Seroprevalence of hantavirus antibodies among chronic hemodialysis patients in the Czech Republic.

A total of 348 serum samples were collected from 301 hemodialysis patients with chronic renal failure of four healthcare settings in Western Bohemia. The sera were screened for the presence of hantavirus antibodies using ELISA kits (PROGEN Biotechnik GmbH) with Hantaan and Puumala antigens. Specific anti-Puumala antibodies were detected in five patients (1.7%). Although hantaviruses are known to cause primarily acute renal damage (interstitial nephritis) in Eurasia, chronic effects of hantavirus infection and the detection of specific antibodies in hemodialysis patients have also been reported. Nonetheless, the detection of seropositivity is not proof of an etiological link between hantaviruses and chronic renal failure. The hantavirus seropositivity rate in hemodialysis patients was not significantly higher than that in the general population. Our findings are consistent with the literature data and do not contradict the contribution of hantaviruses to the pathogenesis of chronic renal damage in the Czech Republic.

Effect of L-carnitine supplementation in hemodialysis patients.

BACKGROUND/AIM: L-Carnitine is important in beta-oxidation of fatty acids. A lack of carnitine in hemodialysis patients is caused by insufficient carnitine synthesis and especially by its loss during dialysis. The aim of our study was to test the influence of carnitine supplementation on plasma lipids, red blood cell count, and metabolism of free radicals. METHODS: Twelve regularly dialyzed patients (average age 55.5 years, average dialysis treatment period 22.5 months) were given 15 mg/kg L-carnitine intravenously three times weekly (after each hemodialysis session) for 6 months. Laboratory markers of oxidative stress, lipid metabolism, and red blood cell count were measured before the supplementation and then controlled during two 3-month intervals. Nine patients were retested 3 months after the supplementation had ended. RESULTS: All supplemented patients showed increased plasma free carnitine in comparison with the pretreatment values (113.3 +/- 11.2 vs. 62.3 +/- 16.7 micromol/l, p < 0.001). The proportion of decreased L-carnitine values after hemodialysis was reduced from 79 to 22%. Plasma total cholesterol (4.66 +/- 0.30 mmol/l after treatment vs. 5.65 +/- 1.53 mmol/l before treatment, p < 0.05) and LDL cholesterol (1.74 +/- 0.86 vs. 2.81 +/- 1.43 mmol/l, p < 0.05) decreased. The albumin concentration significantly increased from 34.8 +/- 7.3 to 46.0 +/-5.4 g/l (p < 0.05). Intraerythrocyte reduced glutathione increased from 1.65 +/- 0.25 to 2.23 +/- 0.16 mmol/l (p < 0.001), and the plasma antioxidant capacity increased from 1.65 +/- 0.09 to 2.06 +/- 0.17 mmol/l (p < 0.001). At the same time, plasma malondialdehyde decreased from 4.18 +/- 0.72 to 3.07 +/- 0.35 micromol/l (p < 0.001). The erythropoietin dose could be reduced from an average value of 5,500 to 3,500 U/week. No significant changes in the above-mentioned parameters were observed in a control group of dialyzed patients without L-carnitine supplementation. CONCLUSION: Regular carnitine supplementation of hemodialysis patients can improve their lipid metabolism, protein nutrition, red blood cell count, and antioxidant status.

Glutamine and other amino acid losses during continuous venovenous hemodiafiltration.

Serum amino grams and daily losses of glutamine (Gln) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 +/- 0.1 gN) and reached 4.5% of the daily AA substitution. Gln represented 32.7 +/- 5.9% of the total AA losses (0.19 +/- 0.04 gN). Serum levels of Gln (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gln in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gln losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gln metabolism and distribution that are reflected by a decrease of serum Gln levels at the institution of this treatment. Therefore, the need for Gln supplementation in ICU patients is even greater in the first days of CVVHDF.

[Evaluation of the nutritional status during treatment of anemia using erythropoietin in patients on regular dialysis therapy]. / Hodnocení vývoje nutricního stavu pri lécbe anémie erytropoetinem u nemocyných v pravidelném dialyzacním lécení.

Treatment of anaemia with human recombinant erythropoietin (r-Hu EPO) substantially improves the quality of life of patients receiving regular dialysis treatment. The positive effect on the nutritional state of patients during r-Hu EPO treatment is not accepted unequivocally so far. The authors followed-up 9 patients (6 men and 3 women) who had regular dialysis treatment, and suffered from severe anaemia. The patients were treated for 12 months with r-Hu EPO (preparation Eprex Cilagd Co.) with an initial dose of 30 mu/kg 3x per week by s.c. route with a target haemoglobin (Hb) value of 90-100 g/l. Before treatment during the 6th and 12th month of treatment the basic nutritional parameters of the patients were followed up. In the course of the investigation the Hb level (x +/- SD) increased from 61 +/- 12 g/l to 98 +/- 8 g/l, p < 0.01. On comparison of the nutritional parameters before treatment and after 12 months of treatment with r-Hu EPO the authors recorded rising trends in the patients' body weight (kg) from 67.4 +/- 12.2 to 68.4 +/- 11.2 (n.s.), an increase of the skinfold thickness above the triceps brachii muscle (mm) from 8.6 +/- 5.8 to 9.8 +/- 4.3 (n.s.), a decline of skin reactivity to diphtheric antigen (mm) from 2.1 +/- 2.8 to 1.8 +/- 0.8 (n.s.), a rising trend of reactivity to Candida antigen (mm) from 2.9 +/- 2.2 to 3.9 +/- 2.4 (n.s.), to diphtheric antigen from 3.0 +/- 3.3 to 5.1 +/- 3.8 (n.s.), a rise of the transferrin level (g/l) from 2.5 +/- 0.3 to 2.8 +/- 1.3 (n.s.), a rise of serum urea (mmol/l) from 25.7 +/- 3.6 to 32.5 +/- 9.5 (n.s.), a rise of Mullen's nutritional index from 21.8 +/- 15.5 to 22.3 +/- 24.7 (n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hepatitis C virus antibodies in persons on dialysis]. / Protilátky proti viru Hepatitidy C u dialyzovaných osob.

Using the ELISA method (generation II), the authors made a single examination of 172 dialyzed patients for the presence of antibodies against the virus of hepatitis C (VHC). Antibodies were detected in 82 subjects, i. e. 47.7%. The prevalence of antibodies in the examined subjects increased with the number of dialyses, no relationship was found with the number of transfusions. Of 104 subjects where during inclusion into the dialyzation transplantation programme a rise of ALT occurred 69, i. e. 66.3%, had antibodies. Antibodies were detected in 17 of 44 subjects (38.6%) to whom so far blood was not administered. A decisive place in the prevention of VHC transmission in dialyzed subjects is held by non-specific preventive measures, transfusions are most probably not the decisive vehicle.

Recurrent course of primary affective disorders: explanation by the theory of biorhythms.

The authors present the classification of biorhythms from the cybernetic aspects. They utilize this approach in describing and explaining the clinical course of periodic diseases in general, and of primary affective disorders in particular. In more complex organisms there exists a great number of single subsystems and their interactions, and therefore more possibilities arise for the development of natural biorhythms. If the number of single subsystems is 'n', the number of possible interactions may reach the maximum value of 'n!'. In more simple organisms the pseudobiorhythms may develop. This study focuses on the relationship of proper biorhythms to the recurrent course of illness, especially to that of primary affective disorders (PAD). Based on Fourier's decomposition of the periodical course into single ones, the authors hypothetically explain the peculiarity of the periodic course of PAD. In addition to sine form courses, the recurrences may originate from superimpositions of courses which originate from nonlinearity of single subsystems and are not harmonic. In real biosystems, such courses are undoubtedly more frequent than purely harmonic courses. This observation does not contradict the applied mathematical model, because each of these nonharmonic periodical courses may be decomposed into the harmonic ones. The proposed hypothesis presents an alternative or a supplementary model to the prevailing hypothesis which explains the course of PAD by the desynchronization of circadian rhythms controlled by special biooscillators.

Blood pressure and proteinuria in adolescents.

The study was conducted in two groups of factory apprentices including boys aged 15 to 17 years. The first group consisted of a randomly selected 10% sample of 231 apprentices of the total number of 2,300 boys. The second group included 77 boys with casually found proteinuria. In both groups, the distribution of blood pressure and of the body mass and changes in these indices were followed up over a period of two years. The boys with proteinuria had a significantly higher systolic and diastolic blood pressure and a lower body mass index. Their systolic and diastolic blood pressure was rising more steeply in regression to the body mass. The casual finding of asymptomatic proteinuria in juveniles always calls for a long-term follow-up. It signalizes, inter alia, also the presence of a factor raising blood pressure probably independently of body height and body mass.