Serum sTWEAK and FGF-23 Levels in Hemodialysis and Renal Transplant Patients.

BACKGROUND: Kidney transplantation is the treatment of choice for patients with end-stage renal disease. OBJECTIVE: To evaluate the changes in serum soluble TNF-like weak inducer of apoptosis (sTWEAK) and fibroblast growth factor 23 (FGF-23) in hemodialysis (HD) patients and renal transplant recipients (RTR). METHODS: Serum samples were obtained from 30 patients on chronic HD, 30 RTRs, and 30 normal controls. Biochemical factors, sTWEAK, FGF-23, and interlukin-6 (IL-6) were measured by standard methods. RESULTS: Serum levels of sTWEAK in RTRs were significantly higher than those in the HD patients (p=0.025); RTR and HD patients had significantly lower sTWEAK levels than the controls (p=0.001 and p= 0.038, respectively). Serum levels of FGF-23 in HD patients were significantly (p=0.001) higher than those in the RTR; the level was higher in both studied groups compared to that in the controls (p=0.001 for both groups). The mean serum level of IL-6 in HD was significantly higher than that in RTR patients (p=0.013). IL-6 levels in both groups were significantly higher than those in controls (p=0.001 and p= 0.012, respectively). In HD group a negative correlation was found between FGF-23 and sTWEAK (r= 0.375, p=0.041); there were also a significant correlation between FGF-23 and IL-6 (r= 0.480, p= 0.007) and between IL-6 and sTWEAK (r= 0.409, p=0.025). CONCLUSION: We found that serum sTWEAK is decreased and FGF-23 is increased in HD and RTR groups comparing with the control group. However, further studies are needed to shed light over their direct role on atherosclerosis and cardiovascular outcomes.

Gluteal Necrosis and Lumbosacral Plexopathy in a Diabetic Patient after Renal Transplantation.

A 34-year-old diabetic patient underwent a renal transplant which was complicated by right side lower extremity paresis and numbness with gluteal necrosis. The main reason was ligation of internal iliac artery of the same side as a result of extensive microvascular obstruction due to severe atheromatous plaque. This is a rare complication which is mostly reported in aneurysmal patients after bypass surgery. The gluteal necrosis is a serious complication which, as in our patient, resulted in patient's death in most of the reported cases. Because of catastrophic nature of this condition, identifying preventive measures is extremely important.

Lack of renal protection of ultrafiltration during cardiac surgery: a randomized clinical trial.

AIM: The objective of this study was to determine the intraoperative ultrafiltration effect on postoperative AKI. METHODS: In this prospective randomized clinical trail, 159 patients scheduled for elective cardiac surgery, were randomly assigned to either hemofilter (N.=87) or control group (N.=72). The primary and secondary outcomes were AKI (defined as ≥50% increase in the serum creatinine level) and increased urinary neutrophil gelatinase-associated lipocalin (NGAL) in the postoperative period, respectively. RESULTS: The two groups were similar with respect to comorbidities and also surgical procedure, except ultrafiltration. The incidence of AKI was equal in the both groups (11% vs. 5%, P=0.2, respectively). Creatinine increased after surgery (P=0.00) without significant differences between the both groups (P=0.2). Urinary NGAL also showed no significant difference between the groups. Age, euroscore, hyperlipidemia, pulmonary disease and urinary volume during operation correlated with the development of AKI. Postoperative blood loss was less in the hemofilter than control group (820±550 mL vs. 1100±630 mL, P=0.04). There was no difference in the length of intubation and stay in intensive care unit. CONCLUSION: Routine use of ultrafiltration during cardiac surgery offers no advantages in renal protection and reduction of AKI incidence.

Effect of cyclosporine-a on paraoxonase activity in wistar rats.

BACKGROUND: Many adverse effects have been reported on using cyclosporine (CSA) in organ transplantation. OBJECTIVE: To investigate the effects of CSA on paraoxonase (PON) activity and lipid peroxidation metabolites in early and late-stage of peroxidation and also total antioxidant (TA). METHODS: Twenty 220-250 g adult male Wistar rats were included in the study. The animals were stored for one week in the animal room before the initial injection to habituate with temperature, humidity, and circadian rhythm of day (12 h) and night (12 h). The temperature was kept at 23 °C. Animals had access to food and water ad libitum. RESULTS: A significant (p=0.002) increase in the serum levels of conjugated diones was observed in the case compared to the control group. At the end of the study, malondialdehyde (MDA) levels in CSA group was significantly (p=0.01) higher than the control group. Serum PON1 activity was significantly (p=0.004) lower in the case than the control group. CONCLUSION: CSA administration could impair oxidant-antioxidant pathways and increase oxidative stress. Antioxidant therapy could be beneficial in patients treated with CSA.

Effect of Isoproterenol on LDL Susceptibility to Oxidation and Serum Total Antioxidant Capacity in Cyclosporine-Treated Rats.

BACKGROUND: Cyclosporine therapy is associated with a variety of adverse effects. Recent studies have suggested increased oxidative stress as a cause of these side effects. OBJECTIVE: Since, melatonin is one of the most powerful known antioxidants, and considering that isoproterenol is one of the drugs stimulating endogenous melatonin production, we tried to determine the effect of isoproterenol on LDL susceptibility to oxidation and serum total antioxidant capacity in cyclosporine-treated rats. METHODS: 32 male Wistar rats were divided into four groups: group A were controls that received placebo; group B received intraperitoneal isoproterenol (20 mg/kg/d) alone; group C received intravenous cyclosporine (15 mg/kg/d) alone; and group D received both drugs simultaneously at the same doses and durations-cyclosporine one week after administration of isoproterenol. Blood samples were drawn four times from rats in each group: before injections, during the treatment, end of the treatment, and one week after the last injections. RESULTS: There was a significant (p<0.05) increase in LDL susceptibility to oxidation, and a decrease in serum total antioxidant capacity (p<0.05) in group C rats. But, there were no significant changes in group B and D rats in terms of LDL susceptibility to oxidation and total antioxidant capacity. CONCLUSION: Isoproterenol may be capable of delaying adverse effects of cyclosporine by preventing the increase in LDL susceptibility to oxidation, and decrease in serum total antioxidant capacity.

Effect of isoproterenol on cyclosporine-induced nephrotoxicity in rat.

BACKGROUND: Oxidative stress is the main mechanism resulting in cyclosporine-induced nephrotoxicity. Because of its ability to stimulate endogenous melatonin production, isoproterenol is one of the most powerful antioxidant drugs. In this study, we sought to determine the effect of isoproterenol on cyclosporine-induced nephrotoxicity in rats. MATERIALS AND METHODS: Thirty two young male Wistar rats were divided into four groups: of group A were controls that received placebo; group B, received intraperitoneal isoproterenol (20 mg/kg/d) alone; group C, intravenous cyclosporine (15 mg/kg/d) alone; and group D, both drugs simultaneously at the same doses and durations namely cyclosporine 1 week after administration of isoproterenol. Blood samples to measure serum urea, creatinine, and melatonin levels were drawn four times for each group: before injection, at the mid period of treatment, at the end of treatment, and 1 week after the last injections. RESULTS: Isoproterenol increased mean serum melatonin level in groups B and D rats (P < .05). With regard to deteriorated renal function [DRF = (urea + creatinine)/2], administration of cyclosporine with (group D) or without (group C) isoproterenol was associated with decreased renal function (P < .05), although it was more perturbed in the latter instance. Measured DRF at the middle and the end of drug administration periods of A and B (revealed significant differences compared with groups C and D; P < .05). DISCUSSION: Although cyclosporine-induced nephrotoxicity is not completely eliminated by isoproterenol, the latter showed some protective effects.

Anatomical differences in the right and left renal arterial patterns.

The aim of this study was to determine the pattern and character of the renal arteries in patients referred for preoperative or diagnostic evaluation of the renal or abdominal arteries by multi-detector computed tomography and, by comparing the arterial anatomy of the right and left kidneys, to evaluate the effect of differences in their anatomical position on the characteristics of the arteries. During a cross-sectional study from August 2005 to October 2007, 117 patients underwent contrast-enhanced 64-slice multi-detector computed tomography renal angiography in Tabriz Imam Khomeini Hospital (Parsian Centre). The number of arteries, the number of branches and the presence of accessory arteries and early branching were assessed in the renal arteries on both sides. In all, the data for 117 patients data were analysed, 76 (65%) of whom were male and 41 (35%) female. The mean of age of the patients was 39.26 +/- +/- 17.03 years. The mean diameters of the aorta and renal artery were 2.62 +/- +/- 1.55 mm and 0.62 +/- 0.11 mm respectively and the distance to branching was 3.39 +/- 1.59 mm. There was no significant difference in diameter between the left and right renal arteries or in the distance to branching (0.62 +/- 0.11 vs. 0.61 +/- 0.12 mm; p = 0.35; 3.24 +/- 1.2 vs. 3.56 +/- 1.77 mm; p = 0.11). An accessory artery was presented in 58 kidneys and this significantly more often occurred on the right side than on the left side: 38 of 117 (32.47%) right kidneys vs. 20 of 117 (17.09%) left kidneys (p = 0.01). There was early branching in 42 subjects (35.89%). In a comparison of early branching of the arteries of the right and left kidneys, no significant difference was found, despite the higher incidence of branching on the right side. The diameters of the right and left renal arteries and the distances to branching did not differ. Apart from width, there was no difference in kidney size. An accessory artery occurred more frequently in the right renal artery than in the left.

Effects of losartan and enalapril on high-sensitivity C-reactive protein and total antioxidant in renal transplant recipients with Renin-Angiotensin system polymorphisms.

BACKGROUND: As renin-angiotensin system (RAS) activity may affect the severity of oxidative stress and inflammatory markers, we assessed the effects of enalapril (E) and/or losartan (L) on these markers in renal transplant recipients with RAS polymorphisms. PATIENTS AND METHODS: After determination by PCR of RAS genotypes, consisting of the angiotensin-converting enzymes (ACE I/D), angiotensinogens (AGT M235T) and angiotensin II type 1 receptors (ATR1 A1166C), 76 recipients were recruited randomly and assigned 4 groups. The first (n = 17) and second (n = 24) groups were treated with E (E(+): 10 mg/d) and L (L(+): 50 mg/d) alone, respectively. The third positive control group (n = 17) received E + L (E(+)L(+): 10 mg/d + 50 mg/d) and the fourth negative control group (n = 18) received no medication (E(-):L(-)). High-sensitivity C-reactive protein (hs-CRP) and total antioxidant (TA) inflammatory and antioxidative markers were measured after 2 months. After a 2-week washout period, the E(+) group was changed to L(+) and vice versa in a crossover design. They were followed for another 8 weeks before retesting hs-CRP and TA. A value of P < or = .05 was considered significant. RESULTS: After 2 and 4 months of treatment with the drug regimen, hs-CRP and TA levels were significantly decreased and consequently increased among the E(+)L(+), L(+) and E(+) groups (P < .05). On analyzing the relationship between RAS polymorphisms and baseline hs-CRP or TA levels, CC genotype of ATR1 showed lower hs-CRP levels (P = .04). However, none of the RAS polymorphisms predicted the antioxidant and anti-inflammatory response rates to the drugs (P > .05). CONCLUSION: Although hs-CRP was lower in the CC genotype patients of ATR1 polymorphisms E and/or L reduced hs-CRP and increased TA regardless of the RAS genotype.

Doppler ultrasonographic indices after renal transplantation as renal function predictors.

OBJECTIVES: Doppler ultrasonography is mostly used for assessment of both graft and native kidney vascular status. In this study, correlation between Doppler sonographic indices and transplanted kidney function was evaluated. METHODS: In our retrospective study, we reviewed data on 273 renal transplanted (RTx) patients. The Doppler ultrasonographic evaluation included resistive index (RI), pulsatility index (PI) in interlobar arteries as well as stenosis (TRAS) or thrombosis of renal arteries and veins. Serum creatinine (Cr) and cyclosporine levels (CsA) were measured just prior to sonography. RESULTS: The mean age of 154 male and 119 female patients was 36.67 +/- 13.13 years. Both RI and PI showed significant linear correlations with serum Cr (P = .033 and P = .002, respectively). Also, direct linear correlations existed between patient age and RI and PI values (P = .004; r = +.174 and P = .003; r = +.183 respectively). The prevalence of TRAS was 11.35%. Among patients with TRAS or thrombosis the mean Cr level (2.08 +/- 1.7 mg/dL) was significantly higher than that among patients without TRAS or thrombosis (1.48 +/- 0.97 mg/dL; P = .004). Despite this finding, RI and PI were significantly lower among patients with TRAS or thrombosis than those with a patent renovascular tributary (0.59 +/- 0.15 vs 0.65 +/- 0.11; P = .029 vs 1.02 +/- 0.40 vs 1.18 +/- 0.46; P = .049). CONCLUSIONS: Both RI and PI were two valuable Doppler ultrasonographic markers to evaluate renal allograft function and related vascular complications.

Ankle-arm blood pressure monitoring does not correlate with serum lipoprotein a in renal transplant recipients.

OBJECTIVE: Lipoprotein a [Lp(a)] is a strong biochemical risk factor that predicts posttransplant atherosclerosis. In this study we measured the ankle to arm blood pressure index (AAI) as a predictor of clinical atherosclerosis and assessed its relationship to serum Lp(a) values among 60 renal transplant recipients. MATERIALS AND METHODS: After measuring the AAI in a recumbent position, biochemical factors including cholestrol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and Lp(a) were measured by commercial kits in 60 renal transplant and 30 healthy subjects. Results were analyzed using SPSS. RESULTS: Lp(a) concentrations were significantly higher among transplant recipients compared with the control group (P < .05). AAI was similar between the kidney transplant recipients and controls, showing no significant correlation of Lp(a) concentration with AAI. CONCLUSION: Increased serum Lp(a) in renal transplant recipients, a potent biochemical risk factor for atherosclerosis, was not associated with abnormal AAI.

Calcitriol started in the donor, expands the population of CD4+CD25+ T cells in renal transplant recipients.

OBJECTIVES: Alloreactive T cells recognize antigens via direct and indirect pathways. The competency of costimulatory molecules on antigen-presenting cells (APC) is important. An active form of vitamin D (1,25(OH)(2)D(3), calcitriol) inhibits APC cell maturation and expression of costimulatory molecules. Herein we studied the immunosuppressive effects of calcitriol, which was started in the donors and continued in the kidney recipients. METHODS: In this prospective study, candidates for living donor renal transplantation were randomly assigned into two groups: the treatment group were prescribed calcitriol (0.5 microg/day) started in the donor 6 days before donation and continued in recipient side for 6 months after transplantation. The control group received the conventional immunosuppressive regimen, namely, cyclosporine/mycophenolate mofetil and prednisolone. In each group, a recipient blood sample was obtained before and 6 months after transplantation. Diagnostic study of the T-cell markers-CD3, CD4, and CD25-were performed with a flow cytometry technique. RESULTS: The mean values of CD3(+)CD4(+)CD25(+) T cells in the treatment group (four women and five men; 40.8 +/- 8.5 years) and the control group (four women and six men; 37.2 +/- 10 years) were at 14.2 +/- 4.2% and 15.4 +/- 4.5% of total peripheral lymphocytes. Six months after transplantation, these percentages increased to 29 +/- 6.3% in the treatment group and decreased to 12.1 +/- 4.5% in the controls (P<.0001). No clinical rejection was detected in either group during the study period. CONCLUSION: Calcitriol started in the donors and continued in the kidney allograft recipients lead to expansion of CD4(+)CD25(+) regulatory T cells in recipients. We speculated that costimulatory deficient APC for both direct and in-direct pathways may play a role.

Renin-angiotensin system polymorphisms and hemoglobin level in renal allografts: a comparative study between losartan and enalapril.

INTRODUCTION: In this study, hemoglobin (Hb) concentrations secondary to enalapril (E) or losartan (L) therapy were evaluated with respect to renin-angiotensin system (RAS) polymorphisms in renal transplant recipients. MATERIALS AND METHODS: After determination of RAS polymorphisms [angiotensin-converting enzyme (DD, non-DD), angiotensinogen (TT, non-TT), and angiotensin receptor type 1 (CC, non-CC)] by polymerase chain reaction, 70 renal transplant recipients were recruited to four groups randomly: first and second groups were treated with E (10 mg/d, 15 patients) and L (50 mg/d, 20 patients) alone, respectively. The third group received E+L (10 mg/d + 50 mg/d, 13 patients) and the fourth group (22 patients) received no medication. The treatment protocol was followed for 16 weeks. Complete blood counts were checked before treatment and every 2 months. P<.05 was considered to indicate statistical significance. RESULTS: Treatment for 4 months decreased the Hb level in the E+L (14.15 +/- 0.94 to 12.06 +/- 0.66 g/dL, P=.000), E (14.00 +/- 0.86 to 13.11 +/- 0.82 g/dL, P=.02), and L (14.12 +/- 0.90 to 12.10 +/- 2.35 g/dL, P=.01) groups, but not in the control group (13.55 +/- 0.70 to 13.36 +/- 0.69 g/dL, P>.05). None of these regimens showed greater Hb reduction than the others (P>.05). None of the RAS polymorphisms predicted the intensity of the reduced Hb according to the type of treatment (P>.05). Any other sets of RAS polymorphisms (alone or together) did not impact on Hb levels pre- or post-intervention (P>.05). CONCLUSION: Our findings suggest that low dosages of E and/or L decrease Hb levels regardless of the RAS polymorphisms.

Vascular complication and Doppler ultrasonographic finding after renal transplantation.

OBJECTIVES: Vascular complications are common after renal transplantation. In this study we correlated Doppler sonographic indices and transplant kidney function. METHODS: We reviewed data on 244 renal transplant patients. Doppler ultrasonographic evaluation was performed during the first 2 weeks after renal transplantation. We determined resistive index (RI) and pulsatility index (PI) in the interlobar arteries and thrombosis of renal and lower limb veins. Serum creatinine (Cr) and cyclosporine levels were evaluated prior to sonographic assessment. RESULTS: The mean age of the 142 male and 102 female patients was 36.31 +/- 3.30 years. Prevalence of real artery stenosis was 9.5%. In these patients the mean serum Cr level (2.21 +/- 1.83 mg/dL) was significantly higher than among patients with patent renovascular tributary (1.49 +/- 1.00 mg/dL; P=.03). RI and PI were also significantly correlated with serum Cr(P=.05 and .001, respectively). There was no relationship between cyclosporine level or panel-reactive antibody with RI and PI. Retransplant patients showed higher RI than first renal allograft recipients (0.72 +/- 0.16 vs 0.63 +/- 0.11; P=.006). Serum Cr level was higher among renal allograft recipients with Doppler evidence of thrombosis of the lower limb veins (3.1 +/- 0.98 mg/dL versus 1.56 +/- 1.13 mg/dL; P=.04). CONCLUSIONS: RI and PI are two valuable Doppler ultrasonographic markers to determine renal allograft function and related vascular complications.

Pharmacokinetics, efficacy, and safety of Iminoral compared with Neoral in healthy volunteers and renal transplant recipients.

UNLABELLED: This study sought to evaluate the bioequivalence of Iminoral (test) versus Neoral (reference) in healthy volunteers, as well as safety and efficacy of Iminoral treatment in renal transplant recipients following conversion from Neoral. METHODS: After an overnight fast, 18 healthy volunteers received the assigned treatment (test or reference, 200 mg single dose) in a cross-over fashion with a washout period of 14 days. The blood samples were drawn at various times after drug administration. Cyclosporine blood concentration was measured by high-performance liquid chromatography using an ultraviolet detector. In the second phase of study, stable renal transplant patients who were on Neoral were enrolled in the study in an open-label manner. They were converted from Neoral to Iminoral based on a 1:1 dose equivalence. Cyclosporine trough levels and changes in serum creatinine, lipid profile, electrolytes, and uric acid were measured before and periodically after conversion for 6 months. RESULTS: The 90% confidence interval of the test/reference ratio was within the acceptable limits of 0.8 to 1.25. Relative bioavailability of Iminoral in healthy subjects was 99.0%. There was no significant difference in cyclosporine concentrations and serum creatinines following conversion to Iminoral in renal transplant patients (n=41). There were no reports of major toxicity or of graft rejection and no need for dose adjustment related to Iminoral. CONCLUSIONS: Single doses of Neoral and Iminoral are bioequivalent in healthy subjects. Renal transplant recipients maintained on Neoral can be safely and effectively converted to Iminoral on a 1:1 conversion ratio.

Apolipoprotein a polymorphism predicts lipoprotein a concentration in renal transplant recipients.

Increased serum lipoprotein(a) is an independent risk factor for atherosclerosis in renal transplant recipients. Higher levels may be due to genetic factors, for example, apolipoprotein A isoforms and/or environmental states such as drugs and diets. We evaluated 75 renal transplant recipients including 30 men and 45 women of overall mean age of 30 +/- 7 years and transplantation duration of 57 +/- 10 months as well as 30 healthy controls for apolipoprotein A isoforms, lipoprotein(a) concentrations, serum triglycerides, serum cholesterol, serum creatinine, and serum homocysteine concentrations. High- and low-molecular-weight apolipoprotein A isoforms (>35 and <35 kringle 4) were observed in 71% and 29% of renal transplant recipients and 83% and 17% of controls. Average lipoprotein(a) concentration ratios between high- and low-molecular-weight apolipoprotein A isoenzymes were significantly greater in renal transplant recipients than in controls. Lipoprotein A and cholesterol concentrations that did not correlate with each other were not higher among the eight renal transplant recipients with creatinine levels greater than 1.8 mg/dL. Absolute levels in renal transplant recipients with failed grafts also were not different regarding the various apolipoprotein A phenotypes. Homocysteine levels were significantly higher with high-molecular-weight apolipoprotein A isoenzymes. A relationship existed between lipoprotein(a) and triglycerides, but not cholesterol: higher triglyceride levels were associated more with high-molecular-weight isoforms of apolipoprotein A (P = .027). Lipoprotein(a) concentrations are higher in low-molecular-weight isoforms of apolipoprotein but triglyceride levels and homocysteine concentrations are higher among the high-molecular-weight isoforms of apolipoprotein A. This finding could be used as a guideline to select the most appropriate drug for different apolipoprotein A isoforms.

Findings of Doppler sonography do not correlate with serum lipoprotein and total homocysteine concentrations in renal transplant recipients.

Atherosclerosis may be evaluated by structural or functional changes of the main arteries. We sought to investigate the probable associations of static and dynamic arterial changes with lipoprotein (a) and homocysteine levels, the two risk factors for atherosclerosis. Intima-media thickening and vasodilatory responses to nitroglycerine of the common carotid artery and the renal transplant artery were studied by color Doppler sonography in 75 renal transplant recipients and 30 controls. At 3, 5, and 10 minutes after 0.4 mg of sublingual nitroglycerine are measured resistive index and peak systolic velocity of the common carotid artery and renal transplant artery. Intima-media thickening in renal transplant recipients and controls were 0.86 +/- 0.34 mm and 0.74 +/- 0.14 mm (P = .05), respectively. Although intima-media thickness did not correlate with the duration of renal transplantation, it was significantly higher in older renal transplant recipients. Peak systolic velocity of common carotid artery was significantly decreased by nitroglycerine in the controls (81.8 +/- 16.7 m/s to 73.2 +/- 12.8 m/s, P = .03). This decrement was more obvious in renal transplant recipients, especially at 10 minutes (69.6 +/- 18.5 m/s vs 59.3 +/- 2 m/s, P = .01). These reductions did not correlate with intima-media thickening, latter of which also did not correlate with homocysteine concentrations, which were higher among renal transplant patients with creatinine more than 1.8 mg/dL. Basal resistive indices of the common carotid artery and renal transplant artery were higher among graft recipients with dysfunction than recipients with good function, (0.7 vs 0.59, P = .003). In conclusion, neither homocysteine nor lipoprotein(a) concentrations predict static and dynamic vascular properties.

Effect of L-carnitine on the serum lipoproteins and HDL-C subclasses in hemodialysis patients.

AIMS: Following carnitine administration a decrease in plasma levels of triglyceride (TG) and increase in total high-density lipoprotein cholesterol (HDL-C) has been reported. Our hypothesis was that it also improves the HDL2/HDL3 ratio, symptomatic intradialytic hypotension, and anemia in hemodialysis (HD) patients. METHODS: Forty HD patients with a mean (+/- SD) age of 53 +/- 13 years were treated with 500 mg/day carnitine taken orally for 2 months. Patients were used as their own controls (before treatment). Lipid and lipoproteins were determined by Alcyon Abbott autoanalyzer. HDL subclasses were measured by magnesium precipitation after fractionation with dextran sulfate. Hemoglobin, hematocrit and serum albumin were measured by standard methods. The results were analyzed by SPSS 11.05. RESULTS: We found a significant decrease in serum TG (2.22 +/- 0.99 vs. 1.93 +/- 1.07 mmol/l, p < 0.01) and VLDL-C (0.93 +/- 0.36 vs. 0.81 +/- 0.34 mmol/l, p = 0.01) and a marked increase in HDL-C (0.9 +/- 0.16 vs. 1.06 +/- 0.24 mmol/l, p < 0.05), HDL2-C (0.17 +/- 0.06 vs. 0.27 +/- 0.14 mmol/l, p < 0.05) and albumin (37 +/- 4 vs. 42 +/- 5 g/l, p = 0.01) levels. The serum levels of total cholesterol (4.61 +/- 0.89 vs. 4.5 +/- 0.95 mmol/l, p = 0.1), LDL-C (2.78 +/- 0.85 vs. 2.6 +/- 0.89 mmol/l, p > 0.05), HDL3-C (0.73 +/- 0.1 vs. 0.79 +/- 0.17 mmol/l, p > 0.05), hemoglobin, hematocrit, and intradialytic blood pressure did not change after the treatment. CONCLUSION: Treatment with 500 mg/day carnitine taken orally for 2 months reduces serum levels of TG and VLDL-C, and increases HDL-C, HDL2-C and albumin in HD patients.

Seasonal variations of blood pressure in hemodialysis and renal transplant recipients.

Seasonal variations influence blood pressure (BP) in healthy persons. Its effects on BP in renal replacement therapy, especially after renal transplantation (RTX), have not been proven clearly. We studied 80 stable RTX and 82 hemodialysis (HD) patients for 4 years. Systolic and diastolic BP, body weight (BW), cholesterol (Chol), triglyceride (TG), fasting blood sugar (FBS), blood urea nitrogen (BUN), and creatinine (Cr) were measured monthly. Their relationship with environmental temperature and humidity changes were assessed by Pearson tests and Fourier analysis. Ambient temperature and humidity were between 2.5 degrees C to 25.4 degrees C and 68% to 31% in the winters versus summers, respectively. The mean systolic BP in HD patients was 144 +/- 18 mm Hg and 140 +/- 15 mm Hg during the winter and summer, respectively (P =.004). For the RTX recipients, it was 133 +/- 12 mm Hg in winter and 128 +/- 19 mm Hg in summer (P <.001). The decrement in diastolic BP in warmer seasons was even more significant than that in systolic BP in both HD and RTX groups. Also, BW in summer was significantly lower than winter among HD (61.1 +/- 10 kg vs 63.2 +/- 9 kg; P <.001) and RTX (64.4 +/- 8 kg vs 65.6 +/- 8.4; P <.001) groups. Serum Chol, TG, and FBS did not change significantly during summer and winter in the both groups. Among RTX recipients, BUN level was greater in summer than winter seasons (24.2 +/- 15 vs 39.4 +/- 20 mg/dL; P =.01), but serum Cr did not differ. The degree of humidity did not correlate with BP, BW, or the above biochemical markers. We conclude that BP and BW are decreased in warmer seasons in both HD and RTX patients. The changes are not accompanied by changes in biochemical markers except for BUN in RTX patients.