Ospedale Civile Di Cividale Effect of Fish Oil in a Patient with Post-transplantation

our knowledge, this is the first reported case of TC-related on solute removal and to relate some additional observations which were presented at the annual meeting of the Italian vascular compression. Due to widespread lesions and deep infiltration of TC, operative intervention is generally not Nephrology Society in June, 1998. We studied eight haemodynamically stable patients [six recommended. The treatment of TC is still controversial. Since hyperphosphataemia with high serum Ca×P product males, mean age 60 years (range 47–68 years), mean dialytic age 40 months] who performed low resistance stationary appears to be the major culprit of its formation, reduction of phosphate intake, administration of phosphate-binders, cycling the last 20 min of each hour during conventional thrice-weekly bicarbonate haemodialysis. Cuprammonium, and adequate dialysis may decrease its occurrence or delay its progression. Other medical interventions such as steroid, hemophan or PMMA filters (1.3 m2) were used during the 240 min sessions, in contrast to the patients described by Dr calcitonin, bisphosphonates, and radiation have proved to be unsuccessful [1,3]. Recently, negative calcium balance Kong who underwent haemodiafiltration or high-flux haemodialysis with higher blood (median 450 ml/min vs 300 ml/min) from low-calcium dialysis has successfully reversed the ESRD-related TC [6,8], and this may be the most promising and dialysate flows (800 vs 500 ml/min). To determine solute removal in our study, spent dialysate was sampled continutreatment modality. In our case, thrice-weekly calcium-free dialysis reversed refractory hypercalcaemia. The massive TC ously and analysed for urea, creatinine and phosphate after 120 and 240 min, in contrast to the published study which and swelling of the right arm improved gradually, although the patient died too soon to observe any further response. utilized reduction ratios. Haemodynamic monitoring and statistical analysis were similar between the two studies. In conclusion, evidence is accumulating to support the contention that prolonged hyperphosphataemia and high In agreement with Dr Kong’s results, we found that urea rebound was reduced following dialysis with exercise (11% serum Ca×P product are the most important risk factors for TC formation in patients with ESRD. Therefore, preventvs 13.9%). However, total urea removal did not vary significantly with exercise (35.0±10.5 g) compared to conive control of hyperphosphataemia is indicated in every case of ESRD. Once TC has occurred, treatment is usually trol (34.1±12.1 g). Creatinine removal was significantly increased during exercise (1852±336 mg vs 1716±288 mg; extremely difficult. Intensive dialysis with low-calcium dialysate or calcium-free dialysis may be beneficial, especially in P=0.005). An important finding of our study was that phosphate removal was also significantly increased during patients with hypercalcaemia. exercise (855±363 vs 743±227 mg; P=0.037). Division of Nephrology Sun-Chieh Hsu1 Other investigators have also found that urea removal is Department of Internal Medicine Jeng-Jong Huang1 enhanced during intradialytic exercise [2,3]. In the light of 1National Cheng Kung University Junne-Ming Sung1 our findings we would conclude that increased urea removal Hospital Ming-Cheng Wang1 is dependent upon rapid blood flow. In any event exercise 2Kuo’s General Hospital Chin-Chung Tseng1 during conventional dialysis reduces urea rebound, increases Tainan Szu-Yuan Lee2 creatinine removal and, importantly, increases phosphate Taiwan removal, and also contributes to the general well-being of Republic of China the dialysis patient.