reduced calcium/magnesium fluid containing 1.36% and 3.86% glucose. Calcium and magnesium were measured in dialysate and serum at ° and 240 minutes. Setting Single renal unit of a university teaching hospital. Patients Sixteen patients established on CAPD, and peritonitis-free, for at least 3 months. Results A lower dialysate calcium results in negative mass transfer when serum-ionized calcium exceeds dialysate calcium (mean -.0.21±0.15 mmol/exchange), and positive mass transfer when serum-ionized calcium is less than dialysate calcium in 1.36% glucose solutions (mean 0.57±0.18 mmol/exchange). A negative correlation was found between serum-ionized calcium level and calcium mass transfer. With a 3.86% reduced calcium/magnesium solution, calcium mass transfer is always negative (-.0.88±0.18 mmol/exchange) due to ultrafiltration and solute drag. Fifteen patients were found to be hypermagnesemic at the time of the study. Magnesium mass transfer was neutral with the standard 1.36% glucose fluid (mean -.0.01 mmol/exchange), but negative with the reduced calcium/magnesium 1.36% glucose fluid (mean -.0.58±0.13 mmol/exchange). With the 3.86% glucose solution, both fluids produced negative magnesium mass transfer (mean -.0.32±0.11 and -1.07±0.11 mmol/exchange for standard and reduced calcium/magnesium fluids, respectively). Conclusions We conclude that this fluid formulation should reduce hypercalcemia and hypermagnesemia in CAPD patients.

The graft and patient survivals following renal transplantation in all Type 1 diabetic patients transplanted within the North-West of England between 1981 and 1990 at Manchester Royal Infirmary were studied. Fifty-two Type 1 (insulin-dependent) diabetic patients with end-stage renal failure due to diabetic nephropathy were transplanted during this period. They were compared to controls matched for age, sex, and year of transplantation and also to all 904 patients transplanted during the same period. Graft survival rates at 1 and 5 years in the diabetic patients were lower (80.8% and 62.1%, respectively), compared to controls (88.9% and 77.9%, respectively, p = 0.02) but were similar to those seen in all grafts (80.4% and 59.0%, respectively, p = NS). Actuarial patient survival rate at 5 years was lower in diabetic patients (76.3%) compared to the control group (94.2%, p = 0.003). Myocardial infarction was the main cause (60%) of death in diabetic patients. The results of this large recent series indicate that good graft and patient survival rates can be obtained in Type 1 diabetic patients, although they remain poorer than those of patients with non-diabetic renal disease. More rigorous pretransplantation cardiac assessment and treatment before acceptance of Type 1 diabetic patients for renal transplantation may help to improve patient survival.

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