Hemodialysis catheter malposition induced by a brachiocephalic vein stenosed stent.

Malposition of a central venous hemodialysis catheter, mainly due to central vein stenosis or thrombosis, is not an uncommon complication. Herein, we present a rare cause of a left external jugular vein hemodialysis catheter, malpositioned into the ipsilateral internal jugular-subclavian venous route, due to a stenosed stent that has been placed into the ipsilateral brachiocephalic vein.

Dogma disputed: postdialysis increase of aminotransferase values cannot be attributed to an inhibitor removal by hemodialysis.

The objective of this study was to assess changes of aspartate aminotransferase (AST [serum glutamic oxalacetic transaminase]) and alanine aminotransferase (ALT [serum glutamic pyruvic transaminase]) values after a hemodialysis (HD) session. Aspartate aminotransferase and ALT serum values were measured before and after a 4 h HD session in 37 stable patients (group A), before and after a 3.5 h isovolemic HD (IVHD, with a zero ultrafiltration rate) session in eight patients (group B), as well as before and after a session of "isolated ultrafiltration" (IUF) in eight more patients (group C). In group A, mean predialysis AST and ALT serum values that were 16.4 ± 4.3 and 16.0 ± 5.5 IU/L, increased to 20.1 ± 5.4 and 17.7 ± 6.2 IU/L, respectively (p < 0.0001, comparing pre- to postdialysis values, for both). When the postdialysis values were corrected for hemoconcentration induced by ultrafiltration, no differences were found in ALT values. However, postdialysis-corrected AST values (mean 17.7 ± 4.4 IU/l) remained higher compared with predialysis values (p < 0.001). The AST/ALT ratio was 1.13 ± 0.4 for predialysis values and 1.26 ± 0.5 for postdialysis values (p < 0.0001). Predialysis mean serum AST and ALT values did not show any difference after the 3.5 h IVHD sessions (group B), but increased significantly (p < 0.02) after the removal of 1.7 ± 0.2 L of fluid by IUF (group C). In chronic HD patients, postdialysis serum AST and ALT values increased significantly compared with predialysis values. This increment is mainly due to hemoconcentration induced by ultrafiltration and cannot be attributed to the removal of an aminotransferase inhibitor by HD.

Subtherapeutic serum vancomycin concentrations during on-line hemodiafiltration.

The aim of the study is to study vancomycin serum concentration changes during on-line hemodiafiltration (OL-HDF) and determine whether administration of vancomycin during the last hour of OL-HDF provides therapeutic serum concentrations. Vancomycin was administered intravenously at a dose of 15 mg/kg to 17 chronic hemodialysis patients who were enrolled into two study groups (A and B). In group A patients (n = 11), vancomycin was administered immediately postdialysis. Forty-three hours later, a 4-hour OL-HDF session was performed. Blood samples (S) for vancomycin measurement were drawn before, during, and after the session. In group B patients (n = 6), vancomycin was administered during the last hour of a 4-hour OL-HDF session on Monday. Vancomycin serum concentrations were measured postdialysis, as well as before and after the next two dialysis sessions of the week. In group A patients, mean vancomycin concentrations were reduced by 50% (S(pre): 10.2 ± 1.4 µg/ml, S(post): 5.0 ± 0.9 µg/ml). Vancomycin dialysance was 74.6 ± 29.3 ml/min, while the volume of distribution was 0.42 L/kg. In group B patients, mean vancomycin concentrations before the beginning of Wednesday and Friday dialysis sessions were 3.1 ± 0.7 and 1.4 ± 0.4 µg/ml, respectively. Postdialysis administration of vancomycin followed by OL-HDF resulted in a 50% reduction of vancomycin serum concentrations. Administration during the last treatment hour of OL-HDF results in subtherapeutic vancomycin serum concentrations over the course of the subsequent inter- and intradialytic intervals.

Kikuchi-Fujimoto disease and systemic lupus erythematosus: the EBV connection?

Kikuchi-Fujimoto disease (KFD) is a benign and self-limited disease of unknown etiology that affects mainly young women. It presents with localized lymphadenopathy, usually cervical, accompanied with fever, night sweats, and leucopenia. KFD has been rarely described in association with autoimmune disorders, mainly systemic lupus erythematosus (SLE). We report the case of a young patient presenting with KFD coinciding with SLE. The association of KFD and SLE is reviewed. Moreover, a possible pathogenetic role of Ebstein-Barr virus linking the two clinical entities is discussed.

The anticoagulant activity of enoxaparin sodium during on-line hemodiafiltration and conventional hemodialysis.

To study and compare the anticoagulant activity of enoxaparin sodium during on-line hemodiafiltration (OL-HDF) and conventional hemodialysis (C-HD). Enoxaparin was administered as an anticoagulant to 21 hemodialysis patients at the beginning of a single 4-hour OL-HDF session as an intravenous bolus dose of 80 IU/kg [DOSAGE ERROR CORRECTED] On-line hemodiafiltration was performed using a high-flux polyester polymer alloy dialyzer and a total of 18 L replacement fluid (session A). One week later, the study was repeated in the same patients during a single 4-hour session of C-HD using a low-flux polysulfone dialyzer (session B). Blood samples for the measurement of Hb, blood urea and nitrogen (BUN), activated partial thromboplastin time (APTT), and anti-Xa levels were taken before each study session and 5-minute postdialysis. In 13 more patients, the same study was performed during OL-HDF using a high-flux polysulfone dialyzer (session C). No differences were found between sessions A, B, and C when predialysis values for Hb, BUN, APTT, and anti-Xa were compared. The mean postdialysis APTT and anti-Xa values were 32.5+/-3.8 seconds and 0.19+/-0.11 IU/mL, respectively, in session A, 39.0+/-5.0 seconds and 0.71+/-0.17 IU/mL in session B, and 33.8+/-3.1 seconds and 0.35+/-17 IU/mL in session C (A vs. B, P<0.0001, for both parameters, A vs. C, P<0.003 for anti-XA, and B vs. C, P<0.005, for both parameters). The anticoagulant activity of enoxaparin sodium is decreased significantly during a 4-hour OL-HDF session compared with to a similar session of C-HD. The degree of the reduction seems to depend on the dialyzer's membrane.

Elevated hepatocyte growth factor levels at the beginning of high-flux hemodialysis are due to heparin administration.

BACKGROUND: It has been reported that hemodialysis (HD) stimulates hepatocyte growth factor (HGF) release, but it is not clear if this stimulation is due to HD itself or to heparin used during HD. To clarify this issue, we undertook the present study. METHODS: We studied 18 HD patients using high-flux dialyzers, during a single 4-hr hemodialysis session (session A). The dialyzers were pre-rinse with normal saline without heparin, and HD was started with zero ultrafiltration and without anticoagulation. Anticoagulation was administered as IV injection (80 IU/kg of LMWH enoxaparin sodium) 10 min after the beginning of HD. HD was continued for 10 more minutes and then as prescribed. HGF serum levels were measured before the beginning of the HD session (sample t0) as well as 10 and 20 minutes after the beginning of the session (samples t10 and t20). In six more patients (controls), the same study was repeated but without the administration of LMWH during the first 20 min of HD initiation (session B). RESULTS: In comparison with t0, t10 HGF serum levels changed significantly in neither session A nor in session B. However, at t20, HGF levels increased significantly in session A compared with t0 (increment 666.3 +/- 211.0%, p < 0.0001) and t10 (increment 894.2 +/- 506.0%, p < 0.0001), but not in session B. No differences were found between sessions A and B at samples t0 and t10 (p = NS). HGF serum levels at t20 in session A were found to be higher compared with corresponding levels in session B (p < 0.0001). CONCLUSION: Elevated HGF serum levels at the beginning of high-flux HD session are due to LMWH administration.

The effect of two different doses comprising the simultaneous administration of intravenous B-complex vitamins and oral folic acid on serum homocysteine levels in hemodialysis patients.

BACKGROUND: Several regimens using different doses of folic acid (FA) alone or supplemented with B-complex vitamins (BCVs) have been tested for their ability to reduce total homocysteine (tHcy) serum levels in hemodialysis (HD) patients. In the present study, we assessed the effect of two different doses comprising the simultaneous administration of intravenous (IV) BCVs and an oral FA supplementation on serum tHCy levels in HD patients. PATIENTS-METHODS: In a cohort of 49 patients (31 male, 18 female) undergoing chronic HD treatment for a mean of 40.0+/-40.7 months, serum concentrations of tHcy, folate and vitamin-B12 (vB12) were determined at the end of three sequential periods as follows: 20 weeks without any BCV and/or FA supplementation (period A), 20 weeks with a dose comprising the simultaneous administration of IV BCVs and an oral supplementation of 5 mg of FA once a week (period B), and 20 weeks with a dose comprising the simultaneous administration of IV BCVs and an oral supplementation of 5 mg of FA thrice a week (period C). An IV dose of BCVs consisting of a 5 mL solution containing vitamin B1 (250 mg), vitamin B6 (250 mg) and vitamin B12 (1.5 mg) was administered at the end of hemodialysis. RESULTS: Mean serum tHcy levels were significantly higher at the end of period A relative to levels at the end of periods B and C (35.8+/-23 micromol/L vs. 22.0+/-17.6 and 15.0+/-4.5 micromol/L, respectively; p<0.000001). Mean serum folate levels and mean serum vB12 levels were significantly lower at the end of period A relative to levels at the end of periods B and C (p<0.000001). Mean serum tHcy levels were lowest at the end of period C (p<0.000001 in comparison to periods A and B), and 26 of the 49 HD patients (67.3%) possessed tHcy levels below 16 micromol/L. CONCLUSIONS: In HD patients, high doses consisting of the simultaneous administration of IV BCVs and an oral FA supplementation resulted in the efficient reduction of serum tHcy levels.

HCO3 increment in arterial line can reveal significant vascular access recirculation in high-flux hemodialysis: a preliminary report.

We report a new and simple way that can reveal the presence of vascular access recirculation (VAR) in patients undergoing hemodialysis (HD). Acid-base and blood gas parameters (pH, pO(2), pCO(2), and HCO(3)) were measured in blood samples drawn from an arterial fistula needle before the initiation of HD and from arterial and venous lines simultaneously 5 min later, in 31 patients (group A). Vascular access recirculation was measured using the glucose infusion test (GIT) immediately after the withdrawal of the 5-min samples. The same study was repeated in 30 patients in whom HD lines were reversed (group B). A comparison with baseline (predialysis) values of an analysis of the arterial line in group A at 5 min revealed that pCO(2) increased by 1.14+/-2.5 mmHg and HCO(3) by 0.6+/-0.6 mM/L (p<0.02 and p<0.00001, respectively). The corresponding pO(2) and pH values did not show significant differences. Glucose infusion test at 5 min (GITa) was -0.058+/-0.03%. A comparison with baseline (predialysis) values of an analysis of the arterial line in group B at 5 min revealed that pCO(2) increased by 7.7+/-3.5 mmHg and HCO(3) by 2.9+/-1.0 mM/L (p<0.000001 in each case). The pH level was significantly lower in comparison with baseline values (p<0.00001), while pO(2) did not show a significant difference. Glucose infusion test at 5 min (GITb) was 12.0+/-6.1% (p<0.000001 in comparison with GITa values). Clinically significant VAR was defined as HCO(3) increment >1.8 mM/L, based on the receiver-operating characteristics curve, which showed a threshold value of HCO(3) increment >1.8 mmol/L as a predictor of GIT recirculation. Five minutes after the initiation of high-flux HD with a 0 ultrafiltration rate, there is a small increment in arterial HCO(3) values relative to predialysis values. Clinically significant VAR is present when this increment is higher than 1.8 mM/L.

pO2 and pCO2 increment in post-dialyzer blood: the role of dialysate.

Blood returning from a dialyzer during hemodialysis has a higher pO2 and pCO2 content than blood entering the dialyzer, and this has been attributed to the dialysate. The present study investigates this phenomenon. Acid-base and blood-gas parameters (pH, pO2, pCO2 and HCO3) were measured in three groups of stable chronic hemodialysis patients (A, B, and C) undergoing high-flux hemodialysis. In group A (n = 15), "arterial" (a) and "venous" (v) samples were withdrawn simultaneously before dialysis (samples A0), 5 min after circulation of the blood with the dialysate in the by-pass mode (samples A5), and 5 min after high-flux hemodialysis at a zero ultrafiltration rate (samples A10). In group B (n = 11) (a) and (v) samples were withdrawn simultaneously before dialysis (samples B0), 5 min after isolated-ultrafiltration with closed dialysate ports ("isolated-closed" ultrafiltration) (samples B5), and 5 min after high-flux hemodialysis at a zero ultrafiltration rate (samples B10). In group C (n = 14), after an initial arterial blood sample withdrawal before hemodialysis (sample C0), high-flux hemodialysis at a zero ultrafiltration rate was initiated. Five minutes later, blood and dialysate samples were withdrawn simultaneously from the hemodialysis lines (samples C5). In all cases blood and dialysate (bicarbonate) flow rates were set at 0.300 and 0.700 L/min, respectively. FLX-18 hemodialyzers (membrane PEPA 1.8 m2) were used in this study. Analysis of variance revealed significant changes only in venous samples. A comparison of arterial and venous samples revealed no differences between groups A and B before the initiation of dialysis (A0a vs. A0v and B0a vs. B0v, P = NS). The pO2 content was higher in A5v samples than in A5a samples (83.5 +/- 11.2 vs. 88.8 +/- 14.0 mm Hg, P < 0.02), while the level of HCO(3) was higher in A5a samples than in A5v samples (20.8 +/- 2.0 vs. 20.4 +/- 1.8 mEq/L, P < 0.05). A10a samples possessed a higher pH and lower levels of pO2, pCO2, and HCO3 in comparison to A10v samples (P < 0.001 for all). Mean pO2 and pCO2 values in A5v and A10v samples increased by 6.3% and 12.1% and by 1.29% and 52% in comparison to corresponding values of A5a and A10a samples, respectively. The pO2 level was the only parameter that differed significantly between B5a and B5v samples (B5a = 84.6 +/- 10.1 vs. B5v = 98.0 +/- 12.6 mm Hg, P < 0.005). B10a samples possessed a higher pH and lower levels of pCO2, pO2, and HCO3 in comparison to B10v samples (P < 0.0005 for all comparisons). Mean pO2 and pCO2 values in B5v and B10v samples increased by 16.2% and 16.3% and by -0.29% and 64.8% in comparison to corresponding values of B5a and B10a samples, respectively. C5a samples possessed a higher pH and lower levels of pCO2, pO2, and HCO3 in comparison to C5v samples (P < 0.001 for all). Mean pO2 and pCO2 values in C5v samples were, respectively, 16.0% and 65.0% higher than corresponding values of C5a samples. These results indicate that blood returning from the dialyzer after 5 min of high-flux hemodialysis has a higher pO2 and pCO2 than blood entering the dialyzer, and that this difference is due to O2 and CO2 transfer from the dialysate space into the blood.

Factors influencing patient survival and renal function outcome in pulmonary-renal syndrome associated with ANCA (+) vasculitis: a single-center experience.

Small vessel vasculitides, usually associated with positive antineutrophil cytoplasmic antibodies (ANCA(+)) can cause pulmonary-renal syndrome (PRS). Data from 22 patients, (19 males), aged 28-76 yrs (mean 55), with PRS were analyzed retrospectively. Renal function was estimated at presentation, 1 month after treatment initiation and at the end of follow-up (mean 4.4 +/- 3.3 yrs). Thirteen out of 22 patients had PR3 (+) ANCA and 9/22 patients had MPO (+) ANCA. Mean serum creatinine (Cr) at diagnosis was 6.6 +/- 4.4 mg/dL (M +/- SD) and proteinuria 1.6 +/- 1.4 g/24 hr (M +/- SD). During the 1st month of treatment with corticosteroids and cyclophosphamide, renal function improved in 12 patients (54.5%) (serum Cr from 8.5 +/- 4.5 to 4.3 +/- 2.3 mg/dL, p=0.001) remaining stable thereafter, and renal function deteriorated in nine patients (41%) (serum Cr from 4.1 +/- 3 to 6.5 +/- 2.9 mg/dL, p=0.03); one patient (4.5%) died because of sepsis. At the end of the study, 11/22 patients (50%) had died, eight patients of these (73%) because of respiratory failure, three patients (13.6%) reached end-stage renal disease (ESRD), five patients (36.4%) remained stable, but with impaired renal function and finally three patients (13.6%) improved, achieving almost normal renal function. In multiple regression analysis, factors contributing to final serum Cr were: dialysis dependency at the time of diagnosis p=0.01, initial proteinuria p<0.0001, and percentage of cellular crescents p=0.003. Main differences between PR3 and MPO (+) patients were the chest CT findings (bilateral nodules in PR3 (+) and "ground glass" or fibrosis in MPO (+) patients) and the renal function improvement rate after treatment initiation (rapid decline in serum Cr in PR3 (+) patients). In conclusion, PRS with ANCA (+) is associated with increased mortality. If renal function improves during the 1st month of treatment, it usually remains stable thereafter. The presence of PR3-ANCA is associated with an early response to treatment, while MPO-ANCA vasculits seems to necessitate prolonged treatment.

Functional analysis of a novel GATA3 mutation in a family with the hypoparathyroidism, deafness, and renal dysplasia syndrome.

The hypoparathyroidism, deafness, and renal dysplasia (HDR) syndrome is an autosomal dominant disorder caused by mutations of a member of the GATA-binding family of transcription factors, GATA3. This dual zinc finger transcription factor binds DNA with its C-terminal zinc finger (ZnF2) and stabilizes this binding with its N-terminal zinc finger (ZnF1). ZnF1 also interacts with other zinc finger proteins, notably Friend of GATA (FOG). The HDR syndrome has been described in patients with mutations affecting both ZnF1 and ZnF2 domains; the former result in inefficient interaction with FOG, and the latter result in disruption of DNA binding. We report a patient with renal failure, hypoparathyroidism, and bilateral hearing loss. Assessment of family members indicated that the disease arose as a de novo mutation in her mother. Analysis of GATA3 in the family revealed a heterozygous missense mutation resulting in a nonconservative change of a single amino acid (R276P) in the ZnF1 domain. Functional analysis using dissociation electrophoretic mobility shift and yeast two-hybrid assays showed reduced binding affinity to the GATA motifs but normal interaction with FOG in vitro. These results are consistent with the predicted functions of human GATA3-ZnF1 from three-dimensional molecular modeling and with HDR being a result of GATA3 haploinsufficiency.

Therapeutic plasma exchange in patients with grade 2-3 hematopoietic stem cell transplantation-associated thrombotic thrombocytopenic purpura: a ten-year experience.

In the present retrospective study we report our 10-year experience with therapeutic plasma exchange (TPE) in 18 patients with grade 2-3 hematopoietic stem cell transplantation (HSCT)-associated thrombotic thrombocytopenic purpura (TTP). During TPE a mean total quantity of 26.5 +/- 15.1 L of plasma was exchanged. Five patients (27.7%) had a complete response eight patients (44.4%) had a partial response while five patients (27.7%) died during TPE treatment. Among the survivors, relapse of TTP occured in three patients (23%) and although these patients were treated again with TPE, all died. First-year survival rate was 41.2%. Our results indicate that TPE may be effective in the treatment of some patients with grade 2-3 HSCT-associated TTP.

Heparin solution locked in acute hemodialysis catheters: impact on activated partial thromboplastin time.

Fifteen patients on hemodialysis, wearing acute dual lumen hemodialysis catheters (DLHCs) locked with a 4 ml heparin solution (HS) containing 7,500 IU of conventional heparin (3,750 IU/lumen), were studied. After the preexisting HS was aspirated and discarded, 10 ml of blood was withdrawn from each lumen in a syringe. Then, two 3 ml blood samples (A and B) were withdrawn in a row from the venous lumen; a third blood sample (C) was withdrawn from a peripheral vein, and the 20 ml of blood in the syringe was returned to the patient. Patient to control ratios of activated partial thromboplastin time (aPTT) in samples A, B, and C were 2.87 +/- 1.04, 2.02 +/- 0.85, and 1.06 +/- 0.14, respectively (p < 0.002 comparing A to B and B to C). In these patients, we also studied the effect of the same HS on the aPTT, 10 minutes after the filling of the DLHCs postdialysis. A blood sample (H1) was withdrawn at the end of the session; 10 minutes after injecting each lumen of the DLHC with a 2 ml HS containing 3,750 IU of heparin, a second blood sample (H2) was drawn from a peripheral vein. The aPTT ratios in samples H1 and H2 were 1.15 +/- 0.13 and 3.58 +/- 0.61 respectively (p < 0.0001). We concluded that even after the aspiration of 15 ml from the venous lumen of a DLHC filled with a 2 ml HS containing 3,750 IU of heparin, the next blood sample remains contaminated by heparin. Filling each lumen of a DLHC with the same HS results in a significant increment of the aPTT 10 minutes later.

The effect of long-term intravenous high dose B-complex vitamins with or without folic acid on serum homocysteine in hemodialysis patients.

BACKGROUND: Many regimens using different doses of folic acid (FA) alone or with supplementation of B-complex vitamins (BCV) have been tested for the reduction of total homocysteine (tHcy) levels in hemodialysis (HD) patients. BCV are usually administered orally and for a short period. In the present study, we assessed the effect of long-term intravenous (IV) BCV on serum tHCy levels in HD patients, and the effect produced by moderate oral supplementation with FA. METHODS: In a cohort of 37 patients under chronic HD treatment for a mean of 50.2 +/- 46.7 months, serum concentrations of tHcy, folate and vitamin B12 were determined at the end of four sequential periods: (A) three months without any FA supplementation, (B) three months with oral supplementation of 5 mg of FA three times weekly, (C) six months without FA supplementation, and (D) three months without BVC or FA supplementation. From the start of HD treatment and throughout the study until the beginning of period D, patients received a standard IV dose of BCV (B1 250 mg + B6 250 mg + B12 1.5 mg) three times per week, post-dialysis. RESULTS: At the end of period B, mean serum tHcy levels were significantly lower than in periods A and C (13.7 +/- 3.6 micromol/L vs 19.6 +/- 10.8 micromol/L and 21.3 +/- 9.4 micromol/L, respectively, p < 0.001) and mean serum folate levels were significantly higher (20.7 +/- 7.4 ng/mL vs 5.0 +/- 2.8 ng/mL and 4.5 +/- 1.4 ng/mL, respectively, p < 0.01). At the end of period D, mean serum tHcy levels were significantly higher than in all the previons periods (29.3 +/- 13.5 micromol/L, p < 0.001). Twenty-six of the 37 patients (70.2%) had normal (< 15 micromol/L) serum tHcy levels at the end of period B and only one (2.7%) had normal tHcy at the end of period D. Mean serum vitamin B12 levels at the end of periods A, B and C were 100 times the usual normal values. At the end of period D, although significantly lowered (p < 0.001), they remained above the normal range. CONCLUSIONS: Long-term high-dose BCV IV three times a week post-dialysis reduced serum tHcy levels only when combined with oral FA supplementation.

Lipoprotein abnormalities in hemodialysis and continuous ambulatory peritoneal dialysis patients.

Lipid abnormalities are important variables in the development of vascular atherosclerotic lesions in ESRD patients while Lp(a) represents an independent risk factor. In order to evaluate lipid changes in HD and CAPD patients, serum cholesterol (TC), HDLc, LDLc, TG, apolipoproteins (AI,AII,B,E), Lp(a), and albumin levels were estimated in 109 ESRD dialyzed patients, 46 in HD and 63 in CAPD (mean duration 50 +/- 40 and 25 +/- 19 months, respectively), and 45 volunteers with high serum levels of C and TG, without renal insufficiency. Both HD and PD group revealed statistically significantly higher levels than controls for TC, TG, LDL-C, Apo-B,-E, while HDL-C levels were significantly lower. Except for the lower serum albumin levels in both dialyzed groups after six months lower ApoAI levels and higher ApoB levels were observed in HD and PD patients respectively. Lp(a) levels remained unchanged in HD group, while a statistically significant increase appeared in PD patients that was negative correlated with the decreased serum albumin levels. These results indicate that renal replacement modalities result in a different effect in lipoprotein metabolism that may play an important role in atherosclerotic vascular disease of dialyzed ESRD patients.

Is arterial hypertension an underlying factor in the increased serum Lp(a) levels in ESRD dialyzed patients?

Except for the disorders in lipoprotein metabolism several other factors have been involved in the development of atherosclerotic changes in ESRD patients, including arterial hypertension. Serum lipid profile (total cholesterol (TC), triglycerides (TG), apolipoproteins (AI,AII,B,E) and Lp(a)) was evaluated in 109 ESRD dialyzed patients, 46 in HD and 63 in CAPD and 45 hyperlipidemic patients without renal failure (HL-group). According to the presence of arterial hypertension the dialyzed patients were divided in two groups: group A of 42 hypertensive patients, (mean age 62.3 +/- 15.5 years), which were satisfactorily controlled with anti-hypertensive medication, and group B of 67 non-hypertensive patients, (mean age 66.6 +/- 11.9 years). Lp(a) levels were statistically significantly higher than HL group in both HD (p = 0.001) and PD (p < 0.05) patients. Besides, by dividing HD and PD group in hypertensive and non-hypertensive patients, Lp(a) levels were statistically significantly higher in hypertensive patients, while such a difference was not observed among non-renal failure patients. These results indicate that arterial hypertension may play an important role in Lp(a) serum titles, in ESRD patients undergoing either HD or PD.