Phalangeal quantitative ultrasound measurements in chronic hemodialysis patients: a 4-year follow-up.

In the course of chronic kidney disease, bone metabolism disturbances occur and become aggravated simultaneously with the progression of renal disorder, worsening patients' quality of life. We conducted a 4-year follow-up to assess phalangeal quantitative ultrasound (QUS) measurements in 32 patients undergoing chronic hemodialysis (17 males and 15 females) whose mean ages were 56.3 ± 15.2 years. The QUSs of hand phalanges were performed using DBM 1200 (IGEA, Carpi, Italy) and are expressed as amplitude-dependent speed of sound (Ad-SoS), Z-scores, and T-scores. In comparison with the age-, sex-, and body mass index-adjusted control group, QUS parameters were significantly decreased in all patients undergoing dialysis. During the 4-year follow-up, Ad-SoS and T-scores in all study groups sloped significantly with time. The significant negative relationships between follow-up Ad-SoS results and both baseline and follow-up parathormone values were demonstrated. Our results confirm a high prevalence of bone disturbances in patients undergoing chronic hemodialysis, and they do not improve during renal replacement therapy. The parathormone level seems to be an important agent in influencing bone status, but further studies are needed to understand the other risk factors in kidney-related bone disease.

Continuous glucose monitoring system in 72-hour glucose profile assessment in patients with end-stage renal disease on maintenance continuous ambulatory peritoneal dialysis.

BACKGROUND: Glucose has been the main osmole used in conventional peritoneal fluids (PDFs) since the beginning of continuous ambulatory peritoneal dialysis (CAPD). There is much concern regarding the possible risk to the good level of glycemia control lately observed. The aim of this study was to analyze, with the use of 72-hour continuous glucose monitoring system (CGMS), the influence of PDFs containing supra-physiological glucose concentrations on daily glucose profile in patients with end stage renal disease (ESRD) undergoing CAPD therapy. MATERIAL/METHODS: There were 30 diabetic and non-diabetic patients on CAPD using conventional 1.36% or 2.27% glucose PDFs examined in the study, with a control group of 13 healthy volunteers. All participants underwent 72-hour CGMS and HbA1c evaluation. There was the whole area under the curve (AUC) of each 24-hour glucose profile and of glucose excursion above 90 mg/dl estimated. RESULTS: The high transport status appeared to significantly influence the mean maximum glucose value and its increment following peritoneal exchange (PE) in the study group and in a subgroup of diabetic patients, whereas in non-diabetics the mean 24-hour glucose concentration was importantly influenced. The percentage of glucose levels in the range above 90 mg/dl was significantly influenced by higher glucose concentration in the PDFs, as well as higher peritoneal transport status. CONCLUSIONS: The outcomes indicate that dialysate glucose concentration, as well as type of peritoneal transport, influence the occurrence of persistent hyperglycemia state, and suggest that CAPD may predispose to appearance of glycemic disorders.