RESUMEN
OBJECTIVES: Transplant vasculopathy is a significant predictor of poor outcome. We investigated whether age or pretransplant renal arterial vasculopathy of grafted kidneys affected allograft survival. MATERIALS AND METHODS: This study included 148 recipients and their donors. All donors underwent pretransplant renal arterial biopsy, with renal artery vascular score determined for each artery. Chronic rejection and graft loss were noted for all patients. RESULTS: Variable grades of pretransplant renal arterial lesions were noted in 103 donors (69.6%). A positive correlation was found between donor age and renal artery score (r = 0.650, P < .001), and chronic rejection and graft loss were found to increase with increasing score (P < .001). Recipient and donor age was significantly associated with graft loss and chronic rejection. With either younger or older donors, recipients had similar and best results regarding chronic rejection and graft loss if donors had renal artery scores of 0 or 1, but worse effects if donors had scores of 2 or 3. Five-year allograft survival rates for scores of 0, 1, 2, and 3 were 91%, 68%, 46%, and 33%. Univariate analyses showed that acute rejection episode (relative risk: 2.729, 95% confidence interval, 1.496-4.977; P = .001), older (? 50 y) donor age (relative risk: 1.970, 95% confidence interval, 1.038-3.736; P = .04), and donor renal artery score (relative risk: 2.466, 95% confidence interval, 1.382-4.401; P = .002) were associated with decreased allograft survival. Multivariate Cox analysis showed that only acute rejection episode (relative risk: 3.585, 95% confidence interval, 1.781-7.217; P < .001) and renal artery score (relative risk: 2.642; 95% confidence interval, 1.355-5.150; P = .004) were independent predictors of allograft survival. CONCLUSIONS: Pretransplant vasculopathy in donor renal artery implies a poor prognosis for renal allograft survival and is independent of other risk factors. Pretransplant renal artery biopsy is recommended for both deceased and living donors, and therapeutic interventions to modify transplant vasculopathy progression should start early posttransplant in recipients with affected renal arteries.
Asunto(s)
Selección de Donante , Rechazo de Injerto/etiología , Supervivencia de Injerto , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Donadores Vivos , Obstrucción de la Arteria Renal/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Aloinjertos , Biopsia , Niño , Enfermedad Crónica , Femenino , Rechazo de Injerto/diagnóstico , Humanos , Fallo Renal Crónico/diagnóstico , Masculino , Persona de Mediana Edad , Obstrucción de la Arteria Renal/patología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: The interaction between calcium oxalate deposition and urinary tract infection is not well established. We aimed to identify the association between these and to determine the role of calcium oxalate deposition on interstitial fibrosis development. MATERIALS AND METHODS: Renal allograft biopsies of 967 patients were reviewed to identify those with calcium oxalate deposition in the renal allograft, with 27 (2.8%) identified. Follow-up biopsies were conducted to reevaluate for calcium oxalate presence and interstitial fibrosis development. At time of biopsy, presence of urinary tract infection and oxaluria was also examined from medical records. RESULTS: Mean time for development of calcium oxalate deposition in renal allografts was 1.7 ± 0.4 and 32.7 ± 21.6 months in patients with primary and secondary oxalosis, respectively (P < .001). Of 27 patients with calcium oxalate deposition, 7 (25.9%) showed tubulointerstitial nephritis, with 2 also having urinary tract infection. Four patients (14.8%) had only urinary tract infection. Causes of tubulointerstitial nephritis were secondary to bacterial infection in 2 and secondary to viral infection in 5 patients (2 polyomaviruses, 2 cytomegaloviruses, 1 adenovirus). Time until development of interstitial fibrosis after calcium oxalate deposition was 3.5 ± 2.1 and 10.3 ± 4.1 months in patients with primary and secondary oxalosis, respectively (P = .01). Time until graft loss after calcium oxalate deposition was 9.3 ± 7.8 and 21.8 ± 12 months in those with primary and secondary oxalosis (P < .001), with 1-, 3-, and 5-year kidney graft survival of 43%, 28%, and 0% and 100%, 100%, and 67% in those with primary and secondary oxalosis, respectively. CONCLUSIONS: Calcium oxalate deposits increased the risk of urinary tract infection and tubulointerstitial nephritis, with bacteria inducing increased presence of calcium oxalate deposition in a renal allograft. Calcium oxalate deposition had a significant influence on interstitial fibrosis development, therefore negatively affecting graft survival.
Asunto(s)
Oxalato de Calcio/análisis , Hiperoxaluria Primaria/etiología , Trasplante de Riñón/efectos adversos , Riñón/química , Nefritis Intersticial/etiología , Infecciones Urinarias/etiología , Adolescente , Adulto , Aloinjertos , Biopsia , Niño , Preescolar , Femenino , Fibrosis , Supervivencia de Injerto , Humanos , Hiperoxaluria Primaria/diagnóstico , Riñón/microbiología , Riñón/patología , Masculino , Persona de Mediana Edad , Nefritis Intersticial/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Adulto JovenRESUMEN
BACKGROUND: Patients with end-stage renal disease (ESRD) experience female sexual dysfunction (FSD). The purpose of this study was to compare FSD in different types of renal replacement therapy and control patients. METHODS: The study was consisted of 47 renal transplantation (RT), 46 hemodialysis (HD), and 28 continuous ambulatory peritoneal dialysis (CAPD) patients and 36 healthy control subjects. All groups were evaluated with the following scales: Female Sexual Function Index (FSFI) questionnaire, Short Form (SF)-36 questionnaires, and Beck Depression Inventory (BDI). Demographic data, laboratory values, and hormone levels were obtained. The patients with FSFI score <26.55 were accepted as experiencing sexual dysfunction. RESULTS: Overall, total FSFI scores in RT, HD, CAPD, and control were 22 (range, 2-35), 22.4 (4-34), 18.35 (2-34), and 29.6 (2-35), respectively. The mean total FSFI score was not different in patients receiving different kinds of renal replacement therapy (P > .05) although they were significantly worse then the control group (P < .001). On regression analysis, age was significantly associated with FSD (ß = -0.14; P = .001). In addition, the physiologic health domain of SF-36 was significantly better in control groups (P < .001). The difference in terms of mean of BDI score did not reach statistical significance among patient groups (P > .05). Female sexual dysfunction score was negatively correlated with BDI (r = -0.371; P < .001) and positively correlated with the mental-physical components score of SF-36 (r = 0.423 [P < .001] and r = 0.494 [P < .001], respectively) in all patients groups. Regarding the hormones of the patients, there was a significant difference between RT and the HD and CAPD groups in dihydroepiandrosterone sulfate (DHEAS; P < .001), RT and HD in prolactin (P < .001), and RT and CAPD in free testesterone (P < .001). CONCLUSIONS: Renal transplantation, hemodialysis, and peritoneal dialysis patients were at more risk of developing sexual dysfunction and lower quality of life scores than healthy subjects. Notably, the mode of renal replacement therapy had no impact on female sexual function.
Asunto(s)
Hormonas Esteroides Gonadales/sangre , Inflamación/sangre , Fallo Renal Crónico/terapia , Terapia de Reemplazo Renal , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND/PURPOSE: The objective of this study was to describe factors associated with bloodstream infections (BSIs) with non-albicans Candida species (NAC), compared with Candida albicans BSIs, and antifungal susceptibility patterns in adult intensive care unit (ICU) patients with chronic renal failure undergoing hemodialysis. To the best of our knowledge, this is the first study to report the potential factors for NAC candidemia in ICU patients with end-stage renal disease on chronic hemodialysis. METHODS: This prospective, observational, multicenter study was conducted in the two centers of Baskent University between January 2007 and July 2010. All adult patients excluding patients with neutropenia, malignancy, glucocorticoid treatment or AIDS, were included. RESULTS: Sixty cases (58.8%) of candidemia were due to C. albicans and 42 (41.2%) to NAC. Multivariate regression analysis revealed that the presence of a central venous catheter was the only risk factor independently associated with BSI due to NAC (p=0.046, odds ratio: 5.90, 95% confidence interval: 1.032-33.717). Mortality was more frequent in those with NAC than C. albicans BSIs (64.3% vs. 55%), but the difference was not significant (p=0.067). Except for two Candida glabrata strains, which were dose-dependently fluconazole susceptible, all Candida species were susceptible to fluconazole, caspofungin, voriconazole and amphotericin B. CONCLUSION: Central venous catheterization was the only factor significantly associated with BSI due to NAC in ICU patients with end-stage renal disease.
Asunto(s)
Candida , Candidemia/etiología , Infecciones Relacionadas con Catéteres/etiología , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/etiología , Fallo Renal Crónico/complicaciones , Diálisis Renal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/farmacología , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Candida albicans/efectos de los fármacos , Candida albicans/aislamiento & purificación , Candidemia/microbiología , Candidemia/mortalidad , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/mortalidad , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Farmacorresistencia Fúngica , Femenino , Humanos , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
Peritonitis accounts for considerable morbidity and hospitalization in peritoneal dialysis (PD) patients. We investigated the factors related with time of hospital stay, especially focusing on the peritoneal cell profiles at the time of hospital admission in PD-related peritonitis. Eighty peritonitis attacks were evaluated. Data were collected at the time of hospital admission, clinical and biochemical parameters, including initial systemic and dialysate white cell counts (including percentage and differential count of neutrophils and lymphocytes) and length of hospital stay. Peritoneal leukocyte (r=+0.289, p=0.009) and neutrophil counts (r=+0.403, p<0.0001), peritoneal neutrophil percentage (r=+0.492, p<0.0001), time of hospital admission (r=+0.498, p<0.0001), and C-reactive protein (CRP) (r=+0.231, p=0.042) were positively correlated; lymphomononuclear cell percentage (r=-0.650, p<0.0001) was negatively correlated with hospitalization length. Hospital admission>or=24 hours of symptom onset was associated with higher CRP, dialysate leukocyte and neutrophil counts, longer hospitalization, and with lower dialysate lymphomononuclear cell percentage compared to admission<24 hours (p=0.04, p=0.04, p=0.005, p<0.0001, and p=0.04, respectively). In multiple linear regression, the time of hospital admission (p=0.002), initial peritoneal neutrophil count (p=0.011), and lymphomononuclear cell percentage (p<0.0001) were independently associated with hospitalization length. Hospital admission within first 24 hours of peritonitis symptoms onset is of vital importance; delayed admission is associated with higher peritoneal leukocyte and neutrophil counts, and increased length of hospital stay.
Asunto(s)
Líquido Ascítico/citología , Hospitalización , Diálisis Peritoneal/efectos adversos , Peritonitis/diagnóstico , Adulto , Proteína C-Reactiva/análisis , Soluciones para Diálisis , Femenino , Humanos , Tiempo de Internación , Recuento de Leucocitos , Leucocitos Mononucleares/citología , Masculino , Neutrófilos/citología , Peritonitis/etiología , Peritonitis/microbiología , Peritonitis/patología , PronósticoRESUMEN
AIM: High peritoneal transport status is a determinant of morbidity and mortality in peritoneal dialysis (PD) patients. It was hypothesized that 24 h peritoneal albumin leakage predicted 2 year prospective cardiovascular outcome and survival in patients receiving PD. METHODS: Sixty-six patients were included. A simplified peritoneal equilibration test was performed and 24 h peritoneal albumin leakage was calculated. Patients were followed up for 2 years. Patient outcome (alive or dead) and occurrence of a cardiovascular event were recorded. RESULTS: During a 2 year follow-up period, 10 (15.2%) patients had suffered from a cardiovascular event and seven (10.6%) patients had died. Patients who had suffered from a cardiovascular event during the follow up period were older (54.0 +/- 9.4 years vs 44.3 +/- 14.5 years, P = 0.025), had lower serum pre-albumin concentrations (29.3 +/- 10.0 g/dL vs 36.0 +/- 9.2 g/dL, P = 0.034) and had higher 24 h peritoneal albumin leakage (median, 3.4 g/day (1.66-15.4 g/day) vs 2.4 g/day (0.76-7.31 g/day), P = 0.011) than patients who did not suffer from a cardiovascular event. In the Cox proportional hazards multivariate analysis of factors which differed significantly between patients with and without a cardiovascular event (age, serum pre-albumin and 24 h peritoneal albumin leakage), only advanced age (hazards ratio, 1.083; 95% confidence interval, 1.023-1.147, P = 0.006) was an independent predictor of a cardiovascular event. CONCLUSION: In contrast to the hypothesis, 24 h peritoneal albumin leakage is not a predictor of 2 year prospective cardiovascular outcome and patient survival. Only advanced age independently predicts the occurrence of a cardiovascular event in patients receiving PD.
Asunto(s)
Albúminas/metabolismo , Diálisis Peritoneal/mortalidad , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritoneo/metabolismo , Estudios ProspectivosRESUMEN
AIM: Peritoneal dialysis patients have diminished quality of life scores compared with healthy subjects. Measures of quality of life have been reported to have a significant predictive value for patient survival and hospitalization in peritoneal dialysis patients. The purpose of this study is to determine the clinical, biochemical and psychological predictors for the quality of life in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: This cross-sectional study included 60 CAPD patients (male/female 33/27; age 45.5 +/- 15.7 years, CAPD duration 43.4 +/- 32.7 months). Pittsburg Sleep Quality Index was used for assessing sleep quality. We evaluated each patient's depressive symptoms with Beck Depression Inventory (BDI). Quality of life parameters were assessed by the self-administered SF-36 generic health survey questionnaire. In all patients, demographic variables, personality traits and habits, Charlson Comorbidity Index, clinical and laboratory parameters were recorded and analysed. RESULTS: A Pearson bivariate correlation analysis revealed that total quality of life score was negatively correlated with Pittsburg Sleep Quality Index (-0.533, P < 0.0001), BDI (-0.642, P < 0.0001) scores, C-reactive protein (-0.588, P = 0.001), and positively correlated with blood urea nitrogen (0.336, P = 0.02) and albumin (0.351, P = 0.01). BDI scores (beta = -0.505, P = 0.001) and the serum albumin levels (beta = 0.324, P = 0.009) were the significant independent predictors of quality of life. CONCLUSION: Poor sleep quality, presence of depression, higher C-reactive protein and lower albumin levels are associated with poorer quality of life. In order to improve life quality in CAPD patients, quality of sleep, depression and nutritional status should be serially evaluated and given appropriate treatment when required.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua/psicología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: We examined the association between nutritional status and total plasma homocysteine (tHcy) level, cardiovascular disease (CVD), and mortality in hemodialysis (HD) patients. DESIGN: This prospective study consisted of 124 HD patients. A number of baseline parameters were measured, including tHcy level and laboratory markers of nutrition and inflammation. A CVD history and a malnutrition-inflammation score (MIS) were determined in all patients. The follow-up period was 2 years. RESULTS: Forty-nine patients (39.8%) had a history of CVD. During follow-up, 11 (8.8%) deaths occurred, and of these 7 deaths were attributable to CVD. A low tHcy level and an increased MIS were associated with CVD and mortality. The rates of CVD and mortality were also higher in the lowest tHcy level tertiles. In addition, tHcy level was positively correlated with albumin and creatinine, and was negatively correlated with C-reactive protein, MIS, and comorbidity. The survival rates in Kaplan-Meier survival analysis tests were significantly lower in patients with the highest MIS (log rank, 22.3; P < .001). Patients with higher tHcy levels had significantly longer survival rates (log rank, 9.7; P = .007). CONCLUSIONS: Because of the strong association of tHcy levels with malnutrition- inflammation, the presence of these factors should be considered when tHcy is evaluated as a risk factor of outcomes in HD patients.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Homocisteína/sangre , Inflamación/sangre , Fallo Renal Crónico/sangre , Desnutrición/sangre , Diálisis Renal , Proteína C-Reactiva/análisis , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Creatinina/sangre , Femenino , Estudios de Seguimiento , Humanos , Inflamación/mortalidad , Estimación de Kaplan-Meier , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Masculino , Desnutrición/mortalidad , Persona de Mediana Edad , Estado Nutricional , Estudios Prospectivos , Factores de Riesgo , Albúmina Sérica/análisis , Resultado del TratamientoRESUMEN
Perioperative risk during coronary artery bypass grafting (CABG) is high in patients with chronic renal disease. We aimed to determine postoperative two-year mortality and identify the preoperative risk factors of mortality during CABG surgery in hemodialysis (HD)-dependent and HD-non-dependent CRF patients. We included 102 CRF patients who underwent CABG in Baskent University Hospital between 2000 and 2005. There were 47 patients with CRF undergoing HD (Group I) and 55 CRF patients without dialysis requirement (Group II). We retrospectively retrieved demographic variables; clinical, operative, and echocardiographic data; and biochemical parameters at the time of the operation and six months postoperation. Postoperative HD requirement in Group II patients and infectious complications were recorded. In the second postoperative year, mortality rate was 27.7% in group I and 16.4% in group II (p > .05). When preoperative risk factors evaluated by univariate Cox analysis, only age (RR = 1.06, p = .04) was a significant determinant of survival in Group I patients. Among the operative and postoperative risk factors of mortality such as duration of operation, numbers of coronary vessel bypass, HD requirement, and infection were investigated in Group I and II patients. Rate of infectious complication (including mediastinitis) was found to be a major determinant of mortality by multivariate Cox analyses in both group I (RR = 4.42, p Asunto(s)
Puente de Arteria Coronaria/mortalidad
, Fallo Renal Crónico/mortalidad
, Adulto
, Anciano
, Puente de Arteria Coronaria/efectos adversos
, Femenino
, Humanos
, Masculino
, Persona de Mediana Edad
, Análisis Multivariante
, Complicaciones Posoperatorias/etiología
, Diálisis Renal
, Factores de Riesgo
, Tasa de Supervivencia
RESUMEN
OBJECTIVE: The malnutrition-inflammation score (MIS) is a scoring system that measures malnutrition and inflammation. We sought to explore its associations with depression, sleep disturbance, and quality of life. DESIGN: This was a cross-sectional study. SETTING: This study took place at the Baskent University Outpatient Hemodialysis Unit (Ankara, Turkey). PATIENTS: We enrolled 67 hemodialysis patients (male/female, 34/33; age, 47.7 +/- 11.4 years [mean +/- SD]; hemodialysis duration, 103.7 +/- 59.1 months [mean +/- SD]). INTERVENTION: We retrospectively recorded patients' monthly clinical and laboratory findings from the previous 6 months. The same physician calculated MIS scores. We interviewed all patients, and each completed a Beck Depression Inventory (BDI) assessment. We used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep, and the Medical Outcomes Study 36-item short form (SF-36) questionnaire to evaluate health-related quality of life. MAIN OUTCOME MEASURES: The main outcome measures involved the univariate and multivariate relationships of the MIS with BDI, PSQI, and SF-36. RESULTS: Patients with PSQI scores of < or = 5 ("good sleepers") had lower MIS scores than did poor sleepers (6.8 +/- 2.5 vs. 8.8 +/- 3.2, P < .05). Patients with moderate-to-severe depression (BDI score > or = 19) had higher MIS scores (9.0 +/- 3.2 vs. 6.5 +/- 2.5, P = .005) and higher PSQI scores (7.6 +/- 2.1 vs. 4.7 +/- 1.8, P = .001), compared with patients with BDI scores < 19. Increased MIS scores were correlated with increased comorbidity (P = .01) and poor SF-36 scores (P = .009). CONCLUSION: Increased MIS is significantly associated with the presence of depression, sleep disorders, and poor quality of life. This close relationship may help establish the MIS as an important determinant of the increased morbidity and mortality of hemodialysis patients.
Asunto(s)
Depresión/epidemiología , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Estado Nutricional , Calidad de Vida , Diálisis Renal/psicología , Trastornos del Sueño-Vigilia/epidemiología , Comorbilidad , Estudios Transversales , Depresión/etiología , Femenino , Humanos , Inflamación/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Desnutrición Proteico-Calórica/epidemiología , Estudios Retrospectivos , Trastornos del Sueño-Vigilia/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND/AIMS: Arteriovenous fistulae (AVF) thrombosis is a common cause of morbidity in hemodialysis (HD) patients. Increased soluble endothelial protein C receptor (sEPCR) levels have been associated with increased risk of venous thrombosis. We aimed to investigate the possible effects of sEPCR levels on the development of AVF thrombosis in adult HD patients. METHODS: 60 HD patients and 22 healthy controls were included. Patients were followed for 18 months and were divided into two groups according to AVF thrombosis development: group 1 (with thrombosis) and group 2 (without thrombosis). Also, patients classified into tertiles according to plasma sEPCR levels: lowest, intermediate, and highest. Groups were analyzed for any relationship between sEPCR levels and development of AVF thrombosis. RESULTS: Mean plasma sEPCR levels were significantly higher in HD patients than they were in controls. Group 1 patients had significantly higher sEPCR levels compared with group 2 patients. Patients' groups were similar regarding other possible risk factors for AVF thromboses. The rate of AVF thrombosis development was significantly higher in the highest sEPCR tertile. CONCLUSION: This is the first study to analyze sEPCR levels in HD patients. Our findings demonstrate a relationship between plasma sEPCR levels and development of AVF thromboses.
Asunto(s)
Antígenos CD/sangre , Derivación Arteriovenosa Quirúrgica/efectos adversos , Receptores de Superficie Celular/sangre , Trombosis/sangre , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Receptor de Proteína C Endotelial , Femenino , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Renal , Trombosis/etiologíaRESUMEN
BACKGROUND/AIMS: The aim of this matched case-control study was to evaluate the determinants of coronary artery disease (CAD) other than conventional risk factors in nondiabetic hemodialysis (HD) patients. METHODS: Among 312 consecutive patients on regular HD, 26 nondiabetic patients with angiographically defined coronary artery disease (20 men, 6 women; mean age 57.0 +/- 13 years) constituted the case group (group 1). A subject group of the same gender, smoking status, and hypertension with similar ages and body mass indexes who had normal electrocardiography and myocardial perfusion scintigraphy served as controls (20 men, 6 women; mean age 54.1+/-12 years, group 2). Demographics, high sensitivity C-reactive protein (hs-CRP), erythrocytes dimentation rate (ESR), hematocrit-corrected ESR, beta-2 microglobulin, cardiac troponin I, parathyroid hormone, albumin, calcium (Ca), phosphorus (P), Ca x P, and lipid profiles were compared between the groups. RESULTS: Patients in group 1 had higher hs-CRP and troponin I (18.0+/-12 vs. 7.2+/-5 mg/L, p < 0.001; 0.36+/-0.16 vs. 0.22+/-0.05 ng/mL, p < 0.001, respectively) and lower HDL cholesterol levels than group 2 (37.0+/-10 mg/dL vs. 46.3+/-17 mg/dL, p = 0.02). Backwards stepwise logistic regression analysis revealed that high hs-CRP and troponin I levels (p = 0.03 and p = 0.01) and low HDL cholesterol levels (p = 0.02) were independently related with CAD. CONCLUSION: According to these results, in nondiabetic patients on regular hemodialysis, high hs-CRP, troponin I levels and low HDL-cholesterol were the determinants of CAD.
Asunto(s)
Proteína C-Reactiva/metabolismo , HDL-Colesterol/sangre , Enfermedad de la Arteria Coronaria/sangre , Fallo Renal Crónico/complicaciones , Troponina I/sangre , Adulto , Anciano , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/etiología , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis RenalRESUMEN
AIM: To investigate the influence of anti-HCV positivity on markers of malnutrition and inflammation in hemodialysis (HD) patients. METHODS: Stable HD patients who had persistently negative or positive HCV antibodies (at least three) and without elevated aminotransferase levels in routine periodical tests with a duration of more than 12 months were included. Patients with conditions known to be associated with acute-phase responses or clinically active (HCV RNA positive) or advanced liver failure were excluded. Thirty-six anti-HCV-positive patients (22 male, 14 female, mean age 47.3 +/- 14.5 years, mean time on HD 72.0 +/- 39.0 months), were compared with 36 anti-HCV negative patients with similar age and HD duration (25 male, 11 female, mean age 49.2 +/- 13.8 years, mean time on HD 59.7 +/- 27.1 months). Malnutrition-Inflammation Score (MIS), a fully quantitative score adopted from subjective global assessment, was recorded for each patient (ranges from 0 to 30). High sensitivity serum C-reactive protein (hs-CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and hematocrit-corrected ESR were compared as indices of the degree of inflammation beyond anthropometric evaluation and routine laboratory tests. RESULTS: There was no significant difference in MIS of two groups (6.1 +/- 3.2 vs. 5.6 +/- 3.2, p > 0.05). In the comparison of components of MIS, co-morbidity including number of years on dialysis was higher in anti-HCV-positive patients (p = 0.04). Anthropometric values and serum levels of hs-CRP, IL-6, ESR, and hematocrit-corrected ESR of two groups were not statistically different from each other (p > 0.05 for all). ALT (p = 0.0001) and AST (p = 0.001) levels were higher in anti-HCV-positive patients. CONCLUSION: Anti-HCV positivity without active infection seems to have no additional negative effect on malnutrition and inflammation in maintenance HD patients.
Asunto(s)
Proteína C-Reactiva/metabolismo , Hepatitis C/complicaciones , Inflamación/etiología , Interleucina-6/sangre , Fallo Renal Crónico/complicaciones , Desnutrición/etiología , Adulto , Biomarcadores/sangre , Sedimentación Sanguínea , Estudios de Casos y Controles , Femenino , Hematócrito , Hepatitis C/sangre , Humanos , Inflamación/sangre , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Masculino , Desnutrición/sangre , Desnutrición/diagnóstico , Persona de Mediana Edad , Diálisis RenalRESUMEN
Guidelines for the clinical care and management of intra-abdominal complications in patients transferred from peritoneal dialysis (PD) to hemodialysis (HD) are not well established. In this study, we analyzed the indications for transfer, presence of abdominal complications, and clinical outcome on HD of 26 patients who were followed up between 1996 and 2004. Laboratory and radiology data for the patients (computerized tomographic and ultrasonographic examinations performed during the transfer and annually thereafter) were collected retrospectively. The indications for transfer from PD to HD were peritonitis (19%), mechanical problems (39%), and ultrafiltration failure (42%). At the time of transfer, 11 patients had no intra-abdominal complications, 8 had intra-abdominal loculated fluid collection, and 7 had intra-abdominal free fluid. One year after transfer, intra-abdominal fluid collection was observed in 6 patients, 3 of whom received percutaneous drainage. Patients who had intra-abdominal complications at the time of transfer exhibited significantly lower albumin (p < 0.01), higher levels of C-reactive protein (p < 0.02), and erythropoietin resistance at the time of transfer (p < 0.0001). During the first year after transfer, we observed a tendency toward an increase in albumin and a decrease in C-reactive protein level in the group that had complications, and yet nutritional interventions were still necessary in that group. A high ratio of intra-abdominal problems, which have adverse nutritional and inflammatory impacts, are seen after patients are transferred from peritoneal dialysis.
Asunto(s)
Diálisis Peritoneal/efectos adversos , Diálisis Renal , Ascitis/etiología , Ascitis/terapia , Proteína C-Reactiva/análisis , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/etiología , Pancreatitis/terapia , Peritonitis/etiología , Peritonitis/terapia , Albúmina Sérica/análisisRESUMEN
AIM: The aim of this prospective study was to assess the determinants of the progression of carotid artery intima-media thickness (CA-IMT) for 1 year in haemodialysis (HD) patients without significant comorbidities. METHODS: Fifty-four HD patients younger than 55 years, without diabetes, obesity and any clinical evidence of cardiovascular disease (29 men, 25 women; mean age 33.3 +/- 10 years; mean time on HD 49.4 +/- 43 months) were included in the 1-year study. CA-IMT was assessed at baseline and after 12 months. The difference in IMT between these two points of time was calculated (DeltaCA-IMT). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haematocrit-corrected ESR, beta-2 microglobulin, cardiac troponin I, lipid profile, fibrinogen, homocysteine, CaXP product, intact parathyroid hormone, haematocrit, albumin, uric acid levels, anthropometric parameters (age, body mass index), smoking, hypertension and left ventricular hypertrophy were recorded at baseline. RESULTS: The mean value for CA-IMT at baseline (0.59 +/- 0.05 mm) was significantly lower than that at 12 months (0.64 +/- 0.07 mm) (P < 0.001). CA-IMT had increased in 41 patients (75.9%). Age (P = 0.02), CRP (P = 0.03), beta-2 microglobulin (P = 0.001) and left ventricular hypertrophy (P = 0.01) were independently related with CA-IMT at baseline. Age (P = 0.003) and CRP (P = 0.04) were the independent variables related with CA-IMT, measured at 12 months. DeltaCA-IMT correlated positively with age (r = 0.31, P < 0.05). Age and sex were independent predictors of DeltaCA-IMT (R(2) for the model 0.56). CONCLUSION: In addition to age and male sex, non-specific inflammation may have a possible role in the progression of atherosclerosis in HD patients without significant comorbidities.
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Aterosclerosis/epidemiología , Fallo Renal Crónico/epidemiología , Diálisis Renal/estadística & datos numéricos , Adulto , Distribución por Edad , Aterosclerosis/diagnóstico por imagen , Proteína C-Reactiva/metabolismo , Arterias Carótidas/diagnóstico por imagen , Comorbilidad , Progresión de la Enfermedad , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , Ultrasonografía , Vasculitis/epidemiologíaRESUMEN
BACKGROUND: To assess short- and long-term influence of the TGF-beta1 on renal allografts. METHODS: Expression of TGF-beta1 and TNF-alpha, and the proportion of macrophages and eosinophils in interstitium were evaluated in 64 cases including five cases with nonrejected kidneys (NRK), 18 cases with acute rejection (AR), 26 cases with chronic allograft nephropathy (CAN), and 15 cases with acute cyclosporine A (CsA) toxicity. Follow-up biopsies of all cases with AR and CsA toxicity were evaluated for development of interstitial fibrosis (IF) and graft atherosclerosis (GAS). Additionally, influence of tubular-TGF-beta1 expression on graft function during 6 months after the diagnostic biopsy was evaluated. RESULTS: A significant differences was seen between rejected kidneys and acute CsA toxicity in regards of tubular TGF-beta1 expression that patients with CsA toxicity exhibited significantly higher grade of tubular TGF-beta1 expression than patients with AR (P<0.05) and CAN (P<0.05). A significant difference was found between the grades of tubular TGF-beta1 expression in regards to graft function of cases with AR and CsA toxicity (P<0.05). Higher grade tubular TGF-beta1 expression showed better graft function during 6 months. Besides the degree of renal TGF-beta1 expression was positively correlated with development of diffuse IF and GAS (P<0.05) that the risk of the IF and GAS was higher in cases with grade 2 renal TGF-beta1 expression. CONCLUSIONS: Despite the short-term posttransplantation tubule-repairing effects of TGF-beta1, the overall effects of TGF-beta1 in the kidney seem to be negative that increased expression of TGF-beta1 promotes IF and vasculopathy associated with CAN.
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Ciclosporina/efectos adversos , Rechazo de Injerto/patología , Trasplante de Riñón/patología , Factor de Crecimiento Transformador beta/metabolismo , Adulto , Anticuerpos Monoclonales , Biopsia , Creatinina/sangre , Femenino , Rechazo de Injerto/inmunología , Humanos , Inmunosupresores/efectos adversos , Trasplante de Riñón/inmunología , Túbulos Renales/patología , Macrófagos/patología , Masculino , Estudios Retrospectivos , Factor de Crecimiento Transformador beta1 , Trasplante Homólogo , Resultado del TratamientoRESUMEN
AIM: To investigate the associations of different risk factors with carotid artery intima-media thickness (C-IMT) in non-diabetic haemodialysis (HD) patients who had no clinical evidence of atherosclerosis. METHODS: Seventy-two HD patients (43 men, 29 women; mean age: 34.5 +/- 10.6 years; mean time on HD: 47.9 +/- 40.0 months) and 40 age- and sex-matched healthy controls (26 men, 14 women; mean age: 35.5 +/- 7.1 years) participated in the study. The relationship between C-IMT and haematocrit-corrected erythrocyte sedimentation rate (Hct-corrected ESR), beta 2 microglobulin (beta2M) and serum cardiac troponin I (cTnI) levels beyond C-reactive protein (CRP), lipid profile and lipoprotein(a), fibrinogen, homocysteine and left ventricular hypertrophy (LVH) were examined. RESULTS: Mean C-IMT of the HD patients was significantly greater than that of the control subjects (0.59 +/- 0.06 vs 0.53 +/- 0.07 mm, P = 0.002). C-IMT of patients was positively correlated with age (r = 0.33), body mass index (r = 0.40), Hct-corrected ESR (r = 0.37), CRP (r = 0.34), beta2M (r = 0.34), cTnI (r = 0.26), triglyceride (r = 0.26) and fibrinogen (r = 0.28) levels (P < 0.05 for all). The mean C-IMT was significantly greater in patients with LVH than it was in those without LVH (P = 0.004). In multivariate regression analysis, age (P = 0.02), beta2M (P = 0.001), log-transformed CRP (P = 0.03) and LVH (P = 0.01) were independently related with C-IMT. CONCLUSION: Besides well-known cardiovascular (CV) risk factors, cTnI and beta2M were related with C-IMT in that they may have important roles in early-onset atherosclerosis in this high-risk population.
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Enfermedades de las Arterias Carótidas/epidemiología , Fallo Renal Crónico/epidemiología , Diálisis Renal , Troponina I/sangre , Microglobulina beta-2/sangre , Adulto , Edad de Inicio , Biomarcadores/sangre , Sedimentación Sanguínea , Arterias Carótidas/patología , Enfermedades de las Arterias Carótidas/sangre , Enfermedades de las Arterias Carótidas/patología , Estudios Transversales , Femenino , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Túnica Íntima/patología , Túnica Media/patologíaRESUMEN
Acute renal failure (ARF) is a major complication in infants who undergo cardiac surgery. The aim of this investigation was to identify possible risk factors for ARF and mortality in this patients group. Out of 64 patients, 21 (32.8%) cases developed acute renal failure and overall mortality rate was 25%. The mortality rate was higher in the infants who developed ARF than those who did not (66.7% and 4.7%, respectively, p<0.05). Also, ARF was positively correlated with mortality (r:0.70, p<0.0001). The nonsurvivors had lower mean serum albumin than did the survivors (p<0.05), and serum albumin level was negatively correlated with mortality (r= -0.34, p< 0.05). For the patients with serum albumin level <3.5 g/dL, the unadjusted odds ratio for mortality was 4.3 (CI 95%:1.05-17.86). Total bypass time and aorta clamping time were significantly longer in the nonsurvivor group than in the survivor group (p<0.05 for both). In conclusion, the significant risk factors for mortality in these patients were development of ARF, low serum albumin level, and long total bypass and aorta clamping times, which may be predictive of poor prognosis.
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Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Causas de Muerte , Cardiopatías Congénitas/mortalidad , Cardiopatías Congénitas/cirugía , Lesión Renal Aguda/terapia , Procedimientos Quirúrgicos Cardíacos/métodos , Estudios de Cohortes , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/diagnóstico , Mortalidad Hospitalaria/tendencias , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Probabilidad , Medición de Riesgo , Análisis de SupervivenciaRESUMEN
The aim of this study was to evaluate the influence of vascular endothelial growth factor (VEGF) on renal function and on development of interstitial fibrosis (IF) in renal allografts. Tubular and interstitial expressions of VEGF and TNF-alpha, and density of macrophages in the interstitium were examined in 92 patients with nonrejected kidneys, acute rejection (AR), chronic allograft nephropathy (CAN), borderline changes (BC) and acute cyclosporin A (CsA) toxicity. Follow-up biopsy specimens from patients with AR and BC were evaluated for development of IF. A significant difference in tubular and interstitial VEGF expressions was found between patients with AR, BC, CAN and CsA toxicity (p < 0.001). Macrophage infiltration was positively correlated with VEGF and TNF-alpha expressions (p < 0.001). VEGF expression increased with increasing expression of TNF-alpha (p < 0.001). Renal function in first 6 months after initial biopsy was better in patients with marked tubular VEGF expression (p < 0.01); however, in follow-up, development of IF and graft loss was found earlier in these patients (p < 0.01 and p < 0.05, respectively). Increased renal VEGF expression has protective properties immediately following renal allograft but allows for increased risk of early IF, and therefore poor graft outcome in the long term.
Asunto(s)
Ciclosporina/toxicidad , Rechazo de Injerto/metabolismo , Trasplante de Riñón , Riñón/patología , Factor A de Crecimiento Endotelial Vascular/genética , Humanos , Inmunohistoquímica , Riñón/metabolismo , Glomérulos Renales/metabolismo , Glomérulos Renales/patología , Trasplante Homólogo , Factor A de Crecimiento Endotelial Vascular/biosíntesisRESUMEN
Twenty patients with end-stage renal failure who were on maintenance hemodialysis (HD) underwent pulmonary function testing (PFT) before and shortly after an HD session. On pre-HD PFT, the mean values of all parameters except residual volume (RV) were in the normal range. Mean RV was high (152.9%), and mean diffusing capacity of the lung for carbon monoxide (DLCO) was high-normal (110.4%). The pre-HD static inspiratory (PImax) and expiratory pressures (PEmax) were much lower than normal (67.4% and 36.3%, respectively). After the HD session, repeat PFT revealed a small increase in expiratory flow rates, and a significant drop in PImax. There was a strong correlation between PImax and PEmax (r=0.567, p<0.01) at the pre- and post-HD stages, indicating that common mechanism(s) are responsible for impairment of both inspiratory and expiratory muscle strength. The well-preserved DLCO was thought to be due to the use of biocompatible dialyzer membranes. Chronic vascular congestion might be the other explanation of high DLCO.