Health-related quality of life,depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

Introduction: Impairment of health-related quality of life (HRQoL) and being in a depressive mood were found to be associated with increased mortality in peritoneal dialysis (PD) patients. We aimed to investigate the association between HRQoL, depression, other factors and mortality in PD patients. Materials and methods: Totally 171 PD patients were included and followed for 7 years in this prospective study. Results: Of 171 PD patients, 45 (26.3%) deceased, 18 (10.5%) maintained on PD, 87 (50.9%) shifted to hemodialysis (HD) and 21 (12.3%) underwent transplantation. The most common cause of death was cardiovascular disease (32, 71.1%) followed by infection (6, 13.3%), cerebrovascular accident (5, 11.2%). The etiology of patients who shifted to HD was PD failure (41, 47.1%), peritonitis (33, 37.9%), leakage (6, 6.9%), catheter dysfunction (3, 3.4%), self willingness (4, 4.6%). Non-survivors were older than survivors (56.6?±?15.0 vs. 43.6?±?14.6, p?=?0.003). There were also statistically significant difference in terms of albumin, residual urine, presence of diabetes and co-morbidity. When the groups were compared regarding HRQoL scores, non-survivors had lower physical functioning (p?<?0.001), role-physical (p?=?0.0045), general health (p?=?0.004), role-emotional (p?=?0.011), physical component scale (PCS) (p?=?0.004), mental component scale (MCS) (p?=?0.029). Age, presence of residual urine, diabetes, albumin, PCS and MCS were entered in regression analysis. Decrease of 1?g/dL of albumin and being diabetic were found to be the independent predictors of mortality. Conclusions: Diabetes and hypoalbuminemia but not HRQOL scores were associated with higher mortality in PD patients after 7 years of following period.     

Ménétrier’s病致顽固性低蛋白血症1例

Ménétrier’s病(Ménétrier’sdisease,MD)是一种罕见的肥厚性胃炎,以胃黏膜皱襞粗大、肥厚致大量蛋白质丢失,黏液分泌增加,胃酸分泌减少及低蛋白血症为特征.本文报道MD致顽固性低蛋白血症1例.患者,女,55岁,以"食欲减退,颜面及双下肢水肿半年"入院.其血清总蛋白39.8g/L,白蛋白23.8g/L.CT示胃黏膜皱襞弥漫性、不均匀增厚.胃镜示胃底和胃体黏膜皱襞肥厚、粗大,胃内见大量黏液潴留病理示胃小凹显著变长,呈螺旋状改变,固有层内腺体增生,部分腺体呈囊性扩张,可见黏液积聚.本病例提示,对于无任何胃病症状而出现无法解释的顽固性低蛋白血症患者,及时采取CT和内镜检查有助于早期诊断.     

重组人生长激素治疗肝炎肝硬化伴低蛋白血症20例分析

目的　观察重组人生长激素 (γ -hGH)治疗肝炎肝硬化伴低蛋白血症的疗效。方法　肝炎肝硬化 (乙型 )伴低蛋白血症患者 2 0例 ,以γ -hGH 4IU皮下注射 ,10天为一疗程。观察治疗前后相关指标的变化。结果　血清白蛋白治疗前为 2 9.0 6± 3 .0 3g/L ,治疗后为 3 4.61± 3 .65g/L(P <0 .0 1) ,治疗结束后 10天为 3 4.5 0± 2 .3 3g/L(P <0 .0 1) ;血清前白蛋白治疗前为 2 98± 3 8mg/L ,治疗后为 3 5 9± 85mg/L(P <0 .0 5 ) ,治疗结束后 10天为 3 2 3± 74ml/L(P>0 .0 5 )。结论　γ -hGH能提高肝炎肝硬化 (乙型 )伴低蛋白血症患者的血清白蛋白水平。     

血清离子钙的检测以及在血清蛋白异常病人中变化的观察

为了探讨直接检测血清离子钙的正常参考值范围以及血清钙测定在血清蛋白异常标本中的变化，用美国NOVA—Nucleus全自动分析仪直接对130例正常人血清离子钙进行了检测，结果，血清实测离子钙正常参考范围为0．97±0．08mmol／L，正常化离子钙为1．25±0．10mmol/L。同时，根据血清总蛋白和白蛋白测定结果，对64例血清蛋白异常病人的总钙和离子钙作分组分析，结果显示，当病人血清白蛋白低于正常范围时，血清总钙明显下降（P＜0．01），而离子钙与正常组比较差异无显著性（P＞0．05）．此外，比较了低白蛋白血症病人血清总钙与离子钙的异常率，表明，在低白蛋白血症病人中，不论是血清总钙浓度还是离子钙浓度均有偏低现象出现，但以总钙偏低为多，两者差异有高度显著性（P＜0．01）。离子钙是在人体血液中能真正发挥生理功能的钙，低白蛋白血症患者常因白蛋白水平降低而致与之结合部分的钙浓度降低，造成总钙水平下降，而离子钙不一定偏低，因此，临床上检测离子钙较之总钙更具有意义．     

A Case of Giant Gastric Folds with Hypoalbuminemia Healed by Helicobacter pylori Eradication

A 66-year-old man with hypoalbuminemia was found to have diffuse giant mucosal folds in the body of the stomach. Helicobacter pylori (H pylori) status was evaluated by several examinations, all of which showed positive results. To eradicate H pylori, he was treated with clarithromycin (200mg b. i. d.), lansoprazole (30mg q. d.) and plaunotol (80mg t. i. d.). By two weeks, the serum albumin concentration had risen to 3.4g per dl. Four weeks after finishing clarithromycin therapy, endoscopy was repeated and H pylori status was evaluated as before. All examinations showed negative results and the giant mucosal folds had improved markedly. Before treatment, histological specimens showed irregular elongation of pits with inflammatory infiltrates. After treatment, the architecture of pits returned to its normal form with decreased inflammatory infiltrates. In this case, giant gastric folds and hypoalbuminemia were improved by H pylori eradication, suggesting that H pylori infection may play a role in the giant gastric folds associated with hypoalbuminemia.     

Idiopathic hypoalbuminemia explained by reduced synthesis rate and an increased catabolic rate

OBJECTIVE: To determine the contribution of albumin synthetic and catabolic rates to steady state levels in a patient with idiopathic hypoalbuminemia. METHODS: Using L-[1-(13)C] valine, both FSR (fractional synthesis rate) as well as FCR (fractional catabolic rate) were studied. Human albumin cDNA analysis and determination of the exact albumin mass by electrospray mass spectrometry were performed. RESULTS: Compared with controls, plasma albumin concentration in the patient was reduced (6.7 vs. 37.0 +/- 2.6 g/L). Albumin FSR (= FCR in steady state) was increased compared to controls. The ASR (absolute synthesis rate) of albumin was decreased based on the enrichment in plasma valine and KIV, but estimated to be normal based on VLDL apoB100 at plateau compared to controls. Direct estimation of albumin FCR rejected the latter. No mutation was found in the transcribed region of albumin gene. The exact mass of albumin (66.493 Da) was not different from controls. CONCLUSION: The hypoalbuminemia was a result of accelerated clearance of albumin from plasma in addition to defective albumin synthesis. This study also shows that the chosen method of the precursor pool could lead to misinterpretation of data in hepatic protein synthesis.     

Predictive value of preoperative serum albumin levels on outcomes in patients undergoing LVAD implantation

Background

We performed a single‐center retrospective analysis to determine whether preoperative serum albumin levels were associated with postoperative adverse events and short‐ and long‐term survival in patients who underwent continuous‐flow left ventricular assist device (CF‐LVAD) implantation.

Methods

From November 2003 through March 2016, 526 patients underwent CF‐LVAD implantation. Patients whose preoperative serum albumin level was normal (≥3.5 g/dL) were compared to patients with preoperative hypoalbuminemia (<3.5 g/dL), which was further categorized as moderate (2.5‐3.5 g/dL) or severe (<2.5 g/dL). These groups were compared regarding preoperative demographics, incidence of postoperative complications, and long‐term survival.

Results

Patients with hypoalbuminemia had higher serum levels of liver enzymes (P < 0.05) and total bilirubin (P < 0.001) and significantly lower platelet counts (P = 0.02) and prealbumin levels (P < 0.001) than patients with normal preoperative albumin levels. Survival in patients with moderate and severe preoperative hypoalbuminemia was significantly decreased compared with patients with normal preoperative serum albumin levels (P < 0.001). Preoperative hypoalbuminemia was also associated with higher incidences of postoperative infection, gastrointestinal bleeding, neurological dysfunction, and acute kidney injury (P ≤ 0.01 for all) but did not affect the success of bridge to transplantation or survival after transplantation.

Conclusions

Our data demonstrated that there is a significant association of preoperative low serum albumin levels with postoperative adverse outcomes and lower survival rates. This highlights the importance of a patient's preoperative nutritional status on postoperative outcomes after CF‐LVAD implantation.     

Hypoalbuminemia and poor growth predict worse outcomes in pediatric heart transplant recipients

Children with end‐stage cardiac failure are at risk of HA and PG. The effects of these factors on post‐transplant outcome are not well defined. Using the PHTS database, albumin and growth data from pediatric heart transplant patients from 12/1999 to 12/2009 were analyzed for effect on mortality. Covariables were examined to determine whether HA and PG were risk factors for mortality at listing and transplant. HA patients had higher waitlist mortality (15.81% vs. 10.59%, p = 0.015) with an OR of 1.59 (95% CI 1.09–2.30). Survival was worse for patients with HA at listing and transplant (p ≤ 0.01 and p = 0.026). Infants and patients with congenital heart disease did worse if they were HA at time of transplant (p = 0.020 and p = 0.028). Growth was poor while waiting with PG as risk factor for mortality in multivariate analysis (p = 0.008). HA and PG are risk factors for mortality. Survival was worse in infants and patients with congenital heart disease. PG was a risk factor for mortality in multivariate analysis. These results suggest that an opportunity may exist to improve outcomes for these patients by employing strategies to mitigate these risk factors.