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Summaries – Résumés The effect of chronic renal failure and hemodialysis on carbohydrate metabolism By Hampers, C.L.; Soeldner, J.S.; Doak, P.B. and Merrill, J.P.: J. clin. Invest. 45: 1719 (1966). In an attempt to better define the carbohydrate intolerance of uremia, five patients with abnormal glucose tolerance and chronic renal failure severe enough to require hemodialysis were investigated. After it was certain that calorie intake was adequate the patients were studied with tests of carbohydrate tolerance. In addition, serum immunoreactive insulin (IRI) and free fatty acids were determined in response to intravenous glucose (IVGTT). The patients then underwent frequent hemodialysis, after which they were reevaluated. The frequency of dialysis was subsequently varied in order to determine its effect on glucose metabolism. The data indicate: (1) There is a defect in carbohydrate metabolism present in uremia that is not related to secondary factors such as starvation or latent diabetes melli-tus. (2) This abnormality does not appear to be related to urea per se. (3) The glucose intolerance can be corrected with frequent hemodialysis, but a minimal ‘recovery period’ (approximately 2 weeks) is necessary. (4) The insulin intensitivity and abnormal response to intravenous tolbutamide is also corrected with dialysis. (5) The carbohydrate abnormality will reappear within 7 days if dialysis is withheld. (6) There is a decreased serum IRI response to the IVGTT noted primarily within the first ten minutes of testing. Mean values of IRI were compared with various ‘control’ groups and the ‘uremic’ patients best matched normal subjects after a 7 day fast. The ‘corrected uremics’ (IRI) matched well with normal patients who had similar ‘K’ values. (7) Free fatty acid levels were not significantly different during periods of ‘normal’ and ‘abnormal’ glucose tolerance. It is speculated that a small molecular weight substance(s) accumulates rapidly in uremia and effects carbohydrate metabolism (possibly by interfering with enzyme activity). This is manifest by a decreased serum insulin response to glucose loads and by a peripheral insensitivity to insulin. Author’s address: Dr. C.L. Hampers, Peter Bent Brigham Hospital, Boston, Mass. ¢USA). Chronic hemodialysis using venipuncture and a surgically created arterio-venous ñstula By Brescia, M.J.; Cimino, J.E.; Appell, K. and Hurwich, B. J.: New Engl. J. Med. 275: 1089 (1966). This paper describes a technique for repeated access to arterial and venous blood for chronic hemodialysis utilizing a surgically produced subcutaneous arterio-venous fistula. The fistula is created between the radial artery and a corresponding vein. Dialysis may be instituted the day following surgery and is performed by use of two venipunctures with 14 gauge thin walled needles. Arterial blood is collected by directing the needle toward the fistula. The venous blood is returned from a needle facing in the opposite direction. Thirteen of sixteen patients were treated by such a fistula for a total of 110 dialysis months. Only two fistula attempts were Summaries – Resumes 249 unsuccessful. Of the established shunts all have continued to work well without complications. Blood flow delivered in the shunt is between 250 and 300 ml/min. There has not been a single episode of fistula clotting, infection, or pulmonary embolae. In addition, no detectable change in