Mean Platelet Volume, Association with Inflammatory and Nutritional Markers in Maintenance Hemodialysis Patients.

INTRODUCTION: Mean Platelet Volume (MPV) has been revealed to be a risk factor for ischemic heart disease in the hemodialysis patients .The aim of present study is to investigate the association between MPV level with inflammatory and nutritional factors in patients requiring chronic hemodialysis. METHODS: 100 patients who were on maintenance hemodialysis were included. Based on the median MPV (8.7 fL) patients were divided into two groups of low and high MPV level to assess and compare in terms of inflammatory (erythrocyte sedimentation rate, C-reactive protein, and transferrin), and nutritional (albumin, ferritin, uric acid, blood urea nitrogen, creatinine, triglyceride, cholesterol, low density lipoprotein, and high density lipoprotein) parameters. RESULTS: The median MPV level in our patients was 8.7 ± 1.8 fl. There was no statistical difference in the level of inflammatory and nutritional markers between the two groups, and none of them were related to MPV level (P > .05). The prevalence of IHD was significantly higher in the high MPV group (P < .05). After adjustment for the age, no association was observed between different parameters and MPV level except for transferrin in patient's ≤ 60 years old. Mean transferrin levels were significantly lower in the high MPV group (P < .05). CONCLUSION: Present study did not show any association between inflammatory and nutritional markers with MPV level in hemodialysis patients except for the transferrin level in younger cases.

Renal Artery Microaneurysm in a Woman With Amyloidosis.

Amyloidosis is an extracellular deposition of abnormal serum proteins. Systemic amyloidosis could involve different organs such as the spleen, liver, and kidneys. Renal artery microaneurysm is very rare in renal amyloidosis. We report a 44-year-old woman who was referred to our general hospital for evaluation of rising serum creatinine level, anemia, and pathological fracture. Two hours following renal biopsy, she developed severe pain in the left flank during voiding and ultrasonography revealed a large perinephric hematoma. She underwent angiography that incidentally showed pseudoaneurysm with diffused renal artery microaneurysm. The feeding artery to the pseudoaneurysm was completely ligated by an interventional radiologist. The subsequent histopathological report of the kidney revealed amyloidosis.

Effects of oral enalapril and verapamil on dialysis adequacy and solute clearance in chronic ambulatory peritoneal dialysis.

Peritoneal dialysis offers several advantages such as better clearance of intermediate/large molecules and better preservation of renal residual function when compared with hemodialysis. However, dialysis adequacy is one of the subjects of concern of this modality. There are some drugs that are capable of influencing solute transport in the peritoneum, such as acetyle co-enzyme inhibitors (ACE-I) medications and calcium channel blockers. Captopril and Verapamil are often mentioned, but their use has shown varying conclusions and initial studies were performed with the intra-peritoneal administration of these drugs and there are only a few studies on the effect of the oral administration of these drugs. This study was undertaken with the aim to evaluate the effects of oral administration of Verapamil and Enalapril among continuous ambulatory peritoneal dialysis (CAPD) patients. The results of this study showed that Verapamil and Enalapril do not have any effects on glucose, creatinine, sodium, potassium and urea clearance (during the 4-h peritoneal equilibration test (PET) test). However, it was shown that Enalapril significantly increased the peritoneal urea Kt/V and caused a meaningful decrease in the diastolic and mean blood pressures. Therefore, we feel that Enalapril may be administered as an anti-hypertensive medication of choice in CAPD patients, which can also result in better dialysis adequacy. However, further studies with larger sample sizes are needed in the future.

Efficacy of low dose spironolactone in chronic kidney disease with resistant hypertension.

To determine the antihypertensive benefit of adding low dose sprinolactone to multi-drug regimens that included a diuretic, a calcium channel blocker and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in patients with moderately severe chronic kidney disease (CKD) [glomerular filtration rate (GFR) 25-50 mL/min] and resistant hyper-tension, we studied 41 patients randomly divided into two groups: group 1: patients who received placebo as spironolactone and group 2: patients who received spironolactone 25-50 mg/day. The patients were evaluated during follow-up at the 6th and 12th weeks. The mean decrease in systolic and diastolic blood pressure after 6 weeks of spironolactone was 33 ± 8 and 13 ± 2 mmHg, respectively, and it was maintained after 12 weeks of spironolactone wherein the values were 36 ± 10 and 12 ± 2 mmHg, respectively, while there was no change in the blood pressure in the control group. Hyperkalemia (serum potassium >5.5 meq/L) occurred in one subject in the spironolactone group. We conclude that low-dose spironolactone may provide a significant additive blood pressure reduction in CKD patients (stage 2 and 3) with resistant hypertension.

25-hydroxyvitamin D deficiency in kidney transplant recipients.

INTRODUCTION. After kidney transplantation, patients appear to have vitamin D deficiency due to the use of immunosuppressive treatment and prevention of sunlight. This study was designed to determine vitamin D serum levels in kidney transplant patients in comparison with healthy individuals. MATERIALS AND METHODS. Forty-six kidney transplant patients with a creatinine clearance greater than 60 mL/min and 46 healthy individuals with normal kidney function were tested for serum levels of calcium, phosphorus, 25-hydroxyvitamin D, and parathyroid hormone at the end of the summer. RESULTS. Thirty-one participants were men and 15 were women in each group. The mean age was 41.0 ± 14.2 years in kidney transplant recipients and 41.4 ± 13.7 years in the control group. Inadequate serum 25-hydroxyvitamin D was seen in 93.5% of the transplant patients and in 89.1% of the controls. There was a 26.1% [corrected] vitamin D insufficiency (20 ng/mL to 30 ng/mL) and a 67.4% [corrected] deficiency (lower than 20 ng/mL) in the patients, and these rates were 21.7% [corrected] and 67.4% [corrected] in the control group, respectively. There was no significant difference between the two groups. CONCLUSIONS. Vitamin D deficiency is prevalent in kidney transplant patients. Lack of a significant difference between our two groups may be attributable to the high prevalence of vitamin D deficiency in general population and the use of vitamin D supplementation in transplant patients. Indeed, adequate doses of vitamin D in these patients are undetermined. They may need higher doses for normalization of serum vitamin D and metabolic requirements.

C- Reactive protein, cardiac troponin T and low albumin are predictors of mortality in hemodialysis patients.

Overall and cardiovascular mortality are significantly higher in hemodialysis patients with elevated C-reactive protein (CRP). The aim of study was to determine whether CRP, low albumin and troponin are markers of overall and cardiovascular mortality in hemodialysis patients. 138 stable hemodialysis patients were divided into 2 groups n= 66 patients with coronary disease equivalent (known coronary or peripheral vascular disease or diabetes mellitus) and n= 72 patients without it. The two groups were then stratified by biomarkers [cardiac troponin T and albumin and highly sensitive CRP (hs-CRP)] and followed for 30 months. The primary outcome was all causes mortality. Patients with coronary disease equivalents had 3.5 fold greater annual mortality compared to controls (24%% vs 6.9%, P value = 0.005). Elevated troponin T had a further increase in the risk for death while hs-CRP and low albumin were not associated with risk of death In conclusion, circulating cardiac troponin-T was associated with poor prognosis especially in hemodialysis patients with coronary risk factors.

Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients.

Hemodialysis (HD) patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP) as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescence's immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group) (p< 0.05). However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients.

Effect of intravenous ascorbic acid in hemodialysis patients with anemia and hyperferritinemia.

Hemodialysis (HD) patients with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (Epo). The contributory role of chronic inflammation and oxidative stress in its pathogenesis is poorly understood. We assessed the effect of vitamin C, an antioxidant, on Epo-hyporesponsive anemia in hemodialysis patients with un-explained hyperferritinemia levels. Thirty-one of 132 with Hb 15 patients received standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1) and 15 patients received standard care (group 2). After 3 months, Hb and transferrin saturation levels significantly increased in group 1 but not in group 2 (p < 0.05%). Hemoglobin content in reticulocyte and serum ferritin decreased significantly in group 1 but not in control group. In conclusion, hemodialysis patients with refractory anemia and adequate iron stores, vitamin C improved responsiveness to Epo by augmenting iron mobilization and possibly via antioxidant effect.