Effects of peritoneal-and hemodialysis on levels of plasma protein and lipid oxidation markers in diabetic patients.

AIM: The aim of this paper was to evaluate the effects of dialysis procedures on oxidative stress in diabetic patients. METHODS: The study was performed on 15 non-diabetic hemodialysis (HD) patients, 30 non-diabetic perinoteal dialysis (PD) patients, 18 diabetic HD patients (DHD), 15 diabetic PD patients (DPD), and 20 healthy controls. Plasma thiobarbituric acid reactive substances (TBARS), protein carbonyl (PCO), and oxidized LDL (oxLDL) were determined as oxidative stress markers. Plasma thiol (P-SH), erythrocyte glutathione (GSH) levels, and serum paraoxonase (PON1) activities were measured as antioxidants. RESULTS: HD patients have significantly higher oxLDL, TBARS and PCO levels and significantly lower P-SH levels than PD patients. DHD patients have significantly higher PCO levels and PON1 activities and significantly lower GSH levels than non-diabetic HD patients. There was no any difference in oxidative stress parameters between DPD and non-diabetic PD patients. CONCLUSION: Oxidative stress is exacerbated by HD in diabetic patients. Treatment strategy with antioxidants in dialysis patients may be associated with a worsened survival.

Association of glomerular filtration rate and inflammation with left ventricular hypertrophy in chronic kidney disease patients.

BACKGROUND: Although left ventricular hypertrophy (LVH) is an independent predictor of mortality in patients with end stage renal disease, few have examined its prevalence before the initiation of dialysis. The aim of this study was to investigate the relationship between LVH, estimated glomerular filtration rate (GFR), and inflammatory markers in patients with chronic kidney disease (CKD). METHODS: Forty-one CKD patients (18 women, 23 men, mean age 53±17 years) with an estimated GFR between 15 and 59 mL/min (mean 34.2 mL/min) were enrolled and the following tests performed: routine serum biochemical analyses, high sensitivity C-reactive protein (hs-CRP), fibrinogen, ferritin, and homocysteine, and left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and left ventricular fractional shortening (LVFS). RESULTS: LVH was diagnosed in 32/41 patients (78%). CKD patients with LVH (n=32) had significantly higher hs-CRP (p=0.012), fibrinogen (p=0.031), and lower serum albumin (p=0.028) levels than those without LVH (n=9). In all patients, LVMI correlated positively with hs-CRP (r=0.483, p=0.002) and serum fibrinogen (r=0.426, p=0.015). Estimated GFR correlated positively with LVEF (r=0.414, p=0.007) and LVFS (r=0.376, p=0.018). CONCLUSIONS: Important positive associations exist between markers of inflammation and LVMI in patients with CKD. In addition to hs-CRP, elevated fibrinogen may portend the development of LVH in patients with CKD who are not yet on dialysis.

Hypertension and hemostatic/fibrinolytic balance disorders.

BACKGROUND: Hypertension is one of the principal risk factors for cardiovascular disease. We aimed to evaluate the impact of hypertension on fibrinolytic balance and endothelial function by measuring plasma levels of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (tPA), tPA/PAI-1 complex and fibrinogen. METHODS: Patients enrolled into the study were divided into four groups: 22 essential hypertensive (EH), 22 white coat hypertensive (WCH), 22 renovascular hypertensive (RH) and 22 normotensive control subjects. Plasma PAI-1, tPA, tPA/PAI-1 complex levels were measured by enzyme linked immunosorbent assays. RESULTS: There was no difference in the systolic and diastolic blood pressure measurements of the EH and RH groups. The four groups were comparable for age, gender, smoking habits and BMI. Patients with EH, RH and WCH had increased plasma levels of PAI-1, tPA, tPA/PAI-1 complex and fibrinogen compared with controls. No fibrinolytic parameter was associated with blood pressure in hypretensive subjects. CONCLUSION: This prospective study showed that fibrinolytic markers such as PAI-1, tPA, tPA/PAI-1 complex are independently associated with the development of hypertension. This supports the hypothesis that disturbances in fibrinolysis precede a cardiovascular event. Therefore, hypertension may be associated with impaired fibrinolysis.

The response to pegylated interferon alpha 2a in haemodialysis patients with hepatitis C virus infection.

The aim of this retrospective study was to focus the efficacy of pegylated interferon (PEG-IFN) alpha 2a in chronic hemodialysis patients with hepatitis C and to compare the therapy responses with other chronic hepatitis C patients. Of the anti-HCV positive patients who were admitted to the Infectious Diseases and Clinical Microbiology policlinic from January 2004 to December 2006, 99 were candidates for interferon therapy. Of those, 12 patients were on HD. We began 47 patients on PEG-IFN alpha 2a (180 lg/week) subcutaneously plus ribavirin (1,000-1,200 mg/day) (Group 1), and 12 patients on HD, PEG-IFN alpha 2a, without ribavirin at a dose of 135 lg weekly for 48 weeks (Group 2). In this study of PEG IFN alpha 2a with or without ribavirin, the predictability of a sustained viral response (SVR) was based on the early virologic response (EVR) defined at week 12 as an at least 2-log decline from baseline of the HCV RNA level. About 77% (39/47) of patients achieved an EVR in Group 1 and 58% (7/12) in Group 2 (p = 0.004). A total of 34 (72.34%) patients in Group 1 and 6 patients (50%) in Group 2 had negative HCV RNA at the end of the treatment (p = 0.213). We evaluated SVR after 6 months finishing the therapy; 29 (61.7%) patients in Group 1 and 6 patients (50%) in Group 2 had negative HCV RNA (p = 0.109). PEG-IFN alpha 2a (135 lg weekly) for 48 weeks is efficacious and well tolerated in HD patients with HCV, as well as other chronic HCV patients. However, due to more side effects of IFN specially on platelet counts as compared non-renal HCV patients a closer follow-up, in HD patients is suggested.

Quality of life in chronic kidney disease: effects of treatment modality, depression, malnutrition and inflammation.

In the present study, our aim is to investigate the effects of the treatment modality, depression, malnutrition and inflammation on quality of life (QoL) in chronic kidney disease (CKD). Twenty-six patients with CKD on conservative management, 68 patients on haemodialysis (HD), 47 patients on continuous ambulatory peritoneal dialysis (CAPD) and 66 healthy controls were enrolled in the study. QoL was measured by means of the Short Form-36 (SF-36) and subscale scores were calculated. All patients were evaluated for the presence of depression using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders - Clinician Version. The severity of depression was evaluated by means of the Beck Depression Inventory (BDI). Serum C-reactive protein (CRP), ferritin, albumin, haemoglobin and haematocrit (Hct) levels were measured. All the SF-36 subscale scores were lower in the patient groups compared with control group. The SF-36 scores were higher and BDI scores were lower in the CAPD group than CKD and HD groups. In patients with depression, all SF-36 subscale scores were lower than that of the patients without depression. There was a significant negative correlation between all the SF-36 subscale scores and the BDI scores. There was a significant positive correlation between the SF-36 physical and total summary scores and the Hct value and serum albumin levels, but an inverse correlation between the SF-36 physical, mental and total summary scores and the serum CRP level in the HD patients. The authors suggest that the treatment modality, depression, malnutrition and inflammation have an important role on QoL in CKD.

The effects of acute phase proteins on serum albumin, transferrin and haemoglobin in haemodialysis patients.

In the present study, the effects of C-reactive protein (CRP) and ferritin on serum albumin, transferrin and haemoglobin (Hb) were assessed to investigate the relationship between inflammation, hypoalbuminaemia and anaemia in haemodialysis patients. A total of 117 patients who were followed at three haemodialysis units in Kocaeli were enrolled. The mean age was 47.83 +/- 16.85 years. The median time on dialysis was 26 (minimum 1, maximum 209) months. Serum CRP albumin and ferritin concentrations were measured in our laboratory and transferrin, urea reduction ratio (URR) and Kt/V were calculated. There was significant inverse correlation between serum CRP level and albumin (p<0.001), serum CRP and Hb (p<0.001), and serum transferrin and ferritin (p<0.05). There was significant positive correlation between serum albumin and Hb (p<0.001), serum CRP and ferritin (p<0.05), and transferrin and URR (p<0.05). Our findings suggest that inflammation is a contributor in the development of hypoalbuminaemia and anaemia in haemodialysis patients as well as malnutrition and inadequate dialysis.

The influence of hemodialysis on serum sialic acid levels in chronic renal failure.

Background. It has been observed that there is an increase in serum sialic acid level in chronic renal diseases and endstage renal failure requiring hemodialysis, and the hemodialysis procedure causes increased cytokine production. Thus, it is expected that hemodialysis causes increases in the serum levels of acute phase reactants and sialic acid. Nevertheless, the changes in serum sialic acid level in hemodialysis have not been examined sufficiently. In our study, we examined the effect of hemodialysis on serum sialic acid level. Methods. A total of 54 patients on hemodialysis therapy for chronic renal failure (32 men; 22 women) were examined. The patients were evaluated in four groups according to their age, sex, duration of hemodialysis, and whether they were diabetic. Serum sialic acid levels before and after hemodialysis, done with a hemophane membrane, were measured by the thiobarbituric acid method described by Warren. Results. The serum sialic acid levels of chronic renal failure patients requiring hemodialysis were increased with respect to the healthy control group, independent of age, duration of therapy, and whether there was accompanying diabetes. Hemodialysis did not provide clearance of sialic acid; to the contrary, it caused an insignificant increase in serum sialic acid levels. Conclusions. In chronic renal failure, the improved serum sialic acid level probably reaches a definite value, and this value is not affected by factors such as diabetes, age, or sex. Serum sialic acid level is minimally influenced by hemodialysis performed with a hemophane membrane.

Prospective validation of single plasma sample 99mTc-ethylenedicysteine clearance in adults.

UNLABELLED: 99mTc-L,L-ethylene, L, dicysteine (EC) clearance shows strong correlation with orthoiodohippurate clearance, and it is possible to estimate effective renal plasma flow from 99mTc-EC clearance. In routine clinical studies, it is practical to use the one or two plasma sample method instead of multiple plasma samples for clearance determination. A single-sample technique was developed for 99mTc-EC, and a regression formula was generated. A prospective study tested the validity of this regression formula. METHODS: The study population was composed of 26 patients with a wide range of renal function. Multiple plasma sample 99mTc-EC clearances were calculated from all patients using the open two-compartment model. Single plasma sample clearances were also determined from the 54-min plasma sample using the regression formula published previously. RESULTS: The multiple-sample plasma clearance of 99mTc-EC ranged from 46 to 668 mL/min with a mean of 300.76 +/- 150.73 mL/min. The clearances obtained from the 54-min plasma sample ranged from 49 to 699 mL/min, with a mean of 297.39 +/- 152.23 mL/min. There was an excellent correlation between the clearances obtained by the two techniques (r = 0.99, slope = 0.9911). The standard error of estimation was found to be 25.9 mL/min. CONCLUSION: This study suggests that 99mTc-EC clearance can be estimated from 54-min plasma samples with an acceptable error of estimation for most routine clinical studies.