The Relation Between Variability of Intact Parathyroid Hormone, Calcium, and Cardiac Mortality in Hemodialysis Patients.

Chronic kidney disease-mineral and bone disorder (CKD-BMD) is a condition known to be associated with cardiovascular disease and mortality in hemodialysis (HD) patients. The relation between calcium (Ca), phosphorus (P), and intact parathyroid hormone (iPTH) variability in HD patients and cardiac mortality is unknown. The purpose of this study was to assess the relation between variability in these parameters and cardiac mortality. Baseline demographic and biochemical parameters of 218 HD patients together with Ca values corrected with albumin and P values measured on a monthly basis and iPTH levels measured at 3-monthly intervals were recorded over 2 years. Standard deviation (SD) and smoothness index (SI) for each parameter were calculated to assess Ca, P, and iPTH variability. The relations between all parameters and cardiac mortality were then analyzed. Cardiac mortality was observed in 38 patients in the 2-year study period. Nonsurviving patients' ages, systolic and diastolic blood pressure (DBP), high sensitivity C-reactive protein (HsCRP) levels, mean iPTH, and SD iPTH were significantly higher than those of surviving patients, while albumin levels, SI iPTH and SI Ca were significantly lower. Age, low albumin, high DBP, SI iPTH, and SI Ca were identified as independent predictors of cardiac mortality at multivariate analysis. Our study shows that Ca and iPTH variability affect cardiac mortality independently of mean and baseline values. When supported by further studies, the relation between Ca and iPTH variability and cardiac mortality in HD patients can lead to a new perspective in terms of prognosis and treatment planning.

A new player in chronic kidney disease mineral and bone disorder: tenascin-C.

AIMS: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a condition frequently observed in CKD. The search for a reliable and easy to use biomarker in the diagnosis of CKD-MBD is continuing. Tenascin-C (TN-C) is an important extracellular (ECM) protein synthesized by osteoblasts during bone growth and morphogenesis. The purpose of this study was to assess the relation between inflammation and MBD and TN-C in HD patients and to identify a new marker that can be used to help diagnose CKD-MBD. MATERIALS AND METHODS: 136 HD patients and 22 healthy controls were enrolled in this cross-sectional, observational multicenter study. Once patients' demographic and biochemical parameters had been recorded, peripheral blood samples were collected for TN-C measurement before the mid-week HD session. The relationship between TN-C levels and demographic and biochemical parameters was then assessed. RESULTS: TN-C levels were significantly higher in the HD patient than in the control group (P<.001). Intact parathormone (iPTH) affected TN-C levels in the HD patient group. TN-C levels was significantly higher in both the high (>300 pg/ml) and low iPTH groups (<150 pg/ml) compared to the 150-300 pg/ml iPTH group (P<.001, <.001 respectively). CONCLUSIONS: This study showed, for the first time in the literature, high levels of TN-C in the low and high iPTH groups and that this elevation was associated with iPTH. We think that if our study is supported by further research, TN-C can be a biomarker capable of use in diagnosing CKD-MBD.

A new predictor of mortality in hemodialysis patients; Tenascin-C.

AIM: Cardiovascular disease is the most frequent cause of mortality in hemodialysis patients. There are a number of inconsistencies in terms of cardiovascular risk factors in these patients. Tenascin C (TN-C) is a matricellular protein which may be a prognostic predictor after myocardial infarction and many cardiac diseases. The purpose of this study was to determine TN-C levels in hemodialysis patients and to evaluate the association between TN-C levels and cardiac mortality. MAIN METHODS: In this multicenter prospective observational research, blood specimens were collected at the start of the study for the measurement of TN-C and other biochemical parameters. After 2 years' follow-up we investigated the association between TN-C and other biochemical and demographic parameters and cardiac and all cause mortality. KEY FINDINGS: Two hundred thirty-eight patients and 25 healthy individuals were enrolled. TN-C levels in the hemodialysis group were higher than those in the control group (p b 0.001). All-cause mortality was observed in 47 (19%) patients and cardiac mortality in 39 (15%). At multivariate Cox regression analysis, TN-C, age and systolic blood pressure were identified as independent predictors of cardiac mortality. The Kaplan­Meier survival curve revealed greater all-cause and cardiac mortality rates in the high TN-C group (Log rank p b 0.001 and p b 0.05 respectively). SIGNIFICANCE: TN-C levels were higher than those in the control group, and our results suggest that it may be a predictor of cardiac mortality in hemodialysis patients. If further studies support our research, TN-C may be a useful biomarker for detecting cardiac mortality risk.

Can be galectin-3 a novel marker in determining mortality in hemodialysis patients?

BACKGROUND: Cardiovascular (CV) mortality is common in hemodialysis (HD) patients. There are some difficulties involved in determining CV risk. Galectin-3 is a molecule with a demonstrated correlation with CV mortality and which is approved in the stratification of heart failure (HF) risk. The purpose of this study was to assess the previously uninvestigated relationship between galectin-3 and cardiac mortality in HD patients. METHODS: Two hundred ninety clinically stable HD patients aged over 18 and on a thrice-weekly intermittent HD program lasting >3 months and 30 healthy individuals were enrolled in this multi-center, prospective, observational study and monitored over 24 months. Blood specimens were collected at the start of the study for the measurement of galectin-3 and other biochemical parameters. At the end of the study, the relations between galectin-3 and other biochemical and demographic parameters and mortality were analyzed. RESULTS: Galectin-3 levels were significantly higher in the HD group compared to the control group (p < 0.001). All-cause mortality was observed in 63 (21%) patients. At multivariate Cox regression analysis, age, low albumin, low DBP, high galectin-3 and high HsCRP were identified as prognostic determinants of all-cause mortality, while age, low albumin, high galectin-3 and high SBP were identified as prognostic determinants of cardiac mortality. CONCLUSION: This study shows, for the first time in the literature, that galectin-3 may be a novel biomarker of cardiac mortality in HD patients. We think that, when supported by further studies, galectin-3 can be a promising biomarker in predicting cardiac mortality in HD patients.

Do hemodialysis adequacy data reflect reality?

Hemodialysis (HD) adequacy requires monitoring in line with standards and at appropriate intervals. However, the use of inappropriate or incorrectly applied techniques in the determination of HD adequacy can lead to highly unfortunate results. This study was intended to identify the path to a solution by determining how far HD adequacy in HD centers in our region reflects reality. Three hundred and thirty HD patients from eight centers were included. On the first visit, predialysis and postdialysis blood collection with the centers' own methods being used were observed and errors were recorded. Kt/V1 was calculated from pre- and postdialysis blood specimens taken by the units themselves. On the second visit, one session later, pre- and postdialysis blood samples were collected in line with guidelines by ourselves, the authors, and Kt/V2 was calculated from these samples. The eight units' total Kt/V2 value was significantly lower compared with Kt/V1 (<0.0001). The level of patients in all centers with Kt/V1 <1.2 was 13.5%, and that of patients with Kt/V2 <1.2 was 22.1%. No center, apart from one unit, managed to complete the collection of blood specimens as recommended by the guidelines. With one exception, blood collection for HD adequacy was not performed using proper technique in any center. This simple but easily overlooked situation, HD being regarded as adequate though in fact it is not, may lead to patients not being treated effectively and accurately and to a rise in mortality and morbidity in the long term.

Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) level in hemodialysis patients and parameters affecting that level.

BACKGROUND: Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor)-domain-containing protein 1 (SCUBE1) is a cell surface protein belonging to the SCUBE gene family. SCUBE1 has been shown to rise in parallel with platelet activation in acute ischemic events. However, there are no studies showing levels in the hemodialysis patient group, in which there is known to be an increase in platelet function impairment and activation. The purpose of this study was to investigate SCUBE1 levels in a hemodialysis patient group and the factors affecting those levels. MATERIALS AND METHODS: One hundred three hemodialysis patients and 21 age-matched healthy controls were included. SCUBE1 and sCD40L levels were investigated from blood specimens collected on pre- and post-hemodialysis sessions. We investigated the correlation between SCUBE1 levels and sCD40L, patients' demographic data, parameters with hemodialysis treatment and routine biochemical tests. RESULT: SCUBE1 levels were significantly higher in the hemodialysis patient group compared with the controls (p=0.000). There was a significant rise in SCUBE1 levels in the post-hemodialysis session (p=0.000). We determined a positive correlation between SCUBE1 and sCD40L (p=0.016, r=0.215). Gender, blood pressure, BUN, creatinine, hematocrit and high-sensitivity C-reactive protein (hsCRP) levels, hemodialysis membrane surface area, amount of ultrafiltration, blood flow rate, dialysis flow rate and carnitine use significantly affected SCUBE1 levels. CONCLUSION: We have shown, for the first time in the literature, that SCUBE1 level, a potential acute ischemia marker, is elevated in hemodialysis patients with no clinical ischemic event, and that various factors affect this elevation.