Haemochromatosis in a kidney transplant recipient: a case report.

BACKGROUND: Iron overload is inevitably related to chronic kidney disease (CKD) treatment. Haemochromatosis leads to multiorgan damage and is associated with increased mortality. Primary haemochromatosis is the most common autosomal recessive disease in white populations. In most cases, the classic form of hereditary haemochromatosis is caused by mutations, mainly C282Y and H63D, in the haemochromatosis gene (HFE). Secondary haemochromatosis can be triggered by iron administration and blood transfusions. Haemochromatosis is rarely reported in kidney transplant recipients. Atypical factors may evoke haemochromatosis in patients without HFE mutations or other standard risk factors. CASE PRESENTATION: In the current study, we present a patient who started to have haemochromatosis symptoms after kidney transplantation. A 37-year-old man after kidney transplantation from a deceased donor was admitted to the hospital due to high serum ferritin levels and impaired graft function. The patient's past medical history included arterial hypertension, embolization of both renal arteries and necrosis of the left femoral head. Glomerulonephritis was suspected as a cause of CKD; however, severe kidney failure was diagnosed, kidney biopsy was not performed, and the patient started intermittent haemodialysis. While on dialysis to treat anaemia, the patient had received erythropoietin and iron intravenously, and the maximal serum ferritin level was 2115 ng/ml. After kidney transplantation, ferritin levels started to increase rapidly, with a maximum level of 9468 ng/ml one and a half years after surgery. His genetic study showed HFE C282Y heterozygosity. Symptoms of haemochromatosis, such as skin hyperpigmentation, elevated activity of aminotransferases, impaired glucose tolerance and heart failure, were observed. Therapeutic phlebotomy was started, and 36 procedures were performed. After treatment, graft function significantly improved, most haemochromatosis symptoms resolved, and the serum ferritin level significantly decreased. CONCLUSIONS: Haemochromatosis can occur in heterozygotic HFE patients after kidney transplantation. Iron administration, infections, type of immunosuppression and liver dysfunction should be considered potential triggers of haemochromatosis in this group of patients.

Guillain-Barre syndrome: a typical paraneoplastic syndrome in a kidney transplant recipient with allograft renal cell carcinoma: a case report and review of the literature.

BACKGROUND: Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy affecting the peripheral nervous system. This neurological disorder has been previously reported in bone marrow transplant recipients but is uncommon after kidney transplantation. Viral infections and calcineurin inhibitors are the main triggers of GBS in renal transplant recipients. CASE PRESENTATION: In this report, we present a case of a 47-year-old male patient 12 years after his second kidney transplantation who developed GBS due to papillary renal cell carcinoma. Infectious and drug-related origins of GBS were excluded. Despite intensive treatment, graftectomy was performed, after which neurological symptoms resolved. CONCLUSIONS: In kidney transplant recipients, paraneoplastic aetiology should be considered in the differential diagnosis of GBS.

Effect of G(-174)C polymorphism in interleukin-6 gene on cardiovascular disease in type 2 diabetes patients.

Interleukin-6 (IL-6) is an important pro-inflammatory cytokine of relevance to cardiovascular diseases. The aim of this case-control study was to evaluate the association between the G(-174)C functional polymorphism in the IL-6 gene and risk of cardiovascular disease (CVD) in type 2 diabetes patients. We examined 1090 patients with T2DM and 612 controls. All subjects were genotyped for the G(-174)C polymorphism by polymerase chain reaction (PCR) and restriction analysis. There were no significant differences in the distribution of genotypes and alleles between T2DM patients and healthy controls. Significantly higher C allele frequency was observed in CVD+ patients compared to CVD- subgroup (53% vs. 32%, p<0.0001). The odds ratio for C allele was 2.4 (95% CI 1.99-2.9, p<0.0001) and for CC genotype 4.55 (95% CI 3.12-6.63, p<0.000). When the distribution of G(-174)C polymorphism was compared in subgroups with different clinical phenotypes of CVD, a significant association of CC genotype with myocardial infarction was observed. Forty eight percent of patients with MI had the CC genotype compared to 22% of patients without MI (p<0.0001). In conclusion, type 2 diabetes patients carrying the C allele of the IL-6 G(-174)C polymorphism have a significantly increased risk of CVD.

Conversion From Immediate-Release to Prolonged-Release Tacrolimus in Kidney Transplant Patients With Tremor: A Case Series Study.

BACKGROUND/AIM: Tremor is common with tacrolimus treatment and is linked with peak blood drug concentrations. We investigated the effect of switching from immediate-release tacrolimus (IR-TAC) to MeltDose prolonged-release tacrolimus (LCPT) on tremor in kidney transplant recipients experiencing tremor at therapeutic levels of IR-TAC. METHODS: The Activities of Daily Living Subscale (ADL, range 0-48, lower = better) of the Essential Tremor Rating Scale was used to assess the effect of therapy change on speech, occupational impairment and social activities over a 12-month follow-up period. RESULTS: The study included 18 patients (mean age = 45.6 y, range 26-73; median (IQR) time from transplant = 1.1 y (0.6-1.5), with baseline IR-TAC trough concentrations (C0) ranging from 4.2 to 9.4 ng/mL (mean C0 = 6.7 ± 1.3 ng/mL). After the switch to LCPT, the mean ADL score improved from baseline 11.2 to 8.4 after 7 to 14 days (an 18% improvement, P < .001). This improvement was sustained after 3 months (ADL score = 5.0, 46% improvement vs baseline), 6 months (ADL score = 4.4, 48% improvement vs baseline), and 12 months (ADL score = 3.6, 63% improvement vs baseline); all P < .001. Despite a 40% reduction in LCPT daily doses (mean -1.9 mg/day compared to IR-TAC), the achieved C0 was constant during the course of the 12-month observation (P = .755). The renal function remained stable after conversion (eGFR 12 months vs baseline = +1.1 mL/min/1.73 m2, 95% CI: -5.6 to +7.9). CONCLUSION: Conversion to LCPT may alleviate symptom burden and improve daily activities in kidney transplant recipients experiencing tremor within therapeutic IR-TAC concentrations.

[Pseudo-Bartter syndrome--2 cases]. / Rzekomy zespól Barttera--opis 2 przypadków.

Bartter syndrome represents the group of renal disturbances characterized by hypokaliemia and metabolic alkalosis. Some diseases could display hypokalemic metabolic alkalosis without primary tubular dysfunction. These disorders are called pseudo-Bartter syndrome. In this paper we present 2 cases of pseudo-Bartter syndrome related among to other things to overuse of diuretic drugs.

TGF-beta1 and TSC-22 gene polymorphisms and susceptibility to microvascular complications in type 2 diabetes.

BACKGROUND/AIM: There is a strong evidence for the involvement of genetic factors in diabetic microvascular complications. The aim of our study was to investigate the role of molecular variants of the TGF-beta1 (transforming growth factor beta 1) and the TSC-22 (transforming growth factor beta stimulated clone 22) genes in diabetic nephropathy and diabetic retinopathy in type 2 diabetes. METHODS: A case-control study was conducted in 503 patients and 400 healthy subjects. DNA samples were genotyped by polymerase chain reaction and restriction fragment length polymorphism methods. RESULTS: Among the patients, 245 had diabetic nephropathy, 195 had retinopathy, and 168 were free from complications. All subjects were genotyped for T869C and C -509T polymorphisms of the TGF-beta1 gene and for -396 polymorphism of the TSC-22 gene. A significantly increased frequency of the CC genotype of the T869C polymorphism was observed in patients with nephropathy and retinopathy (33 and 48%, respectively, vs. 19 and 15%, respectively, in controls and patients free from complications). The frequency of the C allele was also higher (0.58 for nephropathy and 0.64 for retinopathy vs. 0.42 in controls). The G allele of the TSC-22 polymorphism was associated with an increased risk of diabetic nephropathy (frequency 0.15 vs. 0.07 and 0.06, respectively, in patients free from complications and controls). An interaction was observed between the G allele of the TSC-22 polymorphism and the C-allele of the TGF-beta polymorphism. CONCLUSIONS: Our data suggest the association of TGF-beta T869C gene polymorphism with an increased risk of nephropathy and retinopathy in type 2 diabetes patients. It interacts with the TSC-22 gene involved in the TGF-beta signaling pathway, promoting the development of diabetic nephropathy.

[Femoral neck fractures in hemodialysis patients]. / Zlamania szyjki kosci udowej u chorych przewlekle hemodializowanych.

Femoral neck fractures are important causes of morbidity and mortality. Patients with end-stage renal diseases are 4,4-fold more likely to sustain a hip fracture that the general population. We present our own experience with treatment of femoral neck fractures in hemodialysis patients. The study included 12 patients (6 females and 6 males), mean age 51 years (range 41-77). They were dialysed for a mean duration of 125 months (range 12-271). The femoral neck fracture was treated by bipolar hip arthroplasty. The follow up was from 3 month to 6 years. We did not observe serious complications after operation. One patient was reoperated after 20 months, because of bipolar prosthesis protrusion. One patient died after 4 years from operation with normal hip function. The cause of death was decompensation of cirrhotic hepatitis. We estimate that severe secondary hyperparathyroidism is a risk factor of femoral neck fractures in hemodialysis patients.

[Are there relationship between Helicobacter pylori infection and gastrin levels in long term hemodialysed patients?]. / Czy infekcja Helicobacter pylori u chorych przewlekle hemodializowanych ma zwiazek ze stezeniem gastryny w surowicy krwi?

UNLABELLED: Helicobacter pylori (H. pylori) infection in patients with chronic renal failure plays an important role in the pathogenesis of upper gastrointestinal tract diseases. In our earlier study we did not find significant relationship between parathormone (PTH) concentration abnormalities and H. pylori infection in hemodialysis patients (HD pts). The aim of our present study was to examine other parameters and interrelationships between them, connected with H. pylori infection in HD pts. The serum concentration of the following substances were measured: gastrin (G), parathormone (PTH), and IgG antibodies against H. pylori. The study was conducted in 65 (36 M, 29 F) stable HD pts: age 49 +/- 12 years, dialysed from 6 to 288 months. The control group (CG) consisted of 15 healthy people, mean age 38 +/- 8 years. The mean concentration of serum PTH serum was significantly higher in HD pts than in CG (538 +/- 520 vs 35 +/- 9.3 pg/ml, p < 0.001). The mean concentration of gastrin in serum was significantly higher in HD pts than in CG (155.37 +/- 235.4 vs 87.97 +/- 9.5 pg/ml, p < 0.01). The mean concentrations of IgG antibodies against IgG H. pylori was similar in HD pts and CG (88.1 +/- 80.0 vs 91.34 +/- 66.8 U/ml). We found significant positive correlation between IgG antibodies against H. pylori infection and gastrin level in serum of HD pts (r = 0.315, p < 0.001). We did not find significant correlation between concentrations: PTH vs G and PTH vs IgG against H. pylori. CONCLUSION: Helicobacter pylori infection contributes to hypergastrinaemia in hemodialysed patients. There is no relationships between PTH abnormalities and H. pylori infection.

[Urologic complications as a reason of recurrent urinary tract infections in patients after renal transplantation]. / Schorzenia urologiczne jako przyczyna nawrotowych zakazen dróg moczowych w odleglym okresie po przeszczepieniu nerki.

Urinary tract infections are the most frequent complications after renal transplantation. A retrospective study was conducted in patients treated after renal transplantation. We paid special attention to urinary tract infection connected with urologic complications and other urologic diseases.

Association between lipids, lipoproteins composition of HDL particles and triglyceride-rich lipoproteins, and LCAT and CETP activity in post-renal transplant patients.

High-density lipoprotein (HDL) remodeling within the plasma compartment and the association between lecithin-cholesterol acyltransferase (LCAT) and cholesterol ester transfer protein (CETP) activity, and lipid, lipoprotein concentrations and composition were investigated. The aim was to examine the high sensitivity of C-reactive protein (hsCRP), lipid, apolipoprotein B (apoB), apoAI, total apoAII, apoAIInonB, apoB-containing apoAII (apoB:AII), total apoCIII, apoCIIInonB, apoB-containing apoCIII (apoB:CIII) concentration and LCAT and CETP activity to gain an insight into the association between them and LCAT and CETP, 57 post-renal transplant (Tx) patients with and without statin therapy and in 15 healthy subjects. Tx patients had moderate hypertriglyceridemia, hypercholesterolemia, and dyslipoproteinemia, disturbed triglyceride-rich lipoproteins (TRLs) and HDL composition, decreased LCAT, and slightly increased hsCRP but no CETP activity. Spearman's correlation test showed the association between lipids and lipoproteins and LCAT or CETP, and multiple ridge stepwise forward regression showed that immunosuppressive therapy in Tx patients can disturb HDL and TRLs composition. The results suggest that inhibition or activation of LCAT is due, in part, to HDL-associated lipoprotein. Lipoprotein composition of apoAI, apoAIInonB, and apoCIIInonB in HDL particle and apoB:AII TRLs can contribute to decrease LCAT mass in Tx patients. Tx patients without statin and with lower triglycerides but higher HDL cholesterol concentration and disturbed lipoprotein composition of ApoAI and apoAII in HDL particle can decrease LCAT, increase LDL cholesterol, aggravate renal graft, and accelerate atherosclerosis and chronic heart diseases.

The intercellular adhesion molecule-1 (ICAM-1) gene polymorphism K469E in end-stage renal disease patients with cardiovascular disease.

The intercellular adhesion molecule-1 (ICAM-1) mediates interaction of activated endothelial cells with leukocytes. It plays an important role in the pathogenesis of atherosclerosis. A functionally important polymorphism of the ICAM-1 gene, K469E, has been described. We investigated whether this polymorphism influences the risk of CVD in end-stage renal disease (ESRD) patients. The groups of 1016 ESRD patients and 824 healthy individuals were genotyped by PCR and allele specific oligonucleotide technique. The T allele of the K469E polymorphism was significantly more frequent in ESRD CVD+ patients than CVD- and controls (OR 2.26, 95% CI 1.87-2.72 and 1.82, 95% CI 1.55-2.11, respectively). The TT genotype was also more frequent in CVD+ patients (OR 9.90, 95% CI 6.17-15.88 vs. CVD- subgroup). When patients were stratified according to clinical outcome of CVD, there was a tendency towards higher frequencies of the T allele and TT genotype in patients with myocardial infarction (OR for T allele 1, 57, 95% CI 1.12-2.18 vs. patients without MI). In the multivariate regression analysis the carrier status of T allele of K469E was an independent risk factor of susceptibility to CVD. Our data suggest that the ICAM-1 K469E polymorphism is associated with CVD in ESRD patients.

Cardiac sympathetic dysfunction in haemodialysed patients.

BACKGROUND: The aim of this study was to evaluate the cardiac sympathetic nervous system function in haemodialysed(HD), non-diabetic patients by iodine-123 meta-iodo-benzylguanidine(123I-mIBG). MATERIALS AND METHODS: Planar scintigraphy of the chest was performed in 36 HD, male patients; 15 minutes and 4 hours post injection of 370 MBq of 123I-mIBG. The semi quantitative analysis of myocardial tracer uptake was expressed as routine heart to mediastinum (H/M) ratio: 15 minutes (early H/M) and 4 hour (late H/M) post administration as well as washout of the tracer from myocardium (WR). 24-hour Holter studies were recorded and heart rate variability (HRV) was evaluated. Patients were divided into two groups according to the H/M value: group A patients with H/M > 1.8 which has been accepted as a norm,and group B patients with H/M < 1.8. RESULTS: In 21/36 patients H/M ratio was below normal values.Significant differences between groups A and B were found among the following parameters: early H/M and late H/M ratios,WR and duration of haemodialysis therapy. CONCLUSIONS: In patients with abnormal function of cardiac sympathetic nervous system, expressed by means of H/M ratio below 1.8, duration of haemodialysis treatment was longer.Duration of HD appears to be an important factor influencing cardiac sympathetic nervous system.

Association between moderately oxidized low-density lipoprotein and high-density lipoprotein particle subclass distribution in hemodialyzed and post-renal transplant patients.

Disturbances in the metabolism of lipoprotein profiles and oxidative stress in hemodialyzed (HD) and post-renal transplant (Tx) patients are proatherogenic, but elevated concentrations of plasma high-density lipoprotein (HDL) reduce the risk of cardiovascular disease. We investigated the concentrations of lipid, lipoprotein, HDL particle, oxidized low-density lipoprotein (ox-LDL) and anti-ox-LDL, and paraoxonase-1 (PON-1) activity in HD (n=33) and Tx (n=71) patients who were non-smokers without active inflammatory disease, liver disease, diabetes, or malignancy. HD patients had moderate hypertriglyceridemia, normocholesterolemia, low HDL-C, apolipoprotein A-I (apoA-I) and HDL particle concentrations as well as PON-1 activity, and increased ox-LDL and anti-ox-LDL levels. Tx patients had hypertriglyceridemia, hypercholesterolemia, moderately decreased HDL-C and HDL particle concentrations and PON-1 activity, and moderately increased ox-LDL and anti-ox-LDL levels as compared to the reference, but ox-LDL and anti-ox-LDL levels and PON-1 activity were more disturbed in HD patients. However, in both patient groups, lipid and lipoprotein ratios (total cholesterol (TC)/HDL-C, LDL-C/HDL-C, triglyceride (TG)/HDL-C, HDL-C/non-HDL-C, apoA-I/apoB, HDL-C/apoA-I, TG/HDL) were atherogenic. The Spearman's rank coefficient test showed that the concentration of ox-LDL correlated positively with HDL particle level (R=0.363, P=0.004), and negatively with TC (R=-0.306, P=0.012), LDL-C (R=-0.283, P=0.020), and non-HDL-C (R=-0.263, P=0.030) levels in Tx patients. Multiple stepwise forward regression analysis in Tx patients demonstrated that ox-LDL concentration, as an independent variable, was associated significantly positively with HDL particle level. The results indicated that ox-LDL and decreased PON-1 activity in Tx patients may give rise to more mildly-oxidized HDLs, which are less stable, easily undergo metabolic remodeling, generate a greater number of smaller pre-ß-HDL particles, and thus accelerate reverse cholesterol transport, which may be beneficial for Tx patients. Further studies are necessary to confirm this.

Relationships between serum lipid, lipoprotein, triglyceride-rich lipoprotein, and high-density lipoprotein particle concentrations in post-renal transplant patients.

OBJECTIVE: Disturbances in lipid and lipoprotein profiles in patients after kidney transplantation (Tx) are still not understood. METHODS: Serum levels of lipids, lipoprotein, triglyceride-rich lipoproteins (TRLs), and high-density lipoprotein (HDL) particles were determined, lipid and lipoprotein ratios were calculated, and their relationships in Tx patients with hypertriglyceridemia (HTG) and lower apolipoprotein AI (apoAI) concentration were examined. Serum lipid and lipoprotein levels were measured in 109 Tx patients and 89 healthy subjects. HDL particle levels were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Tx patients had disturbed concentration, composition, and metabolism of TRLs and HDL particles. Multivariance analysis showed significant and positive correlation between HDL cholesterol/apoAI (HDL-C/apoAI) and HDL-C/HDL ratios, which indicates that both ratios could sensitively reflect changes in the HDL subclasses and their distribution into smaller size particles. In Tx patients, the decreased HDL-C/apoAI ratio indicates that, along with the decreased apoAI concentration, the HDL-C level is decreased. However, a low HDL-C/HDL ratio indicates that HDL particles in Tx patients transport lesser content of HDL-C but more triglyceride (TG) (high TG/HDL ratio), and thus are hypercatabolized and removed; therefore, concentration of HDL particles in serum was decreased. CONCLUSION: The decrease of HDL-C/apoAI ratio seems to be a good marker of HDL subclass distribution into smaller size particles.

Toll-like receptor 4 gene polymorphism and early onset of diabetic retinopathy in patients with type 2 diabetes.

Toll-like receptor 4 (TLR4) is an important mediator of innate immunity. Type 2 diabetes (DM2) might be associated with changed innate immune response. We investigated whether the polymorphisms in the TLR4 gene are associated with diabetic retinopathy (DR). The study group of 864 patients with DM2 and 420 healthy individuals were genotyped. In the patient group 352 subjects were diagnosed with DR. Out of the remaining 512, 140 had DM2 for > or = 10 years but no DR. In the DM2 group 7.4% of patients were heterozygous for the Asp299Gly polymorphism compared with 6.5% controls. For Thr399Ile polymorphism there were 7.2% heterozygotes vs 6.2% controls. In most cases, the linkage disequilibrium between the minor alleles Gly299 and Ile399 was confirmed. Increased frequency of both heterozygous genotypes was observed in patients with retinopathy (11.2% for the Asp299Gly). The frequency of the G allele was significantly higher in patients with early onset retinopathy (n = 80) vs patients without DR (odds ratio = 5.0, and 95% confidence interval = 2.33-10.71). In contrast, in the entire retinopathy group, the odds ratio for the G allele was 1.88 (95% confidence interval = 0.93-3.79). In the multivariate logistic regression analysis, the G allele of Asp299Gly was an independent risk factor of early onset DR (p < 0.001). In conclusion, our results suggest an association between the Asp299Gly polymorphism of the TLR4 gene and early onset of DR in the DM2 patients. Thus the G allele may be a predictor of increased risk of retinopathy.

Disturbed lipids, lipoproteins and triglyceride-rich lipoproteins as well as fasting and nonfasting non-high-density lipoprotein cholesterol in post-renal transplant patients.

Serum levels of lipids and lipoproteins were determined in 98 post-renal transplant fasting patients, and lipids and non-high density lipoprotein-cholesterol (non-HDL-C) and lipid ratios in the same post-renal transplant non-fasting patients were compared. The reference group was 87 healthy subjects. All patients were divided into two groups: patients with dyslipidemia (n = 69) and patients with normolipidemic (n = 29). The post-renal transplant patients (TX) with dyslipidemia had a significantly increased concentration of triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), non-HDL-C, apoB, and TRL and lipid ratios, and decreased HDL-C level and lipoprotein ratios. The lipids, lipoproteins, and lipoprotein ratios were significantly beneficial in TX patients with normolipidemic than in those with dyslipidemia. However, TRL concentration and lipid ratios were significantly increased and apoAI/apoCIII significantly decreased as compared to the reference group. The TX patients with dyslipidemia showed a significant correlation between TG and apoB:CIII (r = 0.562, p < 0.001) and apoCIII (r = 0.380, p < 0.004), but those with normolipidemic showed a significant correlation only between TG and apoCIII (r = 0.564, p < 0.008). Regression and Bland-Altman analyses showed excellent correlation between fasting and nonfasting non-HDL-C levels (r = 0.987, R(2) + 0.987) in TX patients both with dyslipidemia and normolipidemic. We think the finding that nonfasting labs that are reliable for non-HDL-C as well as total cholesterol is important, as fasting labs are not always available. Disturbances of lipids, lipoproteins, and TRLs depend not only on the kind of treatment, but due to multiple factors can accelerate cardiovascular complications in post-renal transplant patients with dyslipidemia and also with normolipidemic. Further studies concerning this problem should be completed.

Association of the VEGF gene polymorphism with diabetic retinopathy in type 2 diabetes patients.

BACKGROUND: Diabetic microvascular complications are the major causes of morbidity and early mortality in diabetes. Vascular endothelial growth factor (VEGF) is a potent multifunctional cytokine which plays a key role in the pathogenesis of diabetic microvascular complications. We examined the possible association of the VEGF gene polymorphisms with diabetic nephropathy and retinopathy in type 2 diabetes patients. METHODS: Genotyping of the VEGF gene insertion/deletion (I/D) and +405 polymorphisms was done by the polymerase chain reaction (PCR) and restriction fragment length polymorphism methods. A total of 426 patients with type 2 diabetes and 493 healthy subjects were genotyped. The frequency of VEGF alleles and genotype distribution were compared in diabetic and control groups. RESULTS: The distribution of the VEGF DD genotype was significantly different in patients with diabetic retinopathy compared with healthy controls, entire diabetic group and patients with no complications (44 vs. 23, 30 and 21%, respectively; P < 0.01). Such differences were not observed in the diabetic nephropathy group. The odds ratio for the D allele was 2.27 (95% CI 1.59-3.25). The multivariate logistic regression analysis revealed that the D allele of the VEGF gene I/D polymorphism was an independent risk factor of retinopathy (P < 0.001). The VEGF +405 genotype was not associated with diabetic complications in type 2 diabetes patients. CONCLUSION: Our study suggests that the I/D polymorphism in the promoter region of the VEGF gene is associated with retinopathy but not nephropathy in type 2 diabetes patients. The multivariate logistic regression analysis showed that the D allele of the VEGF polymorphism is an independent risk factor of diabetic retinopathy after controlling for other clinical variables.

A long-term study of dyslipidemia and dyslipoproteinemia in stable post-renal transplant patients.

BACKGROUND: Dyslipidemia is a major risk factor for atherosclerotic disease in renal transplant patients. METHODS: The serum levels of lipids and lipoproteins were determined in the same 12 post-renal transplant patients (TX) 10-29 and 73-122 months after transplantation. Thirteen healthy subjects--i.e., without diabetes, endocrine disease, liver disease, active inflammatory disease, glucose intolerance, malignancy, obesity, and urinary protein--were used as a reference group. TX patients had stable renal function. Twelve patients received cyclosporine A and prednisone, six received lovastatin, and one received rapa and prednisone. Lipids and lipoprotein (apo)AI and B were determined using Roche kits. An anti-apoB antibody was used to separate apoB-containing apoCIII and apoE lipoproteins as triglyceride-rich lipoproteins (TRLs) in the non-HDL fraction from apoCIIInonB and apoEnonB in the HDL fraction. RESULTS: In both groups of post-renal transplant patients, a statistically significant increase of TG, TC, and non-HDL-C levels was observed. Moreover, statistically significant changes were shown in total apoCIII and apoCIIInonB, as well as in TG/HDL-C and apoAI/apoCIII ratios, as compared to the reference group. On the other hand, in TX patients 73-122 months after transplantation, significantly higher concentrations of TC, LDL-C, and especially non-HDL-C were observed. It was shown that apoCIII, apoCIIInonB, apoB:CIII, and lipid and lipoprotein ratios as risk factors of atherosclerosis and renal risk factors were higher in these patients 73-122 months after transplantation. CONCLUSION: TX patients in a long-term study showed that they had disturbed lipoprotein composition, and its consequence was hyperlipidemia, perhaps partly due to the increased use of immunosuppressants and steroids.

[Comparison of some nutritional parameters in hemodialysis patients over and below 65 years of age]. / Ocena porównawcza wybranych parametrów stanu odzywienia u chorych powyzej oraz ponizej 65 roku iycia, przewlekle hemodializowanych.

UNLABELLED: There is a close relationship between inflammation, malnutrition and atherosclerosis in chronic hemodialysis (HD) patients (pts). This process is closely related to poor clinical outcomes including morbidity and mortality, especially in elderly patients. The aim of this study conducted in HD pts over 65 years old (group A) and in younger pts (group B) was the assessment of some parameters of: nutritional status, inflammation, atherosclerosis and anthropometry. In group A (40 pts), mean age 72,2 +/- 4,7, the time on HD treatment was 37,1 +/- 33,0 months and in group B (83 pts), mean age 48,3 +/- 9,7 years, time on HD treatment was 97,4 +/- 90,1 months. We have measured the serum concentrations (conc.) of some parameters: hemoglobin (Hb), C-reactive protein total (CRP), albumin (alb), cholesterol (t-chol), calcium (Ca), phoshorus (P), intact parathormone (iPTH). The adequacy of HD was measured by Kt/V. We have estimated: body mass index (BMI), interdialytic weight gain (IWG), normalized protein catabolic rate (nPCR) and weekly EPO consumption. Some anthropometric parameters which were studied included: triceps skin fold (TSF), waist circumference (WC), mid-arm muscle circumference (MC). The physical activity was expressed by hand grip test (GT) on the hand without the vascular access. The mean values of Kt/V were similar in both groups (1,2 +/- 0,1 vs 1,2 +/- 0,2). Likewise there were no significant differences in mean levels of CRP (9,7 +/- 9,1 vs 14,1 +/- 12,2 mg/l) and Hb (6,7 +/- 0,7 vs 7,0 +/- 0,9 mmol/l), but weekly EPO consumption was higher in group A (48,1 +/- 35,8 vs 38,6 +/- 29,3 U/kg, p<0,01). We have observed, that in group A the mean serum levels of albumin and t-chol were significantly lower (33,2 +/- 3,1 vs 37,5 +/- 3,9 g/l, p <0,05 and respectively 3,9 +/- 0,7 vs 4,3 +/- 0,9 mmol/l, p<0,05).) and IWG as well (2,1 +/- 1,2 vs 3,3 +/- 1,6 kg; p<0,01). The mean values BMI and nPCR were significantly lower in group A (24,4 +/- 3,2 vs 27,3 +/- 2,5 kg/m2, p<0,01 and respectively: 0,9 +/- 0,1 vs 1,1 +/- 0,2 g/kg/day, p<0,01). Likewise mean values of IWG and MAP were significantly lower in elderly patients (2,1 +/- 1,2 vs 3,3 +/- 1,6 kg; p<0,01 and respectively 91,5 +/- 19 vs 95,5 +/- 13 mm Hg; p<0,01). Mean serum Ca and P conc. were significantly lower in group A (2,1 +/- 0,1 vs 2,3 +/- 0,2 mmol/l, p<0,01 and respectively 1,4 +/- 0,3 vs 1,8 +/- 0,5 mmol/l, p<0,01). Likewise mean iPTH conc. was significantly lower in elderly patients (379,2 +/- 362,3 vs 571,6 +/- 510,9 pg/ml). The mean values of strength of grip were lower in group A (20,5 +/- 11,4 vs 34,7 +/- 13,6 kg, p<0,01). In both groups there were no significant differences between the mean values of TSF (11,2 +/- 3,8 vs 13,4 +/- 6,8 mm), but mean values of WC and as well MC as well were lower in group A (91,0 +/- 8,1 vs 98 +/- 12,4 cm; p<0,05 and respectively 25,5 +/- 3,1 vs 28,9 +/- 3,8 cm; p<0,05). There was a significant negative correlation (cor.) between the age of patient and intradialytic body weight gain (r = -0,4607, p<0,001) and significant positive cor. between: albumin and nPCR (r = 0,433, p<0,01) and albumin and Hb (r = 0,391, p<0,01). There was a significant negative cor. between strength of grip and time of HD treatment (r = -0,350, p<0,05). IN CONCLUSION: The studied elderly hemodialysis patients are more malnourished than younger ones.