Does metabolic syndrome have an impact on the quality of life and mood of hemodialysis patients?

OBJECTIVE: Little is known about the association between metabolic syndrome (MetSyn), health-related quality of life (HRQoL), and depressive symptoms in hemodialysis (HD) patients. We hypothesized that MetSyn may be associated with lower HRQoL and depression in HD patients. DESIGN: This was a cross-sectional study. SETTING: The trial involved HD patients at a tertiary-care hospital. PATIENTS: We evaluated 115 patients (41 women and 74 men; mean age, 48.4 +/- SD 11.9 years SD). METHODS: MetSyn was defined according to National Cholesterol Education Panel criteria. The Medical Outcomes Study Short Form-36 (SF-36) and Beck Depression Inventory (BDI) were used to assess HRQoL and signs of depression, respectively. We compared HRQoL and clinical and psychosocial characteristics among participants with and without MetSyn. RESULTS: Fifty patients (43.5%) had MetSyn, and 65 patients (56.5%) were free of MetSyn. Comparisons of SF-36 and BDI scores between HD patients with and without MetSyn revealed no statistically significant differences. The Physical Component Summary Score (PCS) of SF-36 was independently associated with HD duration (beta = -0.274, P = .002), age (beta = -0.206, P = .024), sleep disturbance (beta = -0.175, P = .045), albumin (beta = +0.252, P = .006), and hemoglobin (beta = +0.270, P = .002) in stepwise linear regression analysis. The MetSyn was not associated with PCS. The Mental Component Summary Score of SF-36 was independently associated with hemoglobin (beta = +0.235, P = .016) and BDI score (beta = -0.218, P = .025). CONCLUSIONS: The presence of MetSyn was not associated with HRQoL according to the Mental Component Summary Score. In HD patients, HRQoL and depressive behaviors were not influenced by MetSyn, but by various other factors.

Peritoneal small solute transport rate is related to the malnutrition inflammation score in peritoneal dialysis patients.

BACKGROUND/AIMS: A high peritoneal membrane transport status and peritoneal albumin leakage are determinants of morbidity and mortality in patients receiving continuous ambulatory peritoneal dialysis. In this study, we analyzed the relationship between the malnutrition inflammation score, peritoneal transport status, and 24-hour peritoneal albumin leakage in patients receiving peritoneal dialysis. METHODS: Sixty-six patients receiving peritoneal dialysis (male-female ratio 30/36; age 46.2 +/- 14.1 years; mean duration of peritoneal dialysis 32.4 +/- 23.9 months) who had experienced no attacks of peritonitis within the prior 6 months were included. RESULTS: The malnutrition inflammation score was positively correlated with the serum C-reactive protein concentration, dialysate/plasma creatinine ratio, and 24-hour peritoneal albumin leakage. Triceps and biceps skinfold thicknesses and serum concentrations of prealbumin, total cholesterol, and triglyceride were negatively correlated with the malnutrition inflammation score. Multiple linear regression analysis showed that the malnutrition inflammation score was independently associated with the dialysate/plasma creatinine ratio (p = 0.039) and 24-hour peritoneal albumin amount (p = 0.005). CONCLUSION: High peritoneal transport status and peritoneal albumin leakage are significantly associated with the malnutrition inflammation score.

Mixed connective tissue disease: a case with scleroderma renal crisis following abortion.

The term mixed connective tissue disease (MCTD) has been applied to a particular subset of patients with overlapping clinical features of systemic sclerosis, systemic lupus erythematosus, and polymyositis. Immune response to U1-ribonucleoprotein is the defining serological feature of MCTD. There are different organ and system involvements in MCTD including the heart, lung, kidney, muscle, joints, gastrointestinal, and hematologic involvements. Reports describing pregnancies in patients with MCTD are rare, and the results have been contradictory: a high risk of fetal loss and of disease exacerbation or no influence on fetus or mother. In MCTD, simultaneous pulmonary and renal involvement is very rare. In this paper, we report a case of MCTD with pulmonary involvement that developed scleroderma renal crisis after an abortion.

Acute renal failure in intensive care unit: which factors predict future dialysis dependency?

Management of acute renal failure (ARF) in an intensive care unit (ICU) is difficult. The aim of this study was to identify prognostic factors determining ARF outcome in the ICU in terms of dialysis dependency or independency. We included 35 patients who turned out to be dialysis dependent (DD) and 11 patients who turned out to be dialysis independent (DI) after ARF in the ICU, which necessitated renal replacement therapy. In the post-ARF period, acetylsalicylic acid was protective against dialysis dependency (p < 0.05, odds ratio [OR] = 0.078) and dopamine increased the likelihood of dialysis dependency (p = 0.016, OR = 10.6). Multiorgan dysfunction (p = 0.001, OR = 13.6), especially cardiac (p = 0.009) and hepatic failure (p < 0.0001) were determined to increase risk of dialysis dependency. Mean systolic blood pressures during the first 24 hours (p = 0.023) and 24-48 hours (p = or < 0.0001), mean diastolic blood pressures during first the 24-48 hours (p = 0.03) and 48-72 hours of ARF in ICU (p = 0.023) and at discharge (p = 0.03) were significantly lower in the DD group than in the DI group. Mean thrombocyte counts at hospitalization (p = 0.034), during the first 24 hours (p = 0.019) and 24-48 hours of ARF in ICU (p = 0.038) were lower in the DD than DI group. This study demonstrates the very early prognostic factors influencing ARF outcome in terms of dialysis dependency. Early thrombocyte count and systolic blood pressure and follow-up diastolic blood pressure were prognostic factors for ARF outcome. Acetylsalicylic acid seemed to improve renal outcome, whereas dopamine seemed to worsen the disease process.

Acute tubulointerstitial nephritis and acute leukemia: report of 2 cases.

Acute tubulointerstitial nephritis usually develops due to either acute infection of kidneys or delayed hypersensitivity reaction to medication and may rarely be associated with acute renal failure. The disease may very rarely be associated with hematologic/neoplastic diseases. Tubulointerstitial nephritis associated with leukemia is usually due to chemotherapeutic agents or viral infections of the severely immuno-compromised host mostly after bone marrow transplantation. We herein report 2 cases of acute tubulointerstitial nephritis associated with acute leukemia. To our knowledge, the cases are the first in literature in which acute tubulointerstitial nephritis was simultaneously diagnosed with acute leukemia without any chemotherapeutic insult or apparent viral infection. Despite the usual asymptomatic nature of the disease process, the cases are original in that acute tubulointerstitial nephritis associated with acute leukemia resulted in acute renal failure in both cases and hemodialysis was inevitable in one.

Renal resistive index and nocturnal non-dipping: is there an association in essential hypertension?

Renal Doppler ultrasonography (RDU) is a useful method to determine renal resistive index (RRI). The RRI has been used to evaluate target organ damage (TOD) in essential hypertension. Nocturnal non-dipping of blood pressure (BP) in essential hypertension was also associated with TOD. The relationship between increased RRI and non-dipping has not been specifically studied before. Patients with newly diagnosed essential hypertension underwent 24-h ambulatory BP monitoring, biochemistry analysis, 24-h urine testing, and RDU. Totally, 198 patients (137 women, 61 men, aged 53.8 +/- 11.4 years) were included. Sixty-two patients were non-dippers, and 56 patients had increased RRI. RRI was increased in 32.3% of non-dipper patients and in 26.5% of dipper patients (P = 0.402). The RRIs of dippers were lower than the RRIs of non-dippers (0.65 +/- 0.06 vs. 0.68 +/- 0.07, P = 0.036). Multivariate logistic regression analysis of potential factors predicting increased RRI disclosed that advanced age (OR 1.090, CI 1.042-1.140, P < 0.0001) and increased pulse pressure (OR 1.037, CI 1.012-1.062, P = 0.004) were independently associated with increased RRI. In multivariate linear regression analysis, using the same independent variables, we found that square root-transformed RRI was independently associated with age (Beta + 0.366, P < 0.0001) and pulse pressure (Beta + 0.222, P = 0.001). Increased RRI and nocturnal non-dipping are not independently associated with each other in newly diagnosed essential hypertensive patients. Possible different mechanisms, or the same mechanisms but with different activation levels, may be responsible for the increased RRI and non-dipping as discrete pathologies.

Quality of life in hemodialysis patients: hepatitis C virus infection makes sense.

PURPOSE: Hepatitis C virus (HCV) infection impairs quality of life (QOL) in patients who are not on dialysis therapy. In dialysis patients, how HCV infection affects QOL is unknown. In our study, we investigated the independent relationship between HCV infection and QOL. METHODS: Sociodemographic and laboratory variables were recorded. Severity of depressive symptoms and QOL were assessed by Beck Depression Inventory (BDI) and Short Form-36 (SF-36), respectively. RESULTS: Among 165 patients, 83 were anti-HCV antibody positive and 82 were anti-HCV antibody negative. Anti-HCV antibody positive patients had higher BDI scores than anti-HCV antibody negative patients (P = 0.011). Other than the social functioning subscale, all SF-36 subscales were lower in anti-HCV antibody positive patients when compared with anti-HCV negative patients. Anti-HCV antibody positive patients had lower physical (P = 0.003) and mental component summary scores (P = 0.018) than negative patients. Physical component summary score was independently associated with hemodialysis duration (P = 0.003), sleep disturbance (P = 0.046), BDI score (P = 0.027), albumin (P = 0.002), and serum hemoglobin (P < 0.0001). Physical component summary score was not associated with anti-HCV antibody positivity. Mental component summary score was independently associated with BDI score (P = 0.001), anti-HCV antibody positivity (P = 0.016), and serum hemoglobin (P < 0.0001). CONCLUSION: HCV infection impairs QOL, especially in mental aspects, in hemodialysis patients.