Effect of preload reduction on sonographic myocardial integrated backscatter.

PURPOSE: Sonographic myocardial tissue characterization with integrated backscatter (IBS) is affected by both structural and functional properties of the myocardium. The aim of the present study was to investigate the effect of preload reduction by hemodialysis (HD) on IBS measurements. METHODS: Fifty-two patients on maintenance HD underwent echocardiography before and after a routine HD session. Measurements included the variation of IBS during the cardiac cycle (CV-IBS) and calibrated IBS (cal-IBS). RESULTS: After HD, there were significant reductions in left ventricular end-diastolic and end-systolic dimensions and left atrial diameter. There was a reduction in stroke volume and LV ejection fraction consistent with a reduction in preload. Furthermore, CV-IBS was significantly lower after HD (7.9 +/- 2.2 versus 6.9 +/- 1.8 dB, 7.0 +/- 2.1 versus 6.2 +/- 1.9 dB, and 9.0 +/- 2.6 versus 8.1 +/- 2.0 dB [p < 0.01], respectively, in the left anterior, lateral, and inferior wall of the ventricle). Cal-IBS remained unchanged after dialysis compared with baseline. CV-IBS and ultrafiltration volume were significantly correlated. CONCLUSION: HD leads to a decrease in CV-IBS that appears to be preload-dependent. This finding is in concordance with diminished left ventricular performance during HD.

[Transferrin microheterogeneity in patients treated by maintenance haemodialysis]. / Mikroheterogennosc transferyny u chorych leczonych powtarzana hemodializa.

Transferrin (Tf) plays a crucial role in iron transport in the human body. In physiologically status Tf occurs in four variants. The concentration of Tf and its variants is changing in several conditions, especially during acute phase response, which may take place in end-stage renal disease (ESRD). The aim of this study was the assessment of the associations between changes of glycosylation of transferrin and selected blood cell count and iron metabolism parameters in ESRD patients treated by maintenance hemodialysis (mHD) with long lasting anaemia despite treatment by rHuEPO. Studies were carried out on a group of 55 ESRD patients treated by HD (ESRD group). The reference values were obtained from a group of 20 healthy volunteers (HV group). The Tf concentration was determined by the rocket immunoelectrophoresis according to Laurell. To estimate the microheterogenity of Tf the crossed affinoimmunoelectrophoresis according to Bog-Hansen was used. The concentration of selected hematological variables, and selected liver metabolism variables was assessed by routine laboratory tests, while the concentration of cytokines was measured by ELISA method, and selected acute phase proteins, i.e. C-reactive protein, by immunonephelometry method. Tf in studied sera was divided into four variants Tf1, Tf2, Tf3, Tf4. The percentage contents of variants in HV was Tf1=4%, Tf2=9%, Tf3=82%, Tf4=4%. In the sera of ESRD group the percentage contents of the Tf1, Tf2, Tf4 variants increased to 9%, 16%, 10% respectively, while the Tf3 variant decreased to 65%. Serum concentration of Tf was lower (1441 +/- 526 mg/L) in ESRD patients (p<0.0001) vs. 3539 +/- 955 mg/L in HV group. During this study we have revealed that the quantity and the quality of Tf is changing in ESRD patients. The observed correlations between concentration of Tf3 and selected hematological variables and also between Tf3 and rHuEPO, suggests that the decrease concentration of the Tf3 may lead to an impaired iron transport to the cells and may be one of the factors affecting anaemia in patients treated by HD and rHuEPO.

Comparison of magnesium and zinc levels in blood in end stage renal disease patients treated by hemodialysis or peritoneal dialysis.

The abnormal metabolism of macrominerals and trace metals, a frequently overlooked fact may be one of the factors influencing clinical disorders in chronic dialysis patients. The purpose of this study was to compare to what extent maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) therapy influences the magnesium (Mg) and zinc (Zn) levels in blood of patients treated by these two methods. Additionally, we examined the influence of rhEPO therapy on Hb concentration in erythrocytes, total protein and albumin levels in plasma, and possible impact of rhEPO on Zn and Mg content in blood. Seventy-five ESRD (25 treated and 15 non treated with rhEPO on HD), and (20 treated and 15 non treated with rhEPO on CAPD) patients participated in this study. Forty-five healthy volunteers (HV) served as a reference group. The mean plasma and erythrocytes Mg concentration (mmol/l) in HD and CAPD patients without and with rhEPO treatment was found to be significantly higher than in HV. In HD and CAPD patients treated by rhEPO the mean erythrocytes Mg levels were significantly lower than in non rhEPO treated groups. The inverse relationship between Hb and Mg concentration in erythrocytes in HD and CAPD patients with rhEPO treatment was observed (r = -0.63, P < 0.05 and r = -0.59, P < 0.01 respectively). The mean plasma Zn levels (micromol/l) in HD and CAPD patients with and without rhEPO have been significantly lower than in HV. In patients treated by rhEPO significant increase of Zn erythrocytes levels was found. We was found positive correlation between plasma and erythrocyte Zn levels and Hb concentration in HD and CAPD patients treated by rhEPO (r = 0.35, P < 0.05 and r = 0.4, P < 0.05 respectively). The Hb concentrations, total protein and albumin levels in HD and CAPD with rhEPO therapy were found significantly higher than in patients without rhEPO therapy, but still lower if compared to HV. Mean levels of iron and TIBC in plasma have been found significantly lower in both studied groups treated or non treated by rhEPO, in comparison to HV. In both studied groups of patients without rhEPO or treated by rhEPO plasma GC, GSA, Cr concentrations were significantly higher from those obtained in HV. No statistical correlations were found between Mg, Zn and total protein, albumin, iron levels and TIBC. During rhEPO therapy increased Hb concentration was connected with higher plasma and erythrocytes Zn levels and lower erythrocytes Mg levels. rhEPO may improve the Mg and Zn disturbed metabolism in uraemia.