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Obwohl in einigen Landern das individuelle Risiko fur diabetische Spatkomplikationen rucklaufig ist, muss aufgrund der Vielzahl der betroffenen Menschen von einem weiteren Anstieg von Patienten mit Diabetes mellitus und Nierenerkrankungen gerechnet werden. Das Vorhandensein einer Niereninsuffizienz erhoht das Risiko fur komplizierte Hypoglykamien deutlich. Der HbA1c-Zielwert ist daher in Abhangigkeit von Komorbiditat und Therapiesicherheit individuell einzustellen. Erschwerend kommt hinzu, dass bei Patienten mit fortgeschrittener Niereninsuffizienz der HbA1c-Wert falsch-niedrig ist. Die Nieren tragen auf vielfaltige Weise zur Glukosehomoostase bei. Die SGLT2(„sodium-glucose cotransporter 2“)-Hemmung stellt ein vielversprechendes neues Wirkprinzip dar; fur den klinischen Alltag ist bedeutsam, Art und Dosis der antidiabetischen Therapie an den jeweiligen Grad der Niereninsuffizienz anzupassen. Bei nierentransplantierten Patienten ist mit dem Auftreten eines NODAT („new-onset diabetes after transplantation“) zu rechnen. Entsprechende Screeninguntersuchungen sind ratsam.

The incidence of diabetes mellitus type 2 is greatly increasing worldwide. An early therapy with intensified control of diabetes and blood pressure is especially important to avoid delayed complications. In addition to diabetic foot syndrome, diabetic retinopathy and diabetic nephropathy still represent commonly occurring problems. Despite improvements in the quality of care, the targets of the St. Vincent Declaration have still not yet been achieved. Diabetic retinopathy and diabetic nephropathy show parallels in the course of the disease and in the pathological anatomical alterations which have led to the inauguration of a diabetic renal-retinal syndrome. The ophthalmological assessment of the retina was previously considered to be a diagnostic aid for assessment of diabetic nephropathy; however, nowadays a simple estimation of the glomerular filtration rate using the modification of diet in renal disease (MDRD) formula and determination of microalbuminuria can in contrast give ophthalmologists an early indication of the possible presence of microangiopathic alterations.

Hintergrund Uber einen Zeitraum von 10 Jahren hat sich die Pravalenz alterer Menschen an der Dialyse verdoppelt. Uber 75-Jahrige bilden heute die groste Gruppe, die mit der Dialysebehandlung beginnt. Ziel der Arbeit ist die Darstellung der Behandlungsoptionen im hohen Lebensalter und der daraus resultierenden ethischen Probleme.

Der Ubergang von einem Stadium CKD 5 zu einem Dialysebehandlungsstadium CKD 5 D ist die vulnerable Behandlungsphase bei Patienten mit chronischer Niereninsuffizienz (CKD). Der richtige Zeitpunkt des Dialysebeginns ist daher von besonderer Bedeutung. Fruher zeichnete sich ein Trend zur fruhzeitigen Dialyseeinleitung ab, aufgrund der neueren Studienlage ergeben sich jedoch hieraus keine Vorteile. Ein spaterer Dialysebeginn ist bei klinisch unkomplizierten Patienten moglich, unter der Voraussetzung einer engen nephrologischen Mitbetreuung und guten Adharenz. Bei Patienten mit kardiorenalem Syndrom, oder „acute on chronic renal failure“ ist gegebenenfalls eine fruhzeitigere Dialyseeinleitung notwendig, verbunden mit einer Re-Evaluierung nach Re-Kompensation oder Erholung der renalen Restfunktion. Bei alteren Patienten sollten die Moglichkeiten einer konservativen Therapie ohne Einleitung einer Nierenersatztherapie diskutiert werden. Konsequenterweise wird der Zeitpunkt der Dialyseeinleitung in den Leitlinien stets von dem Vorhandensein einer klinischen Symptomatik und des individuellen Patientenrisikos unter Berucksichtigung des zugrunde liegenden Krankheitsbildes abhangig gemacht und nicht allein von der Verminderung der glomerularen Filtrationsrate.

Hypoglykamien sind die mit Abstand haufigsten endokrinologischen Notfalle. Als vital bedrohliche Storungen ziehen sie eingreifende psychosoziale Auswirkungen nach sich. Daruber hinaus verursacht die Behandlung von Hypoglykamien enorme Kosten. Wie lassen sich Hypoglykamien also moglichst vermeiden?

Die diabetische Nephropathie ist die haufigste Ursache einer dialysepflichtigen Niereninsuffizienz in Deutschland. Im Gegensatz zu vielen anderen Dialysepatienten leiden die betroffenen Patienten nicht nur an einer Niereninsuffizienz und den sich daraus entwickelnden uramischen Komplikationen, sondern auch an den anderen systemischen Folgen des diabetischen Spatsyndroms. Durch die Kombination beider Erkrankungen ergibt sich ein besonderes kardiovaskulares Morbiditats- und Mortalitatsrisiko. Die veranderte Insulinwirkung bei Niereninsuffizienz, die Beeinflussung des Glukosestoffwechsels durch die Dialysetherapie und die autonome Neuropathie fuhren zu einem erhohten intradialytischen Komplikationsrisiko. Individuelle Therapieziele sollten daher die fruhzeitige und konsequente Diagnostik und Therapie der koronaren Herzkrankheit und der peripheren arteriellen Verschlusskrankheit beinhalten. Daruber hinaus sollten sie durch Masnahmen zur Vermeidung hypotensiver und hypoglykamischer Episoden zu einer Verminderung der intradialytischen Komplikation fuhren.

Wahrend sich noch vor Jahren ein Trend zur fruhzeitigeren Dialyseeinleitung abzeichnete, zeigt die neuere Studienlage keine Vorteile fur ein solches Vorgehen. Bezogen auf die glomerulare Filtrationsrate (GFR) ergibt sich kein Unterschied zur Mortalitat oder Lebensqualitat bei fruhem oder spatem Dialysebeginn. Voraussetzung fur einen spateren Dialysebeginn ist die enge nephrologische Mitbetreuung der Patienten, da uramische Komplikationen mit abnehmender GFR haufiger vorkommen. Der richtige Zeitpunkt der Dialyseeinleitung ist daher stets in Abhangigkeit der klinischen Symptomatik und des individuellen Patientenrisikos unter Berucksichtigung des zugrunde liegenden Krankheitsbildes zu bestimmen und nicht allein von der Verminderung der GFR abhangig. Die European Best Practice Guidelines haben sich auch nach Vorlage der neuen Studien nicht signifikant geandert.

Bei der Behandlung von Patienten mit Diabetes mellitus sind Hypoglykamien ein wichtiges Thema. Durch die Ergebnisse der grosen Studien ACCORD, ADVANCE und VADT wurde die Gefahr durch Unterzuckerungen auch fur Typ-2-Diabetiker besonders deutlich. Es gilt, Hypoglykamien und Gewichtszunahme bei den Patienten zu vermeiden und nicht, das HbA1c-Ziel < 6,5% um jeden Preis zu erreichen. Dazu ist eine individuelle Therapiestrategie notwendig, und zwar abhangig von Alter, Begleiterkrankungen und vor allem von der Nierenfunktion.

To date, lipid apheresis procedures can remove low-density lipoprotein (LDL) cholesterol (LDL-C) only from plasma. Thus, initially plasma has to be separated from the blood cells, which increases the costs and complexity of the extracorporeal circuit. This paper describes the first clinical application of a new LDL adsorber that eliminates LDL directly from whole blood. The goal of this pilot study was to test the efficacy, safety, and feasibility of direct lipoprotein adsorption in patients. In a 2 center Phase II clinical trial, 12 hypercholesterolemic patients suffering from overt coronary or peripheral artery disease were treated once with LDL hemoperfusion. The new LDL adsorber (DALI, Fresenius, St. Wendel, Germany) contained 480 ml of polyacrylate coated polyacrylamide gel. The anticoagulation consisted of an initial heparin bolus followed by an acid citrate dextrose (ACD)-A infusion during the treatment. The processing of nearly 1 patient blood volume resulted in a reduction of LDL-C by 45 +/- 8% and triglycerides by 23 +/- 20%. HDL-C, fibrinogen, and cell counts were not significantly influenced. In a subgroup of 5 patients who exhibited elevated lipoprotein (a) (Lp[a]) levels, Lp(a) reduction was 43 +/- 15% (all results corrected for plasma volume shifts). The sessions were clinically uneventful; the system was technically safe and easily handled. In conclusion, short-term LDL hemoperfusion by the DALI proved to be a safe, effective, and simple procedure for the treatment of patients suffering from symptomatic recalcitrant hypercholesterolemia. The present study represents a solid basis for the clinical long-term evaluation of this new technique in the future.

Long-term intermittent heparin-induced extracorporeal low-density lipoprotein (LDL)-cholesterol precipitation was performed in three men - aged 32, 52 and 56 years - with severe familial hypercholesterolaemia and angiographically demonstrated coronary heart disease. This significantly lowered by 65-70% their LDL-cholesterol concentration and by 48-54% their fibrinogen concentration. Fibrinogen elimination reduced plasma viscosity by 13-14% and clearly raised the transcutaneously measured partial pressure of oxygen by 33-50%. Clinically the improved microcirculation achieved a decrease in angina symptoms: the walking distance of the 52-year-old man increased from about 100 m to 4000 m, the daily need of glyceryl trinitrate falling from an average of 12 to 4 aerosol doses.

In den ersten Jahren der chronischen Nierenersatztherapie stellte die Diagnose Diabetes mellitus eine Kontraindikation fur die Aufnahme in ein chronisches Dialyseprogramm dar. Heute ist dagegen Diabetes mellitus die Hauptursache fur die Initiierung einer Nierenersatztherapie. Der Beitrag gibt einen Uberblick uber die Besonderheiten der Dialysetherapie bei Patienten mit Diabetes mellitus. Generelle Probleme der Nierenersatztherapie werden ebenso angesprochen wie verfahrensspezifische Aspekte der Hamo- und Peritonealdialysetherapie.

Direct adsorption of lipids (DALI) is the first LDL-apheresis method compatible with whole blood. Usually, the blood flow rate is adjusted at 60-80 ml/min, which results in session times of about 2 hr. The present study was performed to test the safety and efficacy of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] removal by DALI at high blood flow rates in order to reduce treatment time. Thirteen chronic DALI patients in seven centers suffering from hypercholesterolemia (LDL-C 162 +/- 42 mg/dl at baseline) and coronary artery disease were treated on a weekly or biweekly basis by DALI apheresis. The blood flow rate QB was held constant for at least two sessions, respectively, and was increased from 60 to 80, 120, 160, 200, and 240 ml/min. All patients had pre-existing av-fistulas. The anticoagulation was performed by a heparin bolus plus ACD-A at a ratio of citrate:blood ranging from 1:20 to 1:90. Clinically, the sessions were well tolerated and only 26/201 sessions (12%) of the treatments were fraught with minor adverse events. Acute LDL-C reductions (derived from LDL-C levels determined by lipoprotein electrophoresis) averaged 72/66/60/53/50/48% for QB=60/80/120/160/200/240 ml/min. Lp(a) reductions were 68/67/62/60/58/56%, whereas HDL-C losses were < or =10%. Routine blood chemistries and blood cell counts remained in the normal range. Treatment times averaged 142/83/45 min at Qb=60/120/240 ml/min. On average, DALI LDL-apheresis could be performed safely and effectively at high blood flow rates up to at least 120 ml/min in patients with good blood access, which significantly reduced treatment time from 142 to 83 min (-42%).

The incidence of diabetes mellitus type 2 is greatly increasing worldwide. An early therapy with intensified control of diabetes and blood pressure is especially important to avoid delayed complications. In addition to diabetic foot syndrome, diabetic retinopathy and diabetic nephropathy still represent commonly occurring problems. Despite improvements in the quality of care, the targets of the St. Vincent Declaration have still not yet been achieved. Diabetic retinopathy and diabetic nephropathy show parallels in the course of the disease and in the pathological anatomical alterations which have led to the inauguration of a diabetic renal-retinal syndrome. The ophthalmological assessment of the retina was previously considered to be a diagnostic aid for assessment of diabetic nephropathy; however, nowadays a simple estimation of the glomerular filtration rate using the modification of diet in renal disease (MDRD) formula and determination of microalbuminuria can in contrast give ophthalmologists an early indication of the possible presence of microangiopathic alterations.

In recent years the percentage of diabetic patients on haemodialysis has increased. Considering the high frequency of intradialytic hypotensive and hypoglycaemic episodes experienced by these patients, it was the aim of the present study to evaluate the influence of different dialysate glucose concentrations (5.5 mmol/L or 11 mmol/L) on blood pressure and glycaemic regulation, using special dialysis equipment - the GENIUS® System. This cross-over, prospective and randomised study, total duration 14 weeks, included 20 diabetic patients on maintenance haemodialysis. Group 1: 9 patients dialysed using dialysate with a glucose concentration of 5.5 mmol/L and after 7 weeks switched to dialysate with a glucose concentration of 11 mmol/L. Group 2: vice versa. Results show a statistically higher number of patients with hypoglycaemic and hypotensive episodes using dialysate with a 5.5 mmol/L glucose concentration. Also, mean serum glucose values were higher during haemodialysis sessions with a glucose dialysate concentration of 11 mmol/L. There were no statistical differences between the groups in laboratory values, HbA1C, insulin doses or in anthropometric parameters. Our results suggest that fewer diabetic patients undergoing haemodialysis using a higher dialysate glucose concentration of 11 mmol/L have hypoglycaemic and hypotensive episodes. Since this dialysate glucose concentration had no influence on lipid or hepatic metabolism, anthropometric parameters and especially HbA1C values in this short-term study, the long term examination of its effects is warranted.

BACKGROUND This paper discusses long-term experience with a specific type of dialysis equipment which has been used more than 15 years without variation. The system was designed to allow easy individualization of dialysis fluid composition and to deliver dialysate of the highest hygienic quality. METHODS Data from 399 patients covering the period from 1971 onwards were analysed retrospectively. Survival probabilities were estimated by the Kaplan-Meier method and the median number of days in hospital was calculated. Additional data collected from patient subgroups included serum albumin level, erythropoietin requirement and antihypertensive treatments. Kt/V and PCR from one subgroup were computed using the formulae of Daugirdas and Depner. RESULTS The estimated survival probability after 5 years for all patients was 59.1% (95% CI: 52.6-65.6%). The main risk factors from the available covariables were age and IDDM. The cumulative incidence of carpal tunnel syndrome after 10 years of dialysis was estimated as 7% (95% CI: 0-14%). Data from the subgroups revealed that 82% of the patients had serum albumin levels >4.0 g/dl, 65% of the patients received no antihypertensive drugs and 39% received erythropoietin (37 +/- 28 units/kg bw/week) to correct dialysis anaemia (haemoglobin level = 98 +/- 8 g/l). Average Kt/V was 1.21 +/- 0.17, PCR was 1.10 +/- 0.22 g/kg/day. CONCLUSIONS The setup described permits individualized therapy of high quality. The high serum albumin values and our very low incidence of carpal tunnel syndrome underline the importance of water and dialysate quality.

The transition from CKD 5 to dialysis treatment (CKD 5 D) is characterized by a high mortality risk for patients with chronic kidney disease (CKD). Therefore, the right time to start dialysis is of special interest. While there was a trend towards an earlier initiation of dialysis many years ago, new studies could not demonstrate a benefit on survivals for patients who start dialysis in a higher glomerular filtration rate (GFR). Delaying the start of dialysis to a lower GFR is possible in CKD patients with stable conditions when close nephrological supervision is provided. In patients with cardiorenal syndrom and acute on chronic renal failure, an earlier start of dialysis might be necessary as well as the re-evaluation after re-compensation. In elderly patients the possibilities and risks of a conservative treatment without dialysis should be discussed. Consequently, current guidelines define the optimal time to start dialysis on the basis of the individual risk of the patients, clinical symptoms and underlying disease and not only on the GFR alone.

The efficacy of the heparin-induced extracorporeal LDL-precipitation (HELP)-apheresis procedure has been studied in an open prospective multicentre trial. After 2 years of regular weekly HELP-treatment the data from 39 of 51 patients could be evaluated according to the study criteria. Twelve of the initially recruited study patients were omitted from the evaluation either because of premature termination of the treatment or because they did not fulfil the exact guidelines of the study protocol. A mean of 2.831 plasma was regularly treated on average every 7.85 days. The mean pre-/post-apheresis LDL-cholesterol levels decreased from 286/121 mg dl-1 at the first HELP treatment to 203/77 mg dl-1 after 1 year and to 205/77 mg dl-1 after 2 years of regular apheresis; the corresponding values for fibrinogen were 314/144, 246/98 and 250/105 mg dl-1, respectively. In contrast, the mean pre-/post-apheresis HDL-cholesterol levels rose from 41/38 through 51/44 mg dl-1 after 1 year to 52/43 mg dl-1 after 2 years of treatment. The overall result was a normalization of the atherogenic index (LDL-/HDL-cholesterol ratio) from 6.9/3.2 to 4.0/1.9. The angiographies from 33 patients obtained before and after 2 years of regular treatment could be evaluated blindly using the cardiovascular angiography analysis system. The mean degree of stenosis of all segments decreased from 32.5% (SD = 16) to 30.6% (SD = 16.8) over the 2 years. A regression > 8% was observed in 50/187 (26.7%) segments, whereas 29/187 (15.5%) segments showed progression. In 108/187 (57.8%) segments the lesions were stable (< 8% deviation) over 2 years. We conclude that regular treatment with HELP-LDL-apheresis is able to stabilize progressive atherosclerotic disease and to induce almost twice as much regression as progression of atherosclerotic lesions.

C.E.R.A., a continuous erythropoietin receptor activator, offers once-monthly dosing without compromising haemoglobin control. This study was undertaken to examine whether monthly C.E.R.A. using pre-filled syringes maintains stable haemoglobin levels when administered according to local clinical judgement.MIRACEL was a prospective, open-label, single-arm, multicentre study performed at 90 nephrology centres in Germany. After a 2-month screening phase, haemodialysis patients receiving epoetin or darbepoetin were converted to monthly intravenous C.E.R.A., with a 5-month titration phase followed by a 2-month evaluation phase.Clinicaltrials.gov: NCT00413894 RESULTS: Of 661 patients screened, 424 (64.1%) started C.E.R.A. therapy (previous treatment: 72.2% epoetin, 27.8% darbepoetin); 416 were eligible for inclusion in the intent-to-treat population. A mean of two C.E.R.A. dose changes were required during the 7-month treatment period. The primary efficacy variable, haemoglobin within 11-12.5 g/dL or 10-13 g/dL during the evaluation phase, was achieved in 109 (30.8%) and 265 (74.9%) of the 354 evaluable patients, respectively, with no differences observed between patients formerly receiving epoetin or darbepoetin or different dosing frequencies. During the screening, titration and evaluation phases, mean haemoglobin was 11.7 +/- 0.7 g/dL, 11.6 +/- 0.9 g/dL and 11.4 +/- 1.0 g/dL, respectively, and 90.6% (377/416), 70.4% (293/416) and 82.9% (345/416) of patients exhibitedor = 1 g/dL change from phase-specific individual means. C.E.R.A. was well-tolerated with a safety profile similar to that reported in phase III studies.In this single-arm, open-label, multicentre study, conversion of a large population of haemodialysis patients from epoetin or darbepoetin to monthly C.E.R.A. administration using pre-filled syringes was shown to be practical, convenient and offer good control of haemoglobin levels, regardless of the previous type of therapy or dosing frequency.

We performed serial prospective ultrasound examinations of four flat and 17 soft carotid plaques during an average of 17 months in seven patients with heterozygous hypercholesterolemia during heparin-induced extracorporeal low density lipoprotein elimination on precipitation from plasma. By means of a specially designed quantitative three-dimensional ultrasound analysis, significant plaque volume reduction could be evaluated in all subjects, along with a marked reduction of total and low density lipoprotein cholesterol and fibrinogen serum levels.

Sodium lithium countertransport may be a genetic marker for arterial hypertension and for the risk of diabetic nephropathy in type 1 diabetic patients. Since various factors seem to influence the transport velocity including serum lipid alterations, erythrocytes of seven patients with severe hyperlipoproteinaemia who were chronically and intermittently treated with LDL apheresis were examined before and immediately after therapy. The LDL apheresis reduced sodium lithium countertransport significantly (0.383 vs 0.269, P less than 0.02). Therefore, we conclude that serum lipid composition must be considered when interpreting sodium lithium countertransport velocity.

To assess the tolerability, safety and efficacy of the epoetin beta multidose cartridge formulation, self-administered subcutaneously via a pen device (Reco-Pen), in adult patients with renal anemia.Patients receiving maintenance epoetin therapy were switched to the subcutaneous (SC) multidose formulation of epoetin beta (NeoRecormon). The frequency of adverse events, local tolerability, and changes in blood pressure and laboratory variables were recorded. Hematologic parameters, transfusion requirements and epoetin beta dosage were also assessed.A total of 406 patients were entered in the intention-to-treat analysis. Mean treatment duration was 82.3 days. Fifty patients (12.3%) withdrew from the study; 14 (3.4%) discontinued because of adverse events. Treatment was well tolerated, with adverse events considered probably related to treatment in only 5 cases, and 1 case of local intolerability. There were no clinically significant changes in blood pressure or laboratory variables, and no changes in hematologic parameters or transfusion requirements. Unexpectedly, the epoetin beta dose was reduced by almost one-third in patients previously maintained on SC epoetin.SC administration of this multidose epoetin beta formulation with the Reco-Pen device was well tolerated and effective. It is possible that the improved capacity to individualize dose may have contributed to the considerable reduction in SC epoetin beta dosage requirement.

In recent years the percentage of diabetic patients on haemodialysis has increased. Considering the high frequency of intradialytic hypotensive and hypoglycaemic episodes experienced by these patients, it was the aim of the present study to evaluate the influence of different dialysate glucose concentrations (5.5 mmol/L or 11 mmol/L) on blood pressure and glycaemic regulation, using special dialysis equipment - the GENIUS System. This cross-over, prospective and randomised study, total duration 14 weeks, included 20 diabetic patients on maintenance haemodialysis. Group 1: 9 patients dialysed using dialysate with a glucose concentration of 5.5 mmol/L and after 7 weeks switched to dialysate with a glucose concentration of 11 mmol/L. Group 2: vice versa. Results show a statistically higher number of patients with hypoglycaemic and hypotensive episodes using dialysate with a 5.5 mmol/L glucose concentration. Also, mean serum glucose values were higher during haemodialysis sessions with a glucose dialysate concentration of 11 mmol/L. There were no statistical differences between the groups in laboratory values, HbA1C, insulin doses or in anthropometric parameters. Our results suggest that fewer diabetic patients undergoing haemodialysis using a higher dialysate glucose concentration of 11 mmol/L have hypoglycaemic and hypotensive episodes. Since this dialysate glucose concentration had no influence on lipid or hepatic metabolism, anthropometric parameters and especially HbA/1C values in this short-term study, the long term examination of its effects is warranted.

Ein brauner Tumor stellt eine gutartige Resorptionsgeschwulst des Knochens bei Osteodystrophia fibrosa cystica dar. Die braune Farbe ist durch Hamosiderinablagerungen bedingt. Die Osteodystrophia fibrosa cystica ist die charakteristische Knochenmanifestation des Hyperparathyreoidismus. Wahrend vor 50 Jahren noch etwa 10–25% der Patienten ein solches Krankheitsbild aufwiesen, ist es heute durch die besseren Therapiemoglichkeiten des Hyperparathyreoidismus selten zu sehen [1]. Einzelne Falle im Gesichtsbereich wurden bei unerkanntem primarem Hyperparathyreoidismus beschrieben [1, 2]. Das pathognomonische Zeichen bei der Histologie ist eine Vermehrung der Riesenosteoklasten und ein Ersatz der normalen Zellen und Markelemente durch fibroses Gewebe [3]. Radiologisch nachweisbare Veranderungen sind typischerweise auch Resorptionen der Endphalangen und ein Aufweichen der Kortikalisausenlinie der Fingerknochen (subperiostaler Knochenabbau). Ublicherweise zeigen eine Reihe von Markern einen gesteigerten Knochenumbau an.

Current lipid apheresis techniques can remove atherogenic lipoproteins only from plasma. The initial mandatory separation of plasma and blood cells renders the extracorporeal circuit complex. We recently described the first clinical application of a new lipid adsorber that adsorbs low-density lipoprotein (LDL) and lipoprotein (a) (Lp[a]) directly from whole blood. In continuation of our work, this paper describes the clinical biocompatibility of this new LDL hemoperfusion system. In a 2 center phase II clinical trial, 12 hypercholesterolemic patients suffering from overt coronary or peripheral artery disease were treated once with LDL hemoperfusion. The new LDL adsorber (DALI, Fresenius, St. Wendel, Germany) contained 480 ml of polyacrylate coated polyacrylamide gel. The anticoagulation protocol consisted of an initial heparin bolus followed by an acid citrate dextrose-A (ACD-A) infusion during the treatment. One patient blood volume was treated per session. All sessions were clinically uneventful. No signs of hemolysis or extracorporeal clot formation could be detected, and cell counts remained virtually constant. In a subgroup of patients (n = 4-6), further biocompatibility parameters were studied. Activation of leukocytes (elastase release), thrombocytes (beta-thromboglobulin [beta-TG] extrusion), and monocytes (interleukin (IL)-1beta and IL-6) were minimal. Complement activation (C3a and C5a generation) was negligible. The chosen anticoagulation protocol was both safe (constant ionized calcium levels) and effective (low thrombin-antithrombin formation). In summary, within the scope of a first pilot study, this new LDL hemoperfusion procedure combined the features of excellent clinical tolerance, good biocompatibility, and ease of handling. Phase III clinical trials will have to show whether these encouraging preliminary results can be corroborated in a larger patient population.

Man geht davon aus, dass 40–80% der Diabetiker auch einen Bluthochdruck haben und damit deutlich haufiger als die Allgemeinbevolkerung. Diabetes mellitus ist mit einem erhohten Risiko fur kardiovaskulare Erkrankungen und kardiovaskularen Tod verbunden, aber es ist nach wie vor unklar, welchen Anteil die Stoffwechselstorung allein an diesem erhohten Risiko tragt und welcher auf Begleiterkrankungen wie Hypertonie zuruckzufuhren ist.

Bluthochdruck ist bei Patienten mit Diabetes entscheidend fur die Entwicklung von mikro- und makroangiopathischen Komplikationen. Welche Bedeutung kurzfristige Blutdruckanstiege im Rahmen einer Weiskittelhypertonie fur die Entwicklung von mikro- und makrovaskularen Komplikationen bei diesen Patienten haben, war bisher nicht bekannt.