Dynamic changes of carotid artery intima-media thickness and mortality in hemodialysis patients.

INTRODUCTION: Intima-media thickness (IMT) of the carotid artery is a widely accepted parameter for detection and quantification of atherosclerosis. The aim of the study was the evaluation of the impact of changes of IMT on the mortality of patients on hemodialysis. METHODS: The study was organized as a prospective and observational one. Intima-media thickness was determined by ultrasound in 194 patients who were evaluated every year during a three-year period. We analyzed the mortality rate of patients on hemodialysis in relation to their biochemical parameters, demographic and anthropometric characteristics, type of dialysis, smoking habits and statin therapy. RESULTS: Female gender and hemodiafiltration emerged as good predictors of long-term survival. Baseline IMT values were significantly lower than those at the end of the second (p <0.001) and third years of the study (p <0.001). The baseline values positively correlated with uric acid levels (p =0.027) and body mass index (p =0.024), while at the end of the second year, IMT positively correlated with LDL-cholesterol (p =0.037) and triglyceride levels (p =0.018) and body mass index (p =0.045). Patients on hemodiafiltration had significantly higher values for erythrocytes (p =0.047), hemoglobin (p =0.005), creatinine (p =0.048), Kt/V (p =0.026), albumin (p =0.012), LDL-cholesterol (p <0.001), body mass index (p <0.001),and lower IMT values at the end of the first year (p =0.039), compared to patients on bicarbonate hemodialysis. Predictors of death were the duration of hemodialysis (p <0.001), and IMT at the end of the first (p =0.008) and second years of the study (p =0.005). CONCLUSION: Dynamic changes of IMT of the carotid arteries during the first two years were found in our study to be predictors of mortality in patients on hemodialysis. Hippokratia 2015; 19 (2):158-163.

Obesity in renal failure--health or disease?

The results of numerous investigations on the impact of obesity on renal insufficiency conducted in recent years introduce certain dilemmas about their mutual agreement. Some studies suggest that obesity is negatively correlated with the terminal phase of renal failure. On the other hand, other research has shown that reducing the index of body weight of patients with renal disease improves glomerular filtration. Even more confusion comes from findings indicating that metabolic syndrome in non-diabetic renal disease sufferers increases the risk of occurrence and progression of chronic renal disease. However, some research results suggest that obesity is positively correlated with survival of patients on dialysis, i.e., the higher the index of body weight the lower the mortality rate, especially with extremely obese patients. Reverse epidemiology is a term for the medical hypothesis which holds that the influence of obesity and high body weight indexes may be protective and associated with greater survival of obese patients on haemodialysis. A high serum creatinine concentration is a direct consequence of low rates of glomerular filtration and is inversely correlated with mortality rate. However, observations that high creatinine concentrations before haemodialysis treatment are a predictor of survival may be explained by the fact that they are also the direct consequence of increased muscle mass and a higher dietary protein intake. Thus, improvement of their nutritive state might delay progression and diminish the complications expected for patients suffering from kidney insufficiency. The requirements for daily protein intake by dialysis patients are not clear enough, while a hyperprotein diet may be a significant source of uraemic toxins, phosphate and H(+)-ion, which would be detrimental for their health. Some research has indicated that obesity of dialysis patients is not linked to increased risk of cardiovascular diseases in contrast to the general population. On the other hand, a low body mass index and additional parameters of malnutrition are strong independent indicators of mortality rate in dialysis patients. Although, there is a substantial amount of data that support a protective role for obesity, some authors question the existence of the obesity paradox. They do not oppose the results of that research, but suggest that obese individuals are actually protected in the short-term while later on they are liable to higher mortality risks than people of normal body weight. The role of obesity is undisputed as a significant mortality factor in the general population. Nevertheless, some well-designed studies have confirmed that obesity has a protective influence on patients treated by chronic dialysis procedures. This is not to suggest that obesity is recommended as a model for a higher survival rate in those patients, but the role of 'uraemic adipose tissue' and probable additional factors that might result in a lower mortality rate should be considered.

Nutrition parameters as hemodialysis adequacy markers.

BACKGROUND AND AIM: The nutritive status has significant role in improving the quality of life of dialysis' patients. The aim of this study was to find out if there is any correlation of the anthropometric parameters and markers of nutrition with the adequacy of HD. METHODS: The investigation was organized as a clinical, cross sectional study. Demographic characteristics, co-morbid conditions, smoking, dialysis duration and blood pressure were recorded. Serum total protein, albumin, ferritin and blood-lipids were measured as biochemical markers of nutritional status.One hundred and forty patients, 82 (58.6%) male, and 58 (41.4%) female, 55±12.59 years, were dividied into two groups. Group A consisted of 44 patients (14 women and 30 men) received the recommended hemodialysis dose (Kt/V ≥ 1.2), while the Group B consisted of 96 patients (69 males and 27 females) received non-adequate hemodialysis dose (Kt/V < 1.2). RESULTS: Patients with adequate hemodialysis had been longer on dialysis in correlation with the group of patients with non-adequate hemodialysis (73 ± 56.4 vs. 44 ± 50.1 months; p: 0.004). Group A and group B presented significant differences in the number of leukocytes (p: 0.027), and hemoglobin (p: 0.047), potassium (p: 0.038) and C-reactive protein level (p: 0.048) as well as in serum total protein (69 ± 4.63 vs. 65 ± 5.74 g/L; p < 0.0001) and albumin (38 ± 2.99 vs. 29 ± 4.4 g/L; p: 0.047). Pearsons correlation of factors that may have impact on hemodialysis adequacy indicated a significant relation between serum total protein and the index of hemodialysis adequacy (r: 0.21; p: 0.0446). CONCLUSIONS: All investigated anthropometric parameters and protein status showed significantly higher values in patients with adequate hemodialysis quality (Group A). The Group B showed higher levels of CRP and lower values of hemoglobin.

Characteristics of depression in obese people living in an insecure environment.

BACKGROUND: Obesity and depression are significant characteristics of people living in a state of chronic stress. PURPOSE: Our aim was to determine the characteristics of depression in obese people living in an insecure unstable environment. MATERIALS AND METHODS: The case-control study was organized in two rural environments in Kosovo and Metochia, Serbia. The main criterion for selection of participants was that respondents were more than 18 years old and had a body mass index of 25 kg/m 2 or more. Other anthropometric parameters determined were body weight, height, body fat mass, hip and waist circumference and the waist/hip ratio. The sex, demographic characteristics, profession, marital status, social status, existence of comorbidity, and cigarette smoking habits were recorded, and the arterial blood pressure measured for all participants. In the form of an interview, all respondents answered 17 questions, based on the Hamilton scale for depression. RESULTS: The group of depressed patients was dominated by women (P = 0.009). A significant difference (P = 0.007) was found in relation to profession. Depression was significantly more frequent in those without a regular income (P < 0.001). Depressed patients were significantly older (P = 0.017), more obese (P = 0.04), shorter (P = 0.0001), had a larger hip circumference (P = 0.039) and WHR index (P = 0.049) compared to patients in whom depression was not established. CONCLUSIONS: Depression is a significant characteristic in people living in an insecure environment, more common in women, without a permanent financial income.