Kidney Transplant Recipients Show Limited Lung Diffusion Capacity but Similar Hydrogen Peroxide Exhalation as Healthy Matched Volunteers: A Pilot Study.

Patients with end-stage chronic kidney disease show higher systemic oxidative stress and exhale more hydrogen peroxide (H2O2) than healthy controls. Kidney transplantation reduces oxidative stress and H2O2 production by blood polymorphonuclear leukocytes (PMNs). Kidney transplant recipients (KTRs) may be predisposed to an impairment of lung diffusing capacity due to chronic inflammation. Lung function and H2O2 concentration in the exhaled breath condensate (EBC) were compared in 20 KTRs with stable allograft function to 20 healthy matched controls. Serum interleukin eight (IL-8) and C-reactive protein (CRP), blood cell counts, and spirometry parameters did not differ between groups. However, KTRs showed lower total lung diffusing capacity for carbon monoxide, corrected for hemoglobin concentration (TLCOc), in comparison to healthy controls (92.1 ± 11.5% vs. 102.3 ± 11.9% of predicted, p = 0.009), but similar EBC H2O2 concentration (1.63 ± 0.52 vs. 1.77 ± 0.50 µmol/L, p = 0.30). The modality of pre-transplant renal replacement therapy had no effect on TLCOc and EBC H2O2. TLCOc did not correlate with time after transplantation. In this study, TLCOc was less reduced in KTRs in comparison to previous reports. We suggest this fact and the non-elevated H2O2 exhalation exhibited by KTRs, may result perhaps from the evolution of the immunosuppressive therapy.

Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Is a Biomarker Associated with Left Ventricular Hypertrophy in the Elderly, Specifically in Women.

Left ventricular hypertrophy (LVH) may result in the development of heart failure, which is widespread among people of advanced age. The pathophysiology of LVH is complex and its biochemical pathways are not fully understood in this group. Elevated soluble urokinase-type plasminogen activator receptor (suPAR), a biomarker of immune activation, including fibrosis, reflects subclinical organ damage in systematic diseases. The present study assesses the clinical role of suPAR measurement in determination of LVH-associated cardiac disorders in the elderly. The studied population consisted of 238 individuals aged 76-91 years; of these, 139 (58%) were diagnosed with LVH. Serum biomarkers measurement (suPAR, troponin T, NT-proBNP and CRP) and echocardiography were performed in all subjects. The suPAR level was significantly higher in the LVH group (4.01 vs. 3.82 ng/mL, p = 0.033) and correlated with the parameters of cardiac diastolic function. Stepwise logistic regression found suPAR level (OR = 1.55, p = 0.016), BMI (OR = 1.17, p = 0.0003) and hypertension (OR = 2.42, p = 0.046) to be independently associated with LVH in women. In men, the strongest predictors of LVH were hypertension (OR = 7.52, p = 0.014) and BMI (OR = 1.42, p = 0.032). The observations indicate suPAR as a promising marker reflecting LVH, especially in women at advanced age, independent of age-associated cardiac remodeling.

Dietary Zinc Is Associated with Cardiac Function in the Older Adult Population.

The elderly is a group at particularly high cardiovascular risk. The coexistence of chronic diseases and use of multiple medications creates the need to look for non-pharmacological agents to improve cardiovascular health in that population. In view of reports on the potential role of zinc in enhancing pathways of myocardial tissue repair, the aim of this study was to evaluate the association between dietary zinc intake and cardiac structure and function in individuals of advanced age. The study group included 251 community-dwelling patients, with a median age of 80 years. Dieta 6.0 software was used for calculation of zinc consumption. Percentage of Recommended Dietary Allowance (RDA) for zinc correlated with left ventricular ejection fraction (LVEF) (r = 0.196, p < 0.05), left ventricular mass index (r = -0.137, p < 0.05) and tricuspid annular plane systolic excursion (TAPSE) (r = 0.153, p < 0.05), while zinc density did so with E/E' ratio (r = -0.127, p < 0.05). In a multiple stepwise regression analysis, the best determinants of LVEF were %RDA for zinc (p = 0.014; ß = 0.143), presence of coronary artery disease (p < 0.001; ß = -0.39) and age (p = 0.036; ß = -0.12). Furthermore, %RDA for zinc (p = 0.009; ß = 0.16), female sex (p = 0.005; ß = -0.171), beta-blocker use (p = 0.024; ß = -0.136), body mass index (p = 0.008; ß = 0.16) and heart rate (p = 0.0006; ß = -0.209) had an independent effect on TAPSE. In conclusion, in individuals of very advanced age, lower zinc intake is associated with poorer cardiac function. Therefore, increasing the recommended zinc intake in this group deserves consideration.

Clinical and prognostic usefulness of soluble urokinase plasminogen activator receptor in hemodialysis patients.

PURPOSE: Considering its prognostic usefulness and the relationship with chronic kidney disease, we analyzed the clinical utility of soluble urokinase plasminogen activator receptor (suPAR) in end-stage renal disease patients undergoing hemodialysis treatment. We focused on the association between suPAR levels and clinical outcomes, especially those related to cardiovascular events and mortality as well as the effect of hemodialysis on the protein levels. METHODS: We enrolled 64 patients. Blood samples for laboratory tests were collected before and after the midweek hemodialysis. The concentration of suPAR was assessed using suPARNostic ELISA, ViroGates. RESULTS: Spearman rank analyses showed a positive association between suPAR and creatinine, cystatin C, galectin 3, N-terminal prohormone of brain natriuretic peptide and troponin T (p < 0.05). In ROC analysis, the suPAR concentration equal to 11.5 ng/mL was established to be the cutoff value for the prediction of mortality in the analyzed patients. Simultaneous analysis of creatinine and suPAR increased the predictive value of the latter-the area under curve increased to 0.84 (95% CI 0.70-0.94, p < 0.0001). Logistic regression analysis revealed that increase in the suPAR level was associated with the increase in odds ratio for death by 1.3 (95% CI 1.1-1.6, χ2 = 8.2, p = 0.004). In multivariable analysis, the prediction power of suPAR appeared to be stronger after including creatinine (p = 0.0005). CONCLUSIONS: Elevated suPAR levels provide independent information on mortality risk in patients undergoing hemodialysis. The protein appears not to cross the dialysis membrane; thus, blood collection before the second hemodialysis session seems to give reliable information on the suPAR level for clinical interpretation.

A new generation of biomarkers tests of myocardial necrosis: the real quality a physician can get from the laboratory.

BACKGROUND: Recent guidelines recommended by ESC, ACC, AHA, and WHF concerning biomarkers of myocardial necrosis also apply to the work of clinical laboratories. Methodological modification for tests used in determining cardiac biomarkers reduced the time of the analytical procedure to 9 min (STAT version of the tests). We decided to determine and compare analytical quality of the tests in standard and STAT versions for determining serum level: troponin T, MB isoenzyme of creatine kinase, and myoglobin, as well as to verify whether the TnThs STAT test meets the following requirements: CV<10% at the level close to diagnostic, equal to the 99th percentile of reference population, and turnaround time<60 min. MATERIAL/METHODS: We evaluated real precision and accuracy for both standard and STAT versions of tests as well as the correlation of results of physiological and pathological levels. Additionally, observations of turnaround time were made. RESULTS: Calculated values of total errors did not exceed the recommended acceptable total error (<20%). Comparable precision of the 2 measurement methods (CV=3.07%) was obtained. A strong correlation (R>0.99) between both variants of tests for all the parameters was confirmed. Thanks to the application of new reagent kit, the percentage of results with turnaround time<60 min increased from 40% to 75% (n=115; p=0.000008). CONCLUSIONS: The new generation of STAT cardiac biomarkers has high analytical quality and meets international precision requirements. It guarantees high analytical and clinical reliability of results. Use of the STAT version of biomarkers contributes to a significant decrease in turnaround time and allows obtaining a good result of an analysis.

The association between galectin-3 and clinical parameters in patients with first acute myocardial infarction treated with primary percutaneous coronary angioplasty.

BACKGROUND: Galectin-3, a biomarker associated with fibrosis and inflammation, has been implicated in development and progression of heart failure (HF) and predicts increased mortality and morbidity in this condition. HF frequently develops after myocardial infarction (MI), contributing to worse outcome. The aim of this study is to assess the association between galectin-3 levels and various clinical parameters in acute phase of first MI treated with primary percutaneous coronary intervention (pPCI) in patients without prior HF. METHODS: We included 145 consecutive patients with first acute MI treated with pPCI with stent implantation. Exclusion criteria were: prior HF, severe valvular diseases, coexisting cancers, connective tissue diseases and cirrhosis. Serum galectin-3 concentration was measured within 3-5 days after onset of acute MI. RESULTS: Thirty-six patients with the highest galectin-3 levels (4th quartile, > 16 ng/mL) were compared to 109 subjects with a biomarker concentration ≤ 16 ng/mL. Elevated galectin-3 levels were more often observed in females, the elderly, subjects with coexisting diabetes, renaldysfunction and permanent atrial fi brillation (AF). Galectin-3 correlated with N-terminal pro-B-type natriuretic peptide (r = 0.27, p < 0.001) and high-sensitivity C-reactive protein (r = 0.20, p < 0.05). Multivariate analysis revealed that only new-onset AF and diuretics treatment during hospitalization were independently associated with galectin-3 levels > 16 ng/mL. CONCLUSIONS: Elevated galectin-3 levels were associated with a higher rate of new-onset AF and diuretics treatment during hospitalization in patients with first MI treated with pPCI without prior HF.

Obesity indices and adipokines in non-diabetic obese patients with early stages of chronic kidney disease.

BACKGROUND: The aim of this study was to estimate obesity parameters: waist circumference (WC), waist-to-hip ratio (WHR), weight-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI), and serum adipokines (leptin, adiponectin, resistin) and their associations with estimated glomerular filtration rate (eGFR), serum creatinine, and microalbuminuria (MA) in patients with early stages of CKD and in non-CKD obese patients. MATERIAL AND METHODS: 67 non-diabetic obese (BMI ≥ 30 mg/kg(2) out-clinic patients (25 males, 42 females), aged from 36.5 to 64 years were divided into 2 groups: Group A (n=15)--patients with early stages of CKD (eGFR between 30 and 60 ml/min/1.73 m(2) or with MA >20 mg/l in morning urine sample independently from GFR) and Group B--patients without chronic CKD (n=52). RESULTS: In Group A compared to Group B, BAI and leptin were higher (42.2 ± 7.1 vs. 37.5 ± 7.0; p<0.05 and 51.8 ± 26.7 ng/mL vs. 35.3 ± 24.9 ng/mL; p<0.05; respectively) and negative correlations occurred between eGFR and BAI (r=-0.709; p=0.003), leptin (r=-0.68; p=0.005), and resistin (r=-0.528; p<0.05). In Group B, negative correlations occurred between creatinine and VAI (r=-0.332; p<0.05), BAI (r=-0.619; p<0.0001), leptin (r=-0.676; p<0.0001), and adiponectin (r=-0.423; p=0.002), and between eGFR and resistin (r=-0.276; p<0.05). CONCLUSIONS: BAI may be a valuable obesity parameter as a predictor of early stages of CKD in patients with obesity. Leptin may be an important pathogenic factor in obese patients with early stages of CKD. Resistin is associated with eGFR in obese patients, independently of CKD.

The association between galectin-3 and occurrence of reinfarction early after first myocardial infarction treated invasively.

CONTEXT: Galectin-3, as a biomarker of inflammation and fibrosis, has been reported to be associated with coronary artery disease. OBJECTIVE: The study aimed to assess the relationship between galectin-3 levels and the occurrence of reinfarction early after myocardial infarction (MI). METHODS: The study included 145 consecutive patients with first MI treated invasively. Serum galectin-3 was measured using VIDAS (bioMérieux, Marcy-l'Etoile, France). RESULTS: The independent predictors of reinfarction in our group were as follows: female gender, elevated hs-C-reactive protein and galectin-3 levels (measured both at discharge). CONCLUSIONS: Galectin-3 might be an additional useful biomarker in prediction for reinfarction early after first MI.

Examination of serum pregnancy-associated plasma protein A clinical value in acute coronary syndrome prediction and monitoring.

INTRODUCTION: Chronic vascular inflammatory process promotes and intensifies all atherogenic events. The aim of this research was to estimate the clinical value of pregnancy-associated plasma protein A (PAPP-A) measurement associated with plaque destabilization and rupture in prediction and monitoring of acute coronary syndromes (ACS) as well as to assess the predictive value of this biomarker in comparison to traditional myocardial infarction (MI) risk markers. MATERIAL AND METHODS: The study included 119 patients in 2 investigated groups and one control group. PAPP-A assay was performed using manual ELISA kit, DRG. All other parameters were determined using automatic analyzers: Olympus and Dade Behring. RESULTS: A statistically significant difference between PAPP-A concentration median value was found in the investigated group MI individuals' serum and control group individuals' serum (11.42 ng/ml and 7.22 ng/ml respectively, p = 0.003). PAPP-A assay had the highest specificity (83.3%) and sensitivity (53.8%), and therefore the highest clinical value. In patients with clinically and laboratory confirmed MI we proved that PAPP-A serum level is a clinically useful biomarker in ACS prediction, better than C-reactive protein (hsCRP) and fibrinogen (FBG) level. CONCLUSIONS: The highest diagnostic efficiency for ACS prediction was proved for simultaneous panel assays consisting of 2-3 parameters (PAPP-A - hsCRP, PAPP-A - FBG, PAPP-A - hsCRP - FBG), while PAPP-A itself does not show characteristics necessary for it to be used as a biomarker for MI dynamic monitoring. It is possible that prothrombotic component is mainly responsible for repeated major adverse cardiac events, more than inflammatory process.