netilmicin and Uremia

Hemodiafiltration (HDF) is a new dialysis treatment that combines convective and diffusive forces. In order to assess the efficiency of a peculiar model of hypertonic HDF (H HDF), we studied eight uremic patients when they were undergoing five sessions of H HDF of 180 minutes duration and two sessions of standard hemodialysis (HD) of 270 minutes duration with a comparable blood (approximately 400 mL/min) and dialysate flow rate (approximately 520 mL/min). The plasma water clearances (Kw) of small [urea (U), creatinine (C), uric acid (UA), and phosphorus (P)] and middle molecules [netilmicin (N) and inulin (I)] were exceedingly higher in H HDF than in HD; however, because of the different treatment times, U and C removal (R) in HD overcame and UA and P R in HD equalized that in H HDF. The factor time was not sufficient to HD to compensate for the large difference in Kw in the case of I. Additional studies were performed in seven out of the eight patients after two sessions of H HDF and one session of HD. Two significantly higher rebounds were observed when comparing both treatments: for U after HD and for parathyroid hormone (PTH) after H HDF; however, PTH Cx/Cs ratios (ratios of the plasma water concentration of PTH at any postdialysis time to the plasma water concentration of PTH at the start of the run) were not different in both treatments, meaning that there was an increased PTH secretion in the early post H HDF hours in order to compensate for the larger PTH R with H HDF.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Blood; Chronic Disease; Creatinine; Female; Humans; Inulin; Kinetics; Male; Middle Aged; Models, Biological; Netilmicin; Parathyroid Hormone; Phosphorus; Renal Dialysis; Toxins, Biological; Ultrafiltration; Urea; Uremia; Uric Acid

The pharmacokinetics of netilmicin after i.v. administration were studied in 10 adult hemodialyzed patients during and after a dialysis session. The mean interdialysis half-life was 49.6 h, whereas during dialysis this value was reduced to 5.02 h. The mean volume of distribution of netilmicin was about 20% of the total body weight. The dialyzer clearance of netilmicin, measured at 60 and 150 min after the beginning of the session, was about 50 ml/min; this means that 60-65% of the drug may be lost during the 4.5 h standard dialysis. The total body clearance of netilmicin was similar to the dialyzer clearance values, suggesting that the drug is eliminated almost entirely by hemodialysis and that its renal elimination in our patients is negligible. In conclusion, in uremic hemodialyzed patients netilmicin behaves like other aminoglycosides.

Topics: Half-Life; Humans; Kinetics; Netilmicin; Renal Dialysis; Uremia

Clinical aspects of Continuous Ambulatory Peritoneal Dialysis (CAPD) were studied in the first fifty patients started on CAPD at our hospital. CAPD was found to achieve good control of the uremic symptoms and of the biochemical values studied. Hypertension became less pronounced. The costs were found to be low. Twenty-four diabetic subjects were studied in detail. Intraperitoneal administration of insulin resulted in good metabolic control of the diabetes. The two catheters used for peritoneal access were compared. Because of problems related to the removal of the Toronto Western Hospital catheter it was concluded that the Tenckhoff catheter was to be preferred. Peritonitis was found to be the worst complication. Coagulase negative staphylococci accounted for 57% of the cases. During the study an increasing percentage of infections were caused by bacteria with multiple resistance to antibiotics. Netilmicin, a new aminoglycoside, was evaluated for the treatment of CAPD-related peritonitis. 84% of the cases responded. One of the nineteen patients treated sustained reversible vestibular toxicity. No other side effects were noted. In two patients right-sided hydrothorax was found to be a complication of peritoneal dialysis. In one case it was demonstrated that defects in the right diaphragm was the cause of the complication. In the other CAPD was continued despite the complication.

Topics: Anti-Bacterial Agents; Catheters, Indwelling; Diabetic Nephropathies; Humans; Hydrothorax; Netilmicin; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Staphylococcal Infections; Sweden; Time Factors; Uremia

Metabolic balance and morphologic studies were performed on rats receiving gentamicin 100 mg/kg/day for a period of 8--10 days and during the recovery period. Daily urine flow rate increased with the administration of gentamiccin and remained elevated up to 20 days following the discontinuation of gentamicin, although BUN and plasma creatinine were virtually normal 10 days after the discontinuation of gentamicin. During the development of renal failure means daily electrolyte excretion remained normal. During the recovery period, however, sodium and potassium excretion exceeded control values while chloride and net acid excretion remained normal. Proteinuria developed during the administration of gentamicin and returned to normal 6--10 days after the discontinuation of gentamicin. Ten days of netilmicin administration (150 mg/kg/day) resulted in only mild tubular degeneration and no azotemia.

Topics: Animals; Blood Urea Nitrogen; Body Weight; Creatinine; Electrolytes; Gentamicins; Hematocrit; Kidney; Male; Netilmicin; Polyuria; Rats; Time Factors; Uremia