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High plasma concentrations of triglycerides and low plasma concentrations of esterified cholesterol and lysolecithin, with an impaired rate of VLDL and LDL catabolism, have been reported in chronic uremic patients. An important contribution to these abnormalitites might be an impaired activity of the (LCAT). Serum LCAT activity and cholesteryl ester clearance were determined in 11 patients with chronic renal failure and in 10 controls. LCAT activity was determined by using the serum of each patient both as a source of enzyme and as a substrate ("intrinsic" activity) and was compared with the activity determined on a standard substrate ("extrinsic activity), so as to ascertain the presence of inhibitory factors in the patients' sera. Both activityes have been found to be significantly (P less than 0.01) lower in chronic uremic patients than in controls. The cholesteryl ester clearance apparently did not respond to the stimulatory effect of hypertriglyceridemia, as observed in other cases of dislipoproteinemias. The parallel decrease of both enzyme activities makes it unlikely that it is due to the presence of "uremic toxins" inhibiting the enzyme activity. LCAT synthesis in the liver is probably reduced in chronic uremia. These results suggest that in chronic uremia the VLDL fail to cooperate in their own catabolism.

Despite the great impact of continuous ambulatory peritoneal dialysis (CAPD) as an effective modality of treatment for uraemic patients, two limiting factors remain: the high incidence of peritonitis and the need for patients continuously to carry a bag. We have designed a new closed system with two bags connected to the permanent Tenckhoff catheter. Two clamps alternately allow outflow and inflow of peritoneal dialysate. When the exchange manoeuvre is finished the patient frees the whole system from the needle and discards it. Since December 1978, 24 patients have been treated with this technique. The results are similar to the Toronto series with a marked reduction in the incidence of peritonitis (22.5 pt/months).

A new technical approach has been described for the treatment of patients on CAPD. The new approach is based on the use of a two-bag system and closed connection by a connector to the Tenckhoff catheter. After each dialyzate exchange the patient discards the entire system and is completely bag-free, unlike the Oreopoulos CAPD technique. Using this new procedure we have markedly reduced the incidence of peritonitis and we have made the patient free from carrying an uncomfortable burden during the interval of solution exchange.