Many of the complications experienced by patients undergoing hemodialysis can be attributed to their altered host defenses. Increased cutaneous staphylococcal carriage along with repeated intravascular cannulation and defective mucocutaneous barriers lead to frequent invasion by infectious agents. Pathogens encounter granulocytes with subnormal locomotion, phagocytosis, and intracellular killing. Depressed cell-mediated immunity may be explained by shortened lymphocyte survival, lymphopenia, inhibition of lymphocyte transformation, and suppressor T-cell activity. This is manifested by cutaneous anergy, prolonged graft survival, altered tumor surveillance, and abnormal responses to hepatitis B and tuberculosis. Host interaction with the hemodialysis membrane leads to cellular disruption, which may induce autoantibodies. Activation of the alternate complement pathway during hemodialysis leads to granulocyte sequestration in small vessels, specifically within the lungs. These hemodialysis-induced alterations along with the manifestations of underlying chronic renal insufficiency may obscure clinical evaluation of these patients.

Host Defenses and Immunologic Alterations Associated with Chronic Hemodialysis

Infective endocarditis—1973

On the mammalian acetone metabolism: from chemistry to clinical implications.

Valvular and Perivalvular Abnormalities in End-Stage Renal Disease

In recent decades, two facts have changed the opinion of researchers about the function of acetone in humans. Firstly, it has turned out that acetone cannot be regarded as simply a waste product of metabolism, because there are several pathways in which acetone is produced or broken down. Secondly, methods have emerged making possible its detection in exhaled breath, thereby offering an attractive alternative to investigation of blood and urine samples. From a clinical point of view the measurement of breath acetone levels is important, but there are limitations to its wide application. These limitations can be divided into two classes, technical and biological limits. The technical limits include the storage of samples, detection threshold, standardization of clinical settings, and the price of instruments. When considering the biological ranges of acetone, personal factors such as race, age, gender, weight, food consumption, medication, illicit drugs, and even profession/class have to be taken into account to use concentration information for disorders. In some diseases such as diabetes mellitus and lung cancer, as well as in nutrition-related behavior such as starvation and ketogenic diet, breath acetone has been extensively examined. At the same time, there is a lack of investigations in other cases in which ketosis is also evident, such as in alcoholism or an inborn error of metabolism. In summary, the detection of acetone in exhaled breath is a useful and promising tool for diagnosis and it can be used as a marker to follow the effectiveness of treatments in some disorders. However, further endeavors are needed for clarification of the exact distribution of acetone in different body compartments and evaluation of its complex role in humans, especially in those cases in which a ketotic state also occurs.

https://iopscience.iop.org/article/10.1088/1752-7163/aa66d3/pdf

Breath acetone as a potential marker in clinical practice.

To the Editor:— A 70% solution of isopropyl alcohol (isopropanol), rubbing alcohol, is readily available as a potential source of poisoning; however, reported intoxications with this compound are not common A case of isopropyl alcohol intoxication was successfully treated by means of hemodialysis So far as we know, the isopropyl alcohol blood level in this patient was higher than that in any case previously reported This report should emphasize the life-saving potential of hemodialysis for severe isopropyl alcohol poisonings Report of a Case— A 28-year-old white man was admitted to the Indianapolis Veterans Administration Hospital at 8:00 PM on April 7, 1968 Forty-five minutes prior to admission, the patient was observed to have ingested approximately 1 liter of rubbing alcohol over a ten-minute period Physical examination revealed a blood pressure of 60/40 mm Hg, a pulse rate of 70 beats per minute, and a rectal temperature of 97 F (361 C)

Hemodialysis for isopropyl alcohol poisoning.

Bacterial endocarditis in chronic hemodialysis patients: A complication more common than previously suspected

Serum hepatitis occurred in 19 of 43 hemodialysis patients who received whole blood or packed cells before institution of the exclusive use of reconstituted frozen erythrocytes for transfu...

Decreased Incidence of Transfusion Hepatitis After Exclusive Transfusion with Reconstituted Frozen Erythrocytes

An economic and sound apparatus for lipid dialysis proved effective in a case of glutethimide intoxication.

Dana L. Shires

Papers

Hemodialysis for isopropyl alcohol poisoning.

Bacterial endocarditis in chronic hemodialysis patients: A complication more common than previously suspected

Decreased Incidence of Transfusion Hepatitis After Exclusive Transfusion with Reconstituted Frozen Erythrocytes

A Clinically Efficient and Economical Lipid Dialyzer: Use in Treatment of Glutethimide Intoxication

Accelerated renal allograft rejection following blood transfusion.