Digitalislike Immunoreactive Substances and Extracellular Fluid Volume Status in Chronic Hemodialysis Patients

The Kidney and Hypertension: Causes and Treatment

“…A host of other factors have been suggested to be of importance in the pathogenesis of hypertension in the CKD population, including nitric oxide deficiency, 10 the presence of circulating inhibitors of Na + /K + ‐ATPase, 11 abnormalities in calcium‐phosphate homeostasis, 12 and hyperuricemia 13 ; the latter 2 factors have been most recently linked to CKD‐related hypertension. In that regard, defects in Ca 2+ metabolism are ubiquitous in dialysis patients and are typically manifested by secondary hyperparathyroidism, which may increase BP via Ca 2+ entry into vascular smooth muscle cells.…”

Treatment of Digoxin Intoxication in a Renal Failure Patient with Digoxin-Specific Antibody Fragments and Plasmapheresis

“…In addition, there is a bewildering array of both cardiac and noncardiac manifestations of digitalis toxicity that not only force the clinician to have a high index of suspicion but also to meaningfully inter pret those manifestations that may be due to this agent [8], Compounding these problems is the realization that the serum concentration may be of questionable signifi cance in the clinician's effort to come to a firm conclu sion in this regard, especially if the level has been obtained during the distribution phase [5]. The presence of digoxin-like immunoreactive substances further com plicates the clinical picture and interpretation of labora tory data, especially in the setting of renal failure [9].…”

“…Plasmapheresis should probably be delayed at least 24 h but not beyond 40 h following initial infusion of digoxin-specific Fab. Following infusion, it is important to remember that, in the presence of digoxin-specific Fab, assay anomalies may occur which necessitate the proper choice of testing method to assure accuracy [13,14], What role digitalis like immunoreactive substances, renal insufficiency, rel ative extracellular fluid volume status, and electrolyte concentrations may play in similar cases remains to be elucidated [9], Although it is not possible to state the amount of exchange necessary, we have shown that total digoxin and digoxin-specific Fab fragments can be suc cessfully removed by this method (approximately 75% of the initially noted amount after two treatments) thus obviating the possibility of delayed toxicity remote from the initial immune therapy.…”