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A patient on peritoneal dialysis developed peritonitis due to Paecilomyces variotii. It appears that this relatively rare organism may be starting to assert itself as a more important human pathogen. A plea is made for speciation.

The effect on BP of alteration in dialysate temperature was studied in 150 hemodialysis treatments in 17 patients using a randomized, double-blind protocol. Each patient was treated using dialysate at 35.6 degrees C, 36.7 degrees C, and 37.8 degrees C. Mean BP during 35.6 degrees C dialysis was significantly higher than during 36.7 degrees C or 37.8 degrees C treatments. Symptomatic hypotensive episodes were more frequent at a dialysate temperature of 37.8 degrees C than during use of cooler dialysates. Modest changes in dialysate temperature thus appear to affect BP during hemodialysis. Dialysate cooler than that routinely employed has a beneficial effect while warmer dialysate has a detrimental one on intradialytic BP. The use of dialysate at least 1 degree C cooler than "isothermic" levels may be appropriate.

One hundred ten episodes of renal salt retention (urinary sodium and/or chloride less than 10 mEq/L) were studied retrospectively to determine the significance of discordance of urinary sodium from chloride. In 16 episodes the urinary sodium exceeded chloride by at least 15 mEq/L. This disparity was associated with the necessity for urinary excretion of substantial quantities of poorly reabsorbed anions (penicillin, ketones, or diatrizoate), a rapidly falling serum bicarbonate level (due to resolving metabolic or developing respiratory alkalosis), or substantial renal insufficiency (serum creatinine greater than 3 mg/dL). In 14 of 110 episodes, urinary chloride exceeded urinary sodium by at least 15 mEq/L. These patients were more often oliguric and had a higher mean serum chloride than patients without this dissociation. In patients with oliguria, hyponatremia, or metabolic alkalosis, measurement of urinary sodium or chloride alone will, in a substantial number of cases, fail to detect renal salt retention. When evidence is sought for renal salt retention, both urinary sodium and chloride should be determined.

A controlled double-blind prospective study was undertaken of the effect of dialysate calcium levels on BP during hemodialysis. Twenty patients and 240 dialyses were studied using a protocol in which patients underwent alternate hemodialyses with dialysate calcium of 2.5 and 3.5 mEq/L. Dialysate composition was otherwise the same. Mean BPs during dialysis were significantly lower at 1.5, 2.5, and 3.5 hours of dialysis when the lower dialysate calcium was used (P = .007 to .02). However, the difference in BP between the high and low dialysate calcium treatments was clinically minor, with a maximum mean difference (at 1.5 hours) of 4.6 mm Hg. Subgroups of patients with frequent hypotension and low or normal serum calcium did not appear more sensitive to the hypotensive effect of low calcium dialysate. Dialysate calcium levels of 2.5 and 3.5 mEq/L thus differ in their effect on intradialytic BP in a statistically significant, but clinically minor, way. Low calcium dialysate thus may prove useful in the management of patients in whom large amounts of enteric calcium absorption are indicated or unavoidable.

Desferrioxamine (DFO) was administered intravenously to a 63-year-old chronic hemodialysis patient with osteomalacia believed secondary to aluminum intoxication. Thrombocytopenia was noted after five doses of DFO. Platelet counts normalized after DFO was withheld. Thrombocytopenia recurred upon two rechallenges with this drug. It is suggested that platelet counts be monitored in hemodialysis patients receiving intravenous DFO.

The effect of a reduction in dialysate temperature on BP during hemodialysis was studied in seven patients with end-stage renal disease suffering frequently from intradialytic hypotension. Each patient received six dialyses using 34.4 degrees C dialysate. These treatments were preceded (six dialyses) and also followed (six dialyses) by control periods using a 36.7 degrees C bath. Symptomatic hypotension was defined as systolic BP below 100 mm Hg associated with typical symptoms of hypotension requiring treatment with intravenous (IV) fluid. Cool dialysate reduced the frequency of symptomatic hypotension from 0.58 to 0.05 episodes per dialysis (P = less than 0.016). In addition, the rate of fall of mean BP during treatment was substantially slowed with the reduction in dialysate temperature (P = 0.002). Cool dialysate (34.4 degrees C) substantially ameliorates hemodialysis-associated hypotension.

A double blind controlled trial of acute therapy for hemodialysis-related muscle cramps was undertaken. Cramps were graded by the subjects as moderate or severe. Fifty milliliter doses of one of three solutions were given intravenously in random fashion to 20 patients suffering a total of 100 episodes of muscle cramps. The solutions used were: (1) 7.05% NaCl (osmotic activity equivalent to 15 ml of 23.5% NaCl); (2) 50% dextrose; and (3) 5% dextrose. Relief after 3 min was reported by the subjects as complete, partial, or none. Osmotically similar concentrations of dextrose and NaCl were shown to be equally effective in providing relief of hemodialysis-related muscle cramps; both were superior to 5% dextrose.