RESUMEN
INTRODUCTION AND AIMS: Fatigue is a major determinant for quality of life for patients undergoing chronic hemodialysis (HD) treatment. The aim of this study was to determine the severity and contributing factors of fatigue in patients under chronic HD treatment. METHODS: 154 end-stage renal disease (ESRD) patients under HD treatment (92 M, 62 F, mean age 53 ± 15 y, mean duration of HD treatment 92 ± 65 months) were enrolled. Patients were given Piper's fatigue scale (PFS), Epworth sleepiness scale (ESS) and Beck depression test (BDT). Study participants were evaluated at the end of the HD session. RESULTS: ESS score was above 10 (indicating daytime sleepiness) in only 6 (3.9%) patients. The overall PFS scores were normal-to-mild in 25 (16.2%), moderate in 63 (40.9%) and severe in 66 (42.9%) patients. Total PFS score was correlated with presence of depression (OR: 2.48), employment status (OR: 2.25), calcium (OR: 2.64) and phosphate (OR: 3.70) concentration. PFS behavior score was correlated with employment status (OR: 2.29) and phosphate (OR: 1.96). PFS affective score was correlated with presence of depression (OR: 2.56), employment status (OR: 2.72) and creatinine (OR: 2.25) concentration. PFS sensory score was correlated with advanced age (OR: 1.95), presence of depression (OR: 2.90), albumin (nutritional status) (OR: 0.17), postdialysis serum urea level (OR: 2.37), hemoglobin (anemia) (OR: 0.21). CONCLUSION: Daytime sleepiness is not prevalent; however, fatigue is closely related to presence of depression, employment status, and calcium and phosphate levels.
Asunto(s)
Fatiga/etiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Calidad de Vida , Diálisis Renal , Adulto , Anciano , Anciano de 80 o más Años , Calcio/sangre , Distribución de Chi-Cuadrado , Depresión/etiología , Empleo/estadística & datos numéricos , Fatiga/fisiopatología , Fatiga/psicología , Femenino , Humanos , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/psicología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Fosfatos/sangre , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Encuestas y CuestionariosRESUMEN
BACKGROUND: Free triiodothyronine (FT3) is a marker of comorbidity in end-stage renal disease and in many acute and chronic diseases. The objective of the present study was to investigate the effects of pretransplantation FT3 concentration on graft function. MATERIALS AND METHODS: Between 2003 and 2008, the study enrolled 86 patients who underwent renal transplantation. Twenty-six patients were women, and 60 were men, with overall mean (SD) age of 38 (10) years. In all patients, serum FT3, free thyroxine, and thyroid-stimulating hormone concentrations were determined before transplantation. Demographic data and laboratory values were evaluated at 2 years posttransplantation. RESULTS: The overall graft survival rate at 2 years was 82.1%. Pretransplantation serum FT3 concentration was inversely correlated with 2-year serum creatinine concentration (r=-0.29; P=.01) and proteinuria (r=-0.37; P<.00). Linear regression analysis demonstrated that serum FT3 (r2=0.63; 95% confidence interval, 0.52-0.74; P=.00) was a statistically significant risk factor for increased serum creatinine concentration. No correlation was observed for thyroid-stimulating hormone or free thyroxine and posttransplantation data. CONCLUSION: Patients with end-stage renal disease with low pretransplantation serum FT3 concentration are at greater risk of subsequent graft failure. Measurement of pretransplantation serum FT3 concentration could be a clinically useful method of identifying patients at increased risk of graft failure.
Asunto(s)
Fallo Renal Crónico/sangre , Trasplante de Riñón/métodos , Triyodotironina/sangre , Adulto , Creatinina/sangre , Femenino , Rechazo de Injerto , Humanos , Masculino , Análisis de Regresión , Riesgo , Factores de Riesgo , Tirotropina/sangre , Tirotropina/metabolismo , Tiroxina/metabolismo , Resultado del TratamientoRESUMEN
Rapamycin (RPM) has antiangiogenic and antiproliferative effects on cells. The aim of this study was to evaluate the mechanism of RPM as a novel antifibrotic agent by assessing its effect on interstitial fibrosis (IF). Among 60 renal transplant recipients, group 1 patients (n=20) were treated with RPM and group 2 (n=40), with cyclosporine. The proportions of infiltrating macrophages and lymphocytes in the interstitium were evaluated in 1-year biopsies. The microvessels were highlightened with CD34. After an initial biopsy, the development of diffuse IF over 18 months was evaluated by follow-up biopsies. The mean microvessel density (MVD) was significantly lower among group 1 (69.3±16) versus group 2 (96.5±30; P<.001). The proportions of macrophages and lymphocytes were lower in group 1 compared to group 2 biopsies (P<.001 for both). Fourteen (35%) group 2 and only 2 (10%) group 1 cases developed IF over 18 months (P<.05). The mean MVD in the initial biopsy was 75.6±18 in cases that did not versus 120±28 among those who did develop IF (P<.001). The amount of interstitial inflammation was greater among patients who did compared with cases who did not develop IF (P<.01). The overall 1-, 3-, and 5-year graft survival rates for group 1 were 95%, 95%, and 89% versus 95%, 65%, and 45% for group 2 patients, respectively (P<.001). RPM-treated patients showed a lower incidence of diffuse IF, which can be explained by antiproliferative and antiangiogenic effects of RPM. In conclusion, RPM therapy displayed an independently positive impact on long-term graft survival.
Asunto(s)
Fibrosis/prevención & control , Trasplante de Riñón/métodos , Neovascularización Patológica , Sirolimus/farmacología , Trasplante Homólogo/métodos , Adulto , Antígenos CD34/biosíntesis , Biopsia , Proliferación Celular , Ciclosporina/farmacología , Femenino , Supervivencia de Injerto , Humanos , Inmunosupresores/farmacología , Inflamación , Linfocitos/metabolismo , Macrófagos/citología , Macrófagos/metabolismo , MasculinoRESUMEN
BACKGROUND: Genetic polymorphisms of the renin-angiotensin system (RAS) have been reported to play an important role in the pathogenesis of diabetes mellitus and hypertension. In addition, a close association has been reported between RAS and the progression of both diabetes and hypertension. But the role of RAS on the development of posttransplantation diabetes mellitus (PTDM) is not known. For this purpose we investigated the association of polymorphisms in the genes for angiotensin-converting enzyme (ACE) and angiotensinogen (AGT) with the development of PTDM. METHODS: Genotyping for ACE insertion/deletion (I/D) and AGT M235T polymorphisms was performed in 50 patients who underwent renal transplantation during a 5-year period. Group 1 consisted of 23 recipients who developed PTDM and group 2 consisted of 27 recipients that did not have PTDM. RESULTS: Of 50 patients, 13 (26%) showed the ACE DD, 21 (42%) the ACE ID, and 16 the ACE II genotype. The frequencies of AGT MM, AGT MT, and AGT TT were 0, 54%, and 46%, respectively. Compared with group 2, there were high frequencies of the AGT TT genotype in group 1 recipients (P<.001). In addition the ACE DD genotype was found significantly higher in group 1 patients compared with group 2 patients (P=.001). CONCLUSION: The high frequencies of the AGT TT genotype and ACE DD genotype in recipients may contribute to the high prevalence of PTDM. Our data suggest a synergistic effect between the ACE and AGT polymorphism in the risk of PTDM, but to support this theory a larger patient group must be studied.
Asunto(s)
Angiotensinógeno/genética , Diabetes Mellitus/genética , Eliminación de Gen , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/genética , Trasplante de Riñón/métodos , Peptidil-Dipeptidasa A/genética , Polimorfismo Genético , Adulto , Complicaciones de la Diabetes/genética , Progresión de la Enfermedad , Femenino , Genotipo , Humanos , Hipertensión/genética , Inmunosupresores/farmacología , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Trasplante HomólogoRESUMEN
We sought to investigate predictors of early development of postoperative hypocalcemia in secondary hyperparathyroidism. Thirty-six hemodialysis patients (21 men, 15 women; mean age, 39.6 +/- 13.2 years; mean hemodialysis duration, 77.9 +/- 47.1 months) underwent parathyroidectomy. We recorded preoperative adjusted serum calcium (Ca(+2)), phosphate, alkaline phosphatase, intact parathyroid hormone, and hemoglobin levels; mean systolic and diastolic blood pressure levels; parathyroid ultrasonography and scintigraphic data; and number and weight of the resected adenomas. Patients were divided into two groups based on Ca(+2) levels within 24 hours of parathyroidectomy: the hypocalcemia group (serum Ca(+2) levels < or = 8 mg/dL; n = 26 patients) and the normocalcemia group (>8 mg/dL; n = 10 patients). A total parathyroidectomy with autotransplant was performed in 23 patients and a subtotal parathyroidectomy in 13 patients. Age (36.0 +/- 9.7 vs 49.2 +/- 16.6 years; P = .006); levels of preoperative serum Ca(+2) (9.6 +/- 0.7 vs 10.4 +/- 1.1 mg/dL; P = .01), alkaline phosphatase (346.7 +/- 354.7 vs 653.3 +/- 553.7 mg/dL; P = .05), and hemoglobin (10.5 +/- 1.4 vs 12.3 +/- 2.5 g/dL; P = .009); and number (2.0 +/- 1.3 vs 2.9 +/- 0.9; P = .04) and weight (1.9 +/- 2.1 vs 3.2 +/- 1.7; P = .01) of excised parathyroid adenomas were significantly lower among the hypocalcemia than the normocalcemia group. Among hemodialysis patients with secondary hyperparathyroidism, age, levels of preoperative serum Ca(+2) and alkaline phosphatase, and number and weight of adenomas were associated with early development of postoperative hypocalcemia.
Asunto(s)
Hiperparatiroidismo/fisiopatología , Hipocalcemia/etiología , Complicaciones Posoperatorias/epidemiología , Diálisis Renal , Insuficiencia Renal/etiología , Adulto , Anciano , Fosfatasa Alcalina/sangre , Presión Sanguínea , Calcio/sangre , Femenino , Hemoglobinas/metabolismo , Humanos , Hiperparatiroidismo/complicaciones , Hipocalcemia/epidemiología , Hipocalcemia/fisiopatología , Masculino , Persona de Mediana Edad , Paratiroidectomía/efectos adversos , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Insuficiencia Renal/terapia , Estudios Retrospectivos , Trasplante AutólogoRESUMEN
The metabolic syndrome (MS) is a known cardiovascular risk factor in the general population and a common problem among renal transplant recipients. This study investigated whether MS after renal transplantation affected long-term graft function. We included 112 transplants at our center between 2000 and 2002. We excluded patients with the presence of pretransplant diabetes or nonstable renal function at 1 year after transplantation. We evaluated parameters such as demographic features, medications, smoking history, body mass index, daily proteinuria, blood pressure, number of HLA mismatches, number of acute rejection episodes, delayed graft function, and laboratory parameters. Patients were followed for a mean of 69.86 +/- 21.94 months. The prevalence of MS was determined using the National Cholesterol Education Program-Adult Treatment Panel III criteria. At 1 year after transplant, 28.6% of subjects had MS, whereas only 10.7% had MS before transplantation. Among 27.7% of patients graft failure had occurred during the follow-up; MS was more frequent among these individuals compared with those displaying stable renal function (51.6% vs 19.8%; P = .002). Older donor age, delayed graft function, acute rejection episodes, smoking history, MS, proteinuria, serum creatinine level, and C-reactive protein were associated with graft failure. Upon multivariate Cox regression analysis, patients with MS at 1 year after transplantation showed an increased risk for graft failure (relative risk, 0.22; 95% confidence interval, 0.06-0.75; P = .016). Older donor age and proteinuria level were other independent risk factors for graft failure. The MS was a prominent risk factor for graft failure. Because MS is a cluster of modifiable risk factors, early identification of patients at risk and intervention in due time may improve graft survival.
Asunto(s)
Trasplante de Riñón/efectos adversos , Síndrome Metabólico/epidemiología , Adulto , Presión Sanguínea , Índice de Masa Corporal , Demografía , Antígenos HLA/inmunología , Humanos , Trasplante de Riñón/inmunología , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Proteinuria/epidemiología , Diálisis Renal , Factores de Riesgo , Fumar/epidemiología , Factores de Tiempo , Donantes de Tejidos/estadística & datos numéricos , Adulto JovenRESUMEN
Vitamin D has immunomodulatory and anti-inflammatory activities in the healthy population and in various disease states. There are few data on the quantification of vitamin D status and inflammation with respect to changes in bone mineral density among renal transplantation patients. We analyzed the influence of vitamin D levels on allograft function and inflammatory status at the time of enrollment and at 1-year follow-up. Sixty-four renal transplant patients, including 38 males, showed an overall age of 38.61 +/- 1.05 years, had a mean graft age of 6.15 +/- 3.17 years. We excluded patients who had diabetes mellitus, chronic inflammatory disease, or chronic allograft nephropathy. We obtained pre- and posttransplantation serum samples and daily proteinuria on each patient. Measurements of bone mineral density were performed by dual-energy X-ray absortiometry. After enrollment, we followed the patients for 1 year. Thereafter we assessed serum creatinine, C-reactive protein, albumin, and spot urinary protein levels. The patients were divided into two groups based upon vitamin D levels: group I (n = 29), <20 microg/L versus group II (n = 35), >or=20 microg/L. There was no significant difference in intact parathyroid hormone levels between the two groups. Vitamin D level positively correlated with serum creatinine (r = .32, P = .01) and serum albumin levels (r = .28, P = .023) at the time of enrollment. At 1 year, patients in group I showed significantly higher creatinine (P < .001) and proteinuria levels (P < .05) than those in group II. Low vitamin D levels are not uncommon among renal transplant recipients. There was a significant association of vitamin D levels with renal allograft function. Low vitamin D levels may be a predictor of worsening of graft function and increasing proteinuria.
Asunto(s)
Densidad Ósea , Inflamación/epidemiología , Trasplante de Riñón/fisiología , Vitamina D/sangre , Adulto , Presión Sanguínea , Proteína C-Reactiva/metabolismo , Creatinina/sangre , Femenino , Estudios de Seguimiento , Prueba de Histocompatibilidad , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/inmunología , Masculino , Persona de Mediana Edad , Proteinuria , Albúmina Sérica/metabolismoRESUMEN
BACKGROUND: Cardiovascular disease is the primary cause of death in renal transplant recipients, and elevated renal allograft resistive index (RI) has been associated with patient survival. OBJECTIVE: To evaluate the predictive value of intrarenal RI on atherosclerotic disease. PATIENTS AND METHODS: Ninety-seven patients who had undergone renal transplantation between 1999 and 2001 and had stable renal function were included in the study. Patients with renal artery stenosis, urinary tract obstruction, clinical symptoms of acute rejection, or chronic allograft nephropathy were excluded. Clinical and laboratory information was obtained from the medical records and included demographic data, medications used, body mass index, blood pressure, and laboratory values. Intrarenal RI and carotid intima-media thickness (IMT) were determined using Doppler ultrasonography. RESULTS: At linear regression analysis, RI was significantly correlated with recipient age, C-reactive protein concentration, systolic blood pressure, pulse pressure, body mass index, smoking, and carotid IMT. At multivariate linear regression analysis, only pulse pressure was an independent predictor of intrarenal RI. CONCLUSION: Intrarenal RI is associated with traditional cardiovascular risk factors and carotid IMT. Elevated intrarenal graft RI may be predictive of cardiovascular disease in renal transplant recipients without complications.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Trasplante de Riñón/efectos adversos , Resistencia Vascular/fisiología , Adulto , Presión Sanguínea , Enfermedades Cardiovasculares/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Rechazo de Injerto/diagnóstico por imagen , Humanos , Riñón/diagnóstico por imagen , Riñón/fisiopatología , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Selección de Paciente , Pulso Arterial , Análisis de Regresión , Arteria Renal/diagnóstico por imagen , Arteria Renal/fisiopatología , Ultrasonografía DopplerRESUMEN
Aim. Renin-angiotensin system (RAS) gene mutations have been implicated as a risk factor for the presence and progression of renal disease in vesicoureteral reflux (VUR). However, the results are contradictory, and the effects of RAS polymorphisms in VUR patients with end-stage renal disease (ESRD) have not been defined yet. This study was designed to evaluate the angiotensin-converting enzyme insertion/deletion (ACE-I/D), angiotensinogen (AGT) M235T, and angiotensin II receptor type 1 (ATR1) A1166C and type 2 (ATR2) C3123A gene polymorphisms as risk factors for progression to ESRD in patients with VUR. Methods. ACE-I/D, AGT-M235T, ATR1-A1166C, and ATR2-C3123A were identified in 161 ESRD patients (52 female, 109 male; 77 renal transplant, 84 dialysis; age: 34.4 +/- 11.2 years). VUR was the ESRD etiology in 40 patients. Genetic polymorphisms of the ACE gene I/D, AGT gene M235T, ATR1 gene A1166C, and ATR2 gene C3123A were identified in all of the patients. Results. We detected no linkage between genetic polymorphisms of ATR1-, ATR2-, AGT-, and VUR-related ESRD. When ACE gene was considered, VUR(+) patients had 63.6% DD, 36.4% ID, and no II alleles, whereas VUR(-) patients had 48.6% DD, 43.2% ID, and 8.1% II alleles. Conclusion. A striking feature of VUR-related ESRD patients was the absence of II alleles, so the DD genotype may be accepted as a genetic susceptibility factor for progression to ESRD in VUR patients.
Asunto(s)
Fallo Renal Crónico/genética , Polimorfismo Genético , Sistema Renina-Angiotensina/genética , Reflujo Vesicoureteral/complicaciones , Adulto , Angiotensinógeno/genética , Proteínas de la Ataxia Telangiectasia Mutada , Proteínas de Ciclo Celular/genética , Progresión de la Enfermedad , Femenino , Eliminación de Gen , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Humanos , Fallo Renal Crónico/etiología , Masculino , Persona de Mediana Edad , Mutagénesis Insercional , Peptidil-Dipeptidasa A/genética , Proteínas Serina-Treonina Quinasas/genética , Medición de Riesgo , Factores de Riesgo , Reflujo Vesicoureteral/genéticaAsunto(s)
Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/etiología , Infecciones Estreptocócicas/complicaciones , Streptococcus anginosus , Anciano , Ampicilina/uso terapéutico , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/terapia , Infecciones Estreptocócicas/tratamiento farmacológico , Sulbactam/uso terapéuticoRESUMEN
OBJECTIVE: Hepatitis C virus (HCV) infection exerts diverse effects on atherogenesis. We investigated whether malnutrition inflammation score (MIS) is associated with the presence of coronary artery disease (CAD) in anti-HCV-positive hemodialysis (HD) patients. SUBJECTS/METHODS: Twenty-two anti-HCV-positive HD patients with CAD and 61 anti-HCV-positive HD patients without CAD (as controls) were included. Data were obtained from hospital records, patients were evaluated for risk factors for CAD. The same physician performed MIS evaluation. RESULTS: MIS of anti-HCV-positive HD patients with CAD were significantly higher than patients without CAD (8.8+/-4.0 vs 6.5+/-2.6, P=0.02). In patients with CAD, basal (P=0.002) and peak C-reactive protein (P=0.03) and serum ferritin (P=0.01) concentrations were higher, serum albumin concentrations (P=0.003) were lower than those patients without CAD. MIS was positively correlated with age (r=+0.359, P=0.001) and viral load (r=+0.629, P<0.0001). In univariate logistic regression analysis, advanced age (odds ratios (OR)=1.093, confidence interval (CI): 1.039-1.150, P=0.001), hypertension (OR=3.143, CI: 1.084-9.116, P=0.035), diabetes mellitus (OR=5.344, CI: 1.343-21.269, P=0.017), low triglyceride (OR=0.992, CI: 0.984-0.999, P=0.026) and high MIS (OR=1.259, CI: 1.066-1.488, P=0.007) were associated with the presence of CAD. Multivariate logistic regression analysis identified age (OR=1.090, CI: 1.007-1.179, P=0.033) and MIS as the factors associated with the presence of CAD (OR=1.232, CI: 1.004-1.511, P=0.04). CONCLUSIONS: MIS may be associated with CAD in anti-HCV-positive HD patients.
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Enfermedad de la Arteria Coronaria/epidemiología , Hepatitis C/complicaciones , Inflamación/patología , Desnutrición/patología , Diálisis Renal , Factores de Edad , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria/etiología , Estudios Transversales , Femenino , Hepatitis C/sangre , Anticuerpos contra la Hepatitis C/sangre , Humanos , Inflamación/sangre , Inflamación/diagnóstico , Inflamación/etiología , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Modelos Logísticos , Masculino , Desnutrición/sangre , Desnutrición/diagnóstico , Desnutrición/etiología , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Albúmina Sérica/metabolismo , Carga ViralAsunto(s)
Soluciones para Diálisis/efectos adversos , Brotes de Enfermedades , Contaminación de Medicamentos , Glucanos/efectos adversos , Glucosa/efectos adversos , Peritonitis/epidemiología , Peritonitis/microbiología , Biopelículas , Humanos , Icodextrina , Fallo Renal Crónico/microbiología , Fallo Renal Crónico/terapia , Turquía/epidemiologíaRESUMEN
Delayed graft function (DGF) is associated with decreased long-term renal allograft survival, however, the entire mechanism of action of DGF has not yet been established. The goal of this study was to determine possible risk factors for DGF in young living-related renal allograft recipients. We retrospectively analyzed the outcome of 142 renal transplant recipients (115 men and 27 women; mean age, 29.7 +/- 9.43 years; 114 living-related donors and 28 cadaveric donors). Data recorded for each patient and donor included gender, age at transplantation, duration of pretransplantation dialysis (recipients only), body mass index, number of human leucocyte antigen mismatches, panel-reactive antibodies, donor creatinine clearance, body weight, systolic and diastolic blood pressure levels, lipid profile, and biochemical parameters. Having obtained the transplant from a cadaveric donor (P<.000, odds ratio [OR]=17.556, confidence interval [CI]=5.961-51.743) and a pretransplantation systolic blood pressure level in the recipient of <120 mm Hg (P<.021, OR=3.600, CI=1.214-10.672) were possible risk factors for DGF. When only living-related recipients were considered, the systolic blood pressure level was significantly associated with DGF. We concluded that a pretransplantation systolic blood pressure level <120 mm Hg is a risk factor for DGF and that preoperative blood pressure control and intervention may help to decrease the risk of DGF.
Asunto(s)
Diástole , Trasplante de Riñón/fisiología , Donadores Vivos , Reoperación/estadística & datos numéricos , Sístole , Adulto , Cadáver , Familia , Femenino , Humanos , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Renal , Donantes de Tejidos , Trasplante Homólogo , Resultado del TratamientoRESUMEN
The preoperative evaluation of pulmonary function is important in renal transplantation candidates. Exercise capacity determined by peak oxygen uptake (peak Vo(2)) is a predictor of perioperative mortality and survival. The aim of this study was to determine the factors associated with the peak Vo(2) among renal transplantation candidates undergoing hemodialysis. Thirty patients with chronic renal failure including 14 women and 16 men of mean age 40.2 +/- 10.3 years had a mean duration of dialysis of 133.1 +/- 63.3 months and were awaiting renal transplantation. None of the patients had signs or symptoms of active infection or inflammation. Each patient underwent pulmonary function and symptom-limited cardiopulmonary exercise tests. Despite the absence of clinically evident inflammation, a malnutrition inflammation score was calculated for each patient to assess comorbid conditions and the risk of atherosclerosis. Demographic and laboratory parameters were obtained from hospital records. The peak Vo(2) was positively correlated with the serum triglyceride level and negatively correlated with serum ferritin level and malnutrition inflammation score. On multiple linear regression analyses, which were performed to assess the potential predictors of the peak Vo(2), the malnutrition inflammation score was the only variable that independently correlated with the peak Vo(2) in hemodialysis patients awaiting renal transplantation. In conclusion, peak Vo(2) is associated with markers of nutrition and the malnutrition inflammation score. We suggest that chronic malnutrition and silent inflammation may be responsible for the preoperative decreased exercise capacity in renal transplantation candidates undergoing hemodialysis.
Asunto(s)
Fallo Renal Crónico/fisiopatología , Trasplante de Riñón/fisiología , Consumo de Oxígeno , Diálisis Renal , Adulto , Proteína C-Reactiva/análisis , Prueba de Esfuerzo , Femenino , Humanos , Inflamación/epidemiología , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Masculino , Desnutrición/epidemiología , Persona de Mediana Edad , Pruebas de Función Respiratoria , Listas de EsperaRESUMEN
The objective of this study was to determine whether early proteinuria after renal transplantation affected long-term allograft survival. The 130 patients included 105 men and 25 women of overall mean age, 29.6 +/- 9.6 years. There were 105 living related and, 25 cadaveric donor transplants. Proteinuria was defined as a level in of more than 300 mg/d. Donor and recipient age at transplantation, duration of pretransplant dialysis, donor type (living related or cadaveric), the presence of delayed graft function or acute rejection, panel-reactive antibodies, the number of human leukocyte antigen mismatches, and the systolic blood pressure level were retrospectively recorded for the study subjects. Cox regression analysis was used to determine the effects of proteinuria on allograft survival. Patients with proteinuria demonstrated significantly lower graft survival rates than did those without proteinuria (54.17% vs 82.62%, respectively; P<.002). Proteinuria at the third month after transplantation (P<.004, odds ratio [OR]=3.26, confidence interval [CI]=1.46 to 7.29), donor age (P<.001, OR=1.06, CI=1.02 to 109), and panel-reactive antibodies (P<.041, OR=1.06, CI=1.00 to 1.12) were significantly associated with decreased allograft survival. Early proteinuria after renal transplantation was indicative of a high risk for allograft dysfunction. A reduction of proteinuria may be associated with improved graft survival.
Asunto(s)
Trasplante de Riñón/patología , Proteinuria/diagnóstico , Trasplante Homólogo/patología , Adulto , Cadáver , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Prueba de Histocompatibilidad , Humanos , Trasplante de Riñón/inmunología , Donadores Vivos , Masculino , Complicaciones Posoperatorias/orina , Factores de Tiempo , Donantes de TejidosRESUMEN
Cytomegalovirus (CMV) infection is a risk factor for arteriosclerosis in renal transplant recipients. We sought to investigate the effects of CMV infection on atherosclerotic events (AE) in renal transplant recipients. This retrospective analysis included 200 patients: 52 women and 148 men of overall mean age of 36.18 +/- 10.23 years who were transplanted at our center between 1998 and 2001. We analyzed demographic features, dialysis duration, diabetes, blood pressure level, body mass index (BMI), medications, and lipid parameters. CMV infection was diagnosed in 23.5% of patients in the first 2 years after transplantation; these patients were followed for 4 years. All patients had been assessed for AE, including previous myocardial infarction, angina, revascularization procedures, intermittent claudication, stroke, or transient ischemic attack. AE occurred in 13% during the follow-up period. CMV infection was more frequent among these patients compared to those without AE, namely 42.3% versus 20.6%, respectively. Although the gender, dialysis duration, serum cholesterol level, presence of acute rejection, and BMI were not associated with AE, age, hypertension, and CMV infection did show a relation. A multivariate analysis by logistic regression revealed mean age and CMV infection to be independent risk factors for AE: odds ratio (OR)=5.6, 95% confidence interval (CI)=1.3 to 24.6 (P=0.02) and OR=4, 95% CI = 1.3 to 12.3 (P=.01). This study suggested that the presence of CMV infection may be a triggering factor for AE in renal transplant recipients.
Asunto(s)
Aterosclerosis/epidemiología , Infecciones por Citomegalovirus/epidemiología , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/epidemiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Hyperuricemia is a common complication in renal transplant recipients, and uric acid (UA) may play a role in renal dysfunction. The aim of this study was to evaluate the effects of UA on chronic allograft nephropathy (CAN) in renal transplant recipients. The 133 study subjects included 34 women and 99 men of overall mean age of 34.7 +/- 9.9 years. They underwent renal transplantation between 1998 and 2000. Serum UA levels were measured in the first month after transplantation and then at yearly intervals throughout a 3-year follow-up. In the first month after transplantation, 55.3% of recipients had hyperuricemia (UA >7 mg/dL in men; UA >6 mg/dL in women), but, 3 years after transplantation, 84.6% of the subjects had that disorder (P<.001). CAN was diagnosed in 31.5% of the patients at a mean onset of 31.8 +/- 14.3 months after transplantation. Fifty-two percent of these individuals experienced graft failure within 43.3 +/- 20.8 months after transplantation. UA levels were recorded before the development of CAN. There was no association between UA levels and CAN according to a Cox regression analysis (P>.05; relative risk, 1.082; 95% confidence interval [CI] 0.9-1.3). We concluded that the prevalence of hyperuricemia was higher among recipients than in healthy individuals, but that the UA level did not affect the development of CAN during first 3 years after transplantation.
Asunto(s)
Biomarcadores/sangre , Hiperuricemia/epidemiología , Trasplante de Riñón/patología , Complicaciones Posoperatorias/sangre , Ácido Úrico/sangre , Adulto , Femenino , Estudios de Seguimiento , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Trasplante Homólogo/patologíaRESUMEN
BACKGROUND: Vitamin D receptor (VDR) gene polymorphisms have been widely studied, especially to analyze their effects on calcium-phosphorus metabolism and secondary hyperparathyroidism in patients on dialysis. In this study, we sought to investigate the possible effects of these polymorphisms on the anemia of renal failure and recombinant human erythropoietin (rHuEPO) responses among patients receiving hemodialysis. METHODS: One hundred twenty-eight patients (52 females/76 males) underwent genotyping for the insertion/deletion Bsml (B-->b, restriction site, exon VIII-->IX) and Tagl (T-->t, 352 exon IX) VDR gene polymorphisms. The mean value of the last 6 months' monthly evaluated laboratory values (C-reactive protein, hemoglobin, iron indices, PTH, and albumin) and clinical findings (rHuEPO requirement, cumulative iron supplementation doses, and body weight) were analyzed retrospectively excluding patients with chronic inflammation, hemolytic anemia, or active blood loss such as gastrointestinal bleeding. RESULTS: Mean age and dialysis durations were 41.5 +/- 11.8 years and 91.8 +/- 45.3 months, respectively. Polymorphism percentages were as follows: Bsml; BB/Bb/bb: 32.2/63.6/4.2 and Tagl; TT/Tt/tt: 40.5/55.4/4.1%, respectively. BB variant of Bsml gene was related to lower rHuEPO needs (P < .05) and also higher hemoglobin levels (P < .005) when compared with the Bb/bb variant. Considering Tagl variants, transferrin saturation levels were lower (P < .03) among patients with the Tt/tt variant, but there was no other significant difference in the mean values of other data between TT and Tt/tt variants. CONCLUSION: The BB variant of Bsml was related to decreased rHuEPO requirements to achieve higher hemoglobin levels among maintenance hemodialysis patients without chronic inflammation.
Asunto(s)
Eritropoyetina/uso terapéutico , Fallo Renal Crónico/terapia , Polimorfismo Genético , Receptores de Calcitriol/genética , Diálisis Renal , Adulto , Femenino , Ferritinas/sangre , Genotipo , Hemoglobinas/metabolismo , Humanos , Hiperparatiroidismo Secundario/etiología , Infusiones Intravenosas , Hierro/administración & dosificación , Hierro/sangre , Hierro/uso terapéutico , Fallo Renal Crónico/genética , Masculino , Persona de Mediana Edad , Selección de Paciente , Reacción en Cadena de la Polimerasa , Transferrina/metabolismoRESUMEN
BACKGROUND: Immunosuppressive therapy is the major cause of hyperlipidemia after renal transplantation. We sought to compare the effects of an azathioprine (AZA) combination (n = 26) with corticosteroid and cyclosporine (CyA; group 1) with a mycophenolate mofetil (MMF) combination (n = 71; group 2) in the first year following renal transplantation. METHODS: Ninety-seven renal transplant patients (71 men, 26 women; aged 34.7 +/- 13.1 years; renal transplantation duration, 44.9 +/- 12.9 months) underwent serum lipid profiles--total cholesterol, triglyceride, high-density lipoprotein (HDL); low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) at the initiation of as well as 3-month intervals after grafting for 1 year retrospectively. Serum creatinine for each patient was recorded at 12 months. We evaluated possible risk factors for hyperlipidemia. RESULTS: For all patients, the prevalence of hypercholesterolemia (>200 mg/dL) was 36.1% during the pretransplant period, 60.8% at month 3, 50.5% at month 6, and 38.1% at month 12 after renal transplantation. Total cholesterol and triglyceride levels significantly increased in both groups in the first year (P = .001 and P = .02, respectively). Three-month values for total cholesterol were higher in group 2 than group 1 (P = .001). No significant difference was observed between the groups with respect to total cholesterol and triglyceride levels (P > .05). In both groups, HDL, LDL, and VLDL levels did not change during the 12-month study (P > .05 for all). CONCLUSIONS: Independent of hyperlipidemia risk factors, serum total cholesterol and triglyceride levels tended to increase during CyA and steroid therapy among patients undergoing renal transplantation. Combination with MMF or AZA showed no advantage over one another regarding their effects on the lipid profile.
Asunto(s)
Corticoesteroides/uso terapéutico , Azatioprina/uso terapéutico , Ciclosporina/uso terapéutico , Trasplante de Riñón/fisiología , Lípidos/sangre , Ácido Micofenólico/análogos & derivados , Adulto , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Hipercolesterolemia/epidemiología , Hiperlipidemias/epidemiología , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Complicaciones Posoperatorias/epidemiología , Triglicéridos/sangreRESUMEN
BACKGROUND: The aim of this study was to analyze the effects of elevated parathyroid hormone (iPTH) and C-reactive protein (CRP) on rHuEPO requirements and associated clinical and biochemical parameters of hemodialysis patients. METHODS: A total of 127 hemodialysis patients were included. Laboratory values from the previous 3 months (monthly measured CRP, iPTH, albumin, prealbumin, calcium, phosphorus, and hemoglobin) and clinical findings (rHuEPO requirements, iron supplements, Kt/V) were recorded retrospectively. Patients were subgrouped according to presence of hyperparathyroidism (mean iPTH > 350 pg/mL) and chronic inflammation (mean CRP > 8.5 mg/L) as group I (low iPTH, low CRP, n = 32), group II (high iPTH, low CRP, n = 32), group III (low iPTH, high CRP, n = 32), and group IV (high iPTH, high CRP, n = 31). RESULTS: We found that group IV had lowest hemoglobin (P < .0001, .0001, .01, respectively), albumin (P < .0001), prealbumin (P < .0001, .0001, .02, respectively), and highest rHuEPO requirements (P < .0001, .0001, .01, respectively) compared to other groups despite of similar iron indices. Group III also had lower albumin (P < .002, .0001, respectively), prealbumin (P < .001, .01, respectively), hemoglobin (P < .001, .005, respectively), but higher rHuEPO requirements (P < .01) compared to group I and group II. CONCLUSIONS: We propose that hyperparathyroidism increases rHuEPO requirements and aggravates the negative effects of chronic inflammation in hemodialysis patients.