Thrombophilias and arteriovenous fistula dysfunction in maintenance hemodialysis.

Most episodes of fistula thrombosis are consequences of underlying physioanatomic abnormalities. However, some dialysis access thrombosis develops independent from any obvious anatomic cause. We aimed to clarify the role of thrombophilias in primary and secondary AVF failure. One hundred eighty nine arteriovenous fistulas in 116 adults on maintenance hemodialysis were analyzed. All subjects were evaluated for many thrombotic factors. Fistula information was obtained both from the patients' self reports, and from their medical records. Twenty-seven AVFs in 18 cases (14.3%) had pAVFF. The percentage of subjects with a BMI < 20 kg/m(2) was significantly lower than no-pAVFF group (P = 0.03). ATIII levels and albumin values were significantly lower in patients with sAVFF compared to those with no sAVFF. Other parameters were similar. There was no statistically significant difference between pAFFF versus No-pAFFF and sAFFF versus No-sAFFF groups with respect to all mutant alleles count. Routine extended analyses of all thrombophillic factors are not recommended in AVFF.

The determination of insulin sensitivity in hemodialysis and continuous ambulatory peritoneal dialysis in nondiabetic patients with end-stage renal disease.

OBJECTIVE: To determine the beta-cell function and insulin sensitivity with homeostasis model assessment (HOMA) and area under curve (AUC) in nondiabetic uremic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients cross sectionally. METHODS: The study was performed between January to August 2001 in the Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey. Fifty-one HD patients, 45 CAPD patients, and 50 healthy control subjects were included in the study. Height, weight, waist and hip circumference, fat mass and percentage of body fat, and body mass index (BMI) were measured. The total high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol, triglyceride, urea, creatinine, insulin, potassium, parathyroid hormone (PTH) and 1,25 dihydroxycholecalciferol levels were measured. Oral glucose tolerance test (OGTT) was performed in the mid-week dialysis-free interval in HD patients, whereas after at least a night without dialysis exchanges in CAPD group. Area under curve both of insulin and glucose were calculated. The HOMA [insulin sensitivity (%S)] and AUC were used as indices of tissue insulin sensitivity. RESULTS: The LDL-cholesterol levels of patients with CAPD was higher than the HD group (p<0.001) and control group (p<0.0001). The baseline glucose levels of the 2 groups were not significantly different. Baseline insulin levels of CAPD group were higher than the HD group (p<0.001) and the control group (p<0.0001). Area under curve for glucose (AUCgluc) and insulin (AUCins) value of CAPD patients were higher than the HD patients than the control group (p<0.0001). The HOMA [beta-cell function (%B)] values of CAPD group were higher than both HD (p<0.02) and control group (p<0.04). The HOMA [insulin sensitivity (%S)] levels of CAPD group was significantly lower than the HD patients (p<0.002) and the control group (p<0.001). CONCLUSION: The CAPD treatment may lead to insulin insensitivity in non-diabetic end-stage renal disease patients and the high glucose content of CAPD solutions may be responsible for insulin resistance in CAPD patients.

Serum levels of prostate-specific antigen and vitamin D in peritoneal dialysis patients.

Measuring the free:total ratio of prostate-specific antigen (f/t-PSA) can improve the specificity of single-serum PSA values, distinguishing between benign prostatic hyperplasia (BPH) and prostatic carcinoma (PCa) in men over the age of 50. Additionally, clinical trials have shown that dihydroxyvitamin D3 can slow the rate of PSA rise in PCa patients. However, little is known regarding the applicability of those findings in men undergoing chronic peritoneal dialysis (CPD). In the present study, we investigated the prevalence of increased serum PSA levels among CPD patients and correlated those values with serum levels of vitamin D [25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3]. We undertook a cross-sectional study of 71 male CPD patients without a known history of prostate cancer from 24 centers in Canada, Greece, and Turkey. All of the patients were more than 50 years of age. In these patients, we measured serum concentrations of PSA, free PSA (f-PSA), total PSA (t-PSA), prostate alkaline phosphatase (PAP), 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and intact parathyroid hormone (iPTH). We recorded serum PSA levels < 4 ng/mL in 62 patients (87.3%, group A) and levels > 4 ng/mL in 9 patients (12.7%, group B). The f/t-PSA ratio was < 0.25 in 16 patients (22.5%). Group B patients were older than those in group A (median: 73 years vs. 65 years, p < 0.01) and had a lower body weight (median: 66.5 kg vs. 76.7 kg, p < 0.05). We observed no statistically significant difference between the two groups for serum 1,25-dihydroxyvitamin D3 (median: 9.8 ng/mL vs. 10.1 ng/mL) or 25-hydroxyvitamin D3 (8 ng/mL vs. 8.2 ng/mL) levels. Also, we observed no correlation between vitamin D levels and f/t-PSA, but iPTH levels were significantly higher in group A (200.5 pg/mL vs. 61.2 pg/mL, p < 0.04). Also, serum PAP levels correlated significantly with PSA (r = 0.49, p = 0.01) and with f-PSA (r = 0.56, p = 0.000). Our results showed no clear relationship between vitamin D and serum levels of PSA or-of f/t-PSA in PD patients. However, further studies are needed to better define the uses of these PSA markers in PD patients because, in such patients, other relevant factors might be implicated in their predictive value.