Effect of Fibronectin on C3b and Fc Receptor-mediated Phagocytosis by Peripheral Blood Monocytes in Uraemic Patients

The influence of human fibronectin was evaluated on the phagocytosisin vitro of C. albicans (C3b receptor-mediated) and IgG antibody-coatedsheep erythrocytes .(Fc receptor-mediated) by the peripheralblood monocytes of 40 uraemic patients undergoing periodic haemodialysis.Some nutritional parameters (albumin, transferrin, C4, C3, haematocrit,lymphocyte count, height and bodyweight) were also evaluated.Results showed significantly decreased plasma fibronectin (P<0.001)and reduced C3b receptor (R)- and FcR-mediated phagocytosisin uraemic patients (P<0.001). A strict correlation was foundbetween fibronectin and C3bR-mediated phagocytosis (P<0.001)and between fibronectin and FcR-mediated phagocytosis (P<0.05).In 20 patients with decreased fibronectin concentrations andreduced phagocytic function, the in vitro incubation of peripheralblood monocytes with 50 µg/ml of purified fibronectinsignificantly enhanced C3bR- (P<0.001) but not FcR-mediatedphagocytosis. Study of nutritional parameters in the uraemicpatients revealed that values of fibronectin, C3, IgG and albuminwere significantly reduced. Fibronectin correlated significantly(P<0.00l) with C3. A good relationship (P<0.05) was alsofound between the plasma fibronectin and bodyweight loss. Agreater incidence of infectious disease was observed in patientswith decreased plasma fibronectin than in uraemic patients withnormal values (P<0.05). The results suggest that a decreasein plasma fibronectin in uraemic patients could impair the peripheralblood monocyte phagocytic capacity and be potentially dangerous,predisposing the patient to infections. The determination offibronectin concentration in these patients may, therefore,have a potential value as an indicator of peripheral blood monocyte phagocytic function.     

Cell cholesterol transport to plasma in blood from patients with renal failure or a kidney transplant

Accumulation and distribution of cell cholesterol in plasmalipoproteins of incubated blood was examined in 36 patientswith chronic renal failure including 13 who were dialysis-independent,12 on haemodialysis, and 11 on continuous ambulatory peritonealdialysis (CAPD), 17 renal transplant recipients, and 8 healthycontrols. In addition, transport of cholesterol between redblood cells and high-density lipoprotein subfraction 3 (HDL₃isolated from a subgroup of patients with chronic renal failurewas determined. Significantly less cell cholesterol appearedin plasma (P<0.002) and HDL (P=0.03), the main recipientof cell cholesterol, in patients with chronic renal failurecompared with healthy subjects. Corresponding values in bloodfrom renal transplant recipients were similar to controls. Inpatients with chronic renal failure, plasma HDL₃ cholesterollevels (P<0.02), HDL₃ phospholipid content (P<0.01) andnet transport of red cell cholesterol to isolated HDL₃ (P<0.001)were significantly lower compared with controls. The data suggestthat in patients with chronic renal failure, low levels of plasmaHDL₃ of abnormal composition may restrict the incorporationof cell cholesterol into the antiatherogenic HDL fraction potentiallyleading to inefficient transport of cholesterol from peripheraltissues and the development of atherosclerosis. These abnormalitiesappear to be reversed by renal transplantation.     

Comparison of Erythrocyte Membrane Fatty Acid Contents in Renal Transplant Recipients and Dialysis Patients

BackgroundAlterations of erythrocyte membrane fatty acid (FA) composition play important roles in cellular function because they change the membrane microenvironment, including transmembrane receptors. The erythrocyte membrane oleic acid content is higher among patients with acute coronary syndrome and also in dialysis patients. However, available data are limited concerning erythrocyte membrane FA content in kidney transplant recipients (KTP). We sought to test the hypothesis that erythrocyte membrane FA content among KTP were different from those in dialysis patients.MethodsIn this cross-sectional study, we recruited 35 hemodialysis, 33 peritoneal dialysis 49 KTP, and 33 normal control subjects (CTL). Their erythrocyte membrane FA content were measured by gas chromatography.ResultsThe mean ages of the enrolled dialysis patients, KTP, and CTL were 56.4 ± 10.1, 48.9 ± 10.4, and 49.5 ± 8.3 years, respectively. Mean kidney transplant duration was 89.8 ± 64.8 months and mean dialysis duration, 49.0 ± 32.6 months. The intakes of vegetable lipid and vegetable protein including total calories were significantly increased among KTP versus dialysis patients. Total cholesterol (P < .001) and high density lipoprotein cholesterol (HDL; P < .001) levels were significantly higher and C-reactive protein was significantly lower among KTP compared with dialysis patients. The erythrocyte membrane content of palmitoleic acid (P < .001) was significantly higher but oleic acid (P < .001) significantly lower in KTP compared with dialysis patients. The erythrocyte membrane contents of arachidonic acid and docosahexaenoic acid were significantly higher, and linoleic acid and the omega-6 FA to omega-3 FA ratio (P < .001) significantly lower in KTP compared with dialysis patients. The erythrocyte membrane content of oleic acid was independently associated with monounsaturated fatty acid (beta = 0.771, P < .001), eicosapentaeonic acid (beta = ?0.244, P = .010), and HDL (beta = ?0.139, P = .049) in KTP.ConclusionsFA contents of erythrocyte membranes were significantly different in KTP compared with dialysis patients. These differences may have been associated with improved dietary intake and immunosuppression after kidney transplantation.     

Effects of Omega-3 Fatty Acids on Serum Lipids,Lipoprotein (a), and Hematologic Factors in Hemodialysis Patients

Abstract

Background: Lipid abnormalities, especially high serum lipoprotein (a) [Lp (a)] concentration, and anemia are two major causes of cardiovascular diseases (CVDs) in hemodialysis patients. Therefore, this study was designed to investigate the effects of marine omega-3 fatty acids on serum lipids, Lp (a), and hematologic factors in hemodialysis patients. Methods: Thirty-four hemodialysis patients were randomly assigned to either omega-3 fatty acid supplement or placebo group. Patients in the omega-3 fatty acids group received 2080 mg marine omega-3 fatty acids, daily for 10 weeks, whereas the placebo group received a corresponding placebo. At baseline and the end of week 10, 7 mL blood was collected after a 12- to 14-h fast and serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), Lp (a), blood hemoglobin, hematocrit, red blood cells (RBCs), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were measured. Results: Serum triglyceride decreased significantly in the omega-3 fatty acids group at the end of week 10 compared with baseline (p < 0.05) and this reduction was significant in comparison with the placebo group (p < 0.01). No significant differences were observed between the two groups in mean changes of serum total cholesterol, LDL-C, HDL-C, Lp (a), blood hemoglobin, hematocrit, RBC, MCV, MCH, and MCHC. Conclusion: The results of our study indicate that marine omega-3 fatty acids can reduce serum triglyceride, as a risk factor for CVD, but it does not affect other serum lipids, Lp (a), and hematologic factors in hemodialysis patients.     

Complement Receptor (CR1) and IgG or IgA on Erythrocytes and in Circulating Immune Complexes in Patients with Glomerulonephritis

This study reports the quantitative analysis of complement receptor(CR1) molecules on erythrocyte surface, the amount of immunoglobulin-containingmaterial (IgG-IC and IgA1-IM) on the erythrocyte surface, andthe concentrations of circulating immune complexes (IgG-CICand IgA-CIC); also reported are the HLA phenotypes of 44 patientsaffected by various forms of glomerulonephritis (including 20primary IgA nephropathy, 11 membranous glomerulonephritis, 9lupus nephritis and 4 renal vasculitis). Erythrocyte CR1 molecules were found to be decreased (P<0.02)and erythrocyte IgG-IC were less than in controls (P<0.025)in lupus nephritis patients, whereas IgG-CIC were significantlygreater (P<0.02). In patients affected by primary IgA nephropathy, mean erythrocyteCR1 concentrations were significantly decreased (P<0.02).Patients with impaired renal function had mean erythrocyte CR1values significantly greater than those with normal renal function(P<0.002). Immunoglobulin-containing material on the erythrocytesurface was not significantly increased, whereas the serum concentrationsof both IgA-CIC and IgG-CIC were significantly increased (P<0.02). In membranous nephropathy erythrocyte CR1 molecules were quantitativelysimilar to control data and no increase in CIC was observed.Conversely, erythrocyte IgG-IC were significantly increased(P<0.01). No significant relationship among erythrocyte CR1 molecules,erythrocyte surface-associated immunoglobulins, CIC, and HLAphenotype was observed in any patient group.     

Effects of Testosterone on Lipid Peroxidation,Lipid Profiles and some Coagulation Parameters in Rabbits*

The purpose of this study was to investigate the effects of testosterone on some risk factors of atherosclerosis. Twenty‐four male New Zealand white rabbits were randomly divided into three groups of eight. The first group was used as control. Second group was injected with 10 mg of testosterone propionate. Third group was castrated bilaterally. At the end of 6 weeks, lipid peroxidation (LPO), lipid profile, fibrinogen (FBN) level and coagulation parameters were evaluated. Testosterone administration decreased the level of high‐density lipoprotein cholesterol (HDL‐C), while castration increased this level (P < 0.05). Triglyceride (TG) and total cholesterol (TC) levels in the castration group were significantly higher (P < 0.05) than those in the testosterone group. The ratio of HDL‐C:low‐density lipoprotein cholesterol (LDL‐C) decreased, while TC:HDL‐C ratio increased (P < 0.05) in the testosterone group. No significant differences were found in the LDL‐C and FBN levels among groups. However, there was a tendency for higher FBN level in the testosterone group. Testosterone administration resulted in an increase in the level of LPO (P < 0.05). Clotting time and prothrombin time prolonged in the castration group compared with testosterone group (P < 0.05). As a result, testosterone has exacerbating effect on atherosclerosis risk factors including lipid profile, LPO, FBN and coagulation system.     

Intradialytic parenteral nutrition in malnourished patients on chronic haemodialysis therapy

BACKGROUND.: Malnutrition is frequently encountered in patients on regularhaemodialysis therapy and presents an important determinantof morbidity and mortality. Usual therapeutic approaches toalleviate malnutrition have been unsuccessful. The objectiveof this study was to assess the impact of intradialytic parenteralnutrition (IDPN) with amino acids (in combination with a glucose-containingdialysate) on nutritional parameters and immunocompetence inpatients on regular haemodialysis treatment. METHODS.: Effects of IDPN were evaluated in 16 malnourished patients.After a run-in period of 4 weeks (to define stable baselineconditions) 0.8 g amino acids/kg bodyweight using a novel amino-acidsolution (adapted to metabolic alteration of uraemia and includingthe dipeptide glycyl-tyrosine as tyrosine source) was infusedthrice weekly during each haemodialysis session for 16 weeks. RESULTS.: Intradialytic amino-acid infusion was well tolerated and thedipeptide was rapidly utilized with only traces being detectablein plasma after dialysis. Visceral protein synthesis was improved,serum albumin, prealbumin, and cholinesterase increased duringIDPN (P < 0.05). As indicators of augmented immunocompetenceskin test reactivity against multiple antigens was improved(P < 0.02) and total lymphocyte count was raised (P <0.05). Plasma amino acid pattern did not deteriorate but failedto normalize during IDPN and phenylalanine/tyrosine ratio remainedstable. Anthropometric measurements and eating behaviour asassessed by dietary records were not altered during IDPN. CONCLUSIONS.: Even using a simple and limited intradialytic nutritional supportwith amino acids can improve visceral protein status and stimulateimmunocompetence in malnourished patients on regular haemodialysistherapy.     

The pathogenetic significance of C5b-9 in IgA nephropathy

Renal biopsies from 20 patients with IgAN were retrospectivelystudied using monoclonal antibodies against T cells, monocytes/macrophages(MM), HLA-DR-related antigen and the C5b-9 neoantigen. GlomerularC5b-9 deposits were mainly found in the mesangial areas andshowed an association with IgA (P<0.005) and C3 deposits(P<0.001). Interstitial T cells and MM were highly correlatedwith the interstitial DR+ve cells (P<0.001 and P<0.0005respectively). Tubular C5b-9 deposition was observed on thetubular basement membranes and related to the numbers of interstitialT cells (P<0.005), MM (P<0.005) and DR+ve cells (P<0.01)as well as to the tubular DR expression (P <0.025). The severityof tubular atrophy and interstitial fibrosis showed a positivecorrelation with the interstitial T cells, MM and DR+ve cells,as well as with the intensity of tubular C5b-9 deposition (P<0.05and P<0.05 respectively). Plasma creatinine on presentationwas correlated with the numbers of interstitial T cells (P<0.05),MM (P<0.01), interstitial DR+ve cells (P<0.005), and tubularC5b-9 deposits (P<0.005). No correlation between glomerularT cells, MM, and C5b-9 deposits with plasma creatinine was seen.During follow-up, renal function deteriorated in those patientswith the more extensive tubular C5b-9 deposits In conclusion, glomerular C5b-9 deposition seems to be secondaryto the IgA and C3 deposition. In contrast, tubular C5b-9 isrelated to the numbers of interstitial T cells and MM. Activatedinterstitial mononuclear cells may lead to the tubular depositionof C5b-9, which eventually might contribute to the developmentof tubulointerstitial lesions (TIL) and renal function impairment     

Low-dose aspirin does not prevent thrombovascular accidents in low-risk haemodialysis patients during treatment with recombinant human erythropoietin

Treatment of the anaemia of renal disease with recombinant humanerythropoietin results in an improvement of haemostasis andan increased risk of thrombovascular accidents. In this prospective,placebo-controlled, double-blind, and cross-over study, theeffects of low-dose acetylsalicylic acid (30 mg daily) on thromboticand bleeding events during the initial period of treatment witherythropoietin in anaemic haemodialysis patients without previousthrombovascular accidents or known increased risk for thrombosiswere investigated. During correction of the haematocrit andthe first 3 months thereafter, group A (n = 68) received placeboand group B (n = 69) 30 mg acetylsalicylic acid daily. Cross-overtook place after the 3rd month of a stable haematocrit. Thestudy ended 3 months later. Target haematocrit (30–35%) was reached in 12.4±8 weeks (M ± SD). In group A the bleeding time was 382±285s, decreasing to 282±208 before cross-over (P<0.0l),and increasing to 395±271 (P<0.05) there after. Ingroup B the bleeding time was 390±381 s, 406±267(NS), and 285±238 (P<0.05) respectively. Twenty-twothrombovascular accidents were seen (16%, 13 during acetylsalicylicacid and 9 during placebo, NS), including 17 fistula thromboses.The incidence of bleeding events was not significantly differentbetween regimens. In conclusion, erythropoietin treatment resulted in a reductionof the bleeding time. When 30 mg acetylsalicylic acid was takenduring the treatment, the bleeding time did not decrease. Theregimen did not result in an increased number of bleeding events,but neither were thrombovascular accidents prevented in low-riskpatients.     

Effect of oral gabapentin on postoperative epidural analgesia

Background. Gabapentin has been used successfully as a non-opioidanalgesic adjuvant for postoperative pain management. We hypothesizedthat gabapentin might be a useful adjuvant for postoperativeanalgesia provided with patient-controlled epidural analgesia(PCEA). Methods. Forty patients undergoing lower extremity surgery procedureswere randomly assigned to receive (i) placebo capsules (control)or (ii) gabapentin (1.2 g day^–1) before and for 2 daysafter surgery. Anaesthetic technique was standardized. Postoperativeassessments included verbal rating scale scoring for pain andsedation, PCEA usage, quality of recovery assessment, timesof GI function recovery, and patient satisfaction scoring forpain management. Results. Pain scores at 1, 4, 8, 12, and 16 h (P<0.001),PCEA bolus requirements (n) at 24 [21 (3), 14 (2)], 48 [15 (4),10 (3)] and 72 [8 (5), 2 (3)] (P<0.05) and paracetamol (mg)consumption [700 (523), 350 (400)]; P<0.05), were significantlylower in the gabapentin-treated patients than in the controlgroup. Patient satisfaction with postoperative pain managementat 24 h was better in gabapentin-treated patients [85.5 (7.5),66.5 (15)]; P<0.001). Gabapentin-treated patients had lessmotor block when compared with control group. Times of returnof bowel function, hospitalization, and resumption of dietaryintake were similar in the groups. However, the incidence ofdizziness was higher in the gabapentin group (35% vs 5%; P<0.05). Conclusions. Oral gabapentin (1.2 g day^–1) as an adjunctto epidural analgesia decreased pain and analgesic consumption.Despite an increased incidence of dizziness it also increasedpatient satisfaction.      

Results of a long-term administration of omega-3 fatty acids in haemodialysis patients with dyslipoproteinaemia

In this study we evaluated the effect of a daily administration of 1 g salmon-oil concentrate containing 0.2 g eicosapentaenoic acid (EPA) on the blood pressure, serum cholesterol, HDL and LDL cholesterol, triglycerides and magnesium of ten patients on chronic haemodialysis. Systolic and diastolic blood pressure values decreased significantly from 156 +/- 27.7/84 +/- 14.3 to 140 +/- 22.8/75.6 +/- 8.21 mmHg. Concordantly, mean arterial pressure (MAP) decreased significantly from 108 to 96 mmHg. Total serum cholesterol decreased significantly by 64%, HDL cholesterol increased by 47% (P less than 0.001). Serum triglyceride values decreased significantly to 48%. There was a distinct decline of magnesium from 1.42 +/- 0.27 to 1.28 +/- 0.13 mg/dl (P less than 0.001). According to these results, the administration of omega-3 fatty acids may be considered as a reasonable approach in the treatment of dyslipoproteinaemia in patients on continuous haemodialysis.     

Serum Lipid Profile in Iranian Fat‐tailed Sheep in Late Pregnancy,at Parturition and During the Post‐parturition Period

Blood samples were obtained from 12 Iranian fat‐tailed sheep during 7 weeks pre‐partum, at parturition and 7 weeks post‐partum. The lipids measured were cholesterol, triglyceride, total lipid, high‐density lipoprotein (HDL)‐cholesterol, low‐density lipoprotein (LDL)‐cholesterol, and very low‐density lipoprotein (VLDL)‐cholesterol. The concentrations of cholesterol, triglyceride, HDL‐cholesterol and VLDL‐cholesterol during the 7 weeks pre‐partum, at parturition and the 7 weeks post‐partum were significantly different (P < 0.05). One week before parturition, the concentrations of cholesterol, triglyceride, HDL‐cholesterol and VLDL‐cholesterol were higher (P < 0.05) than at other periods. The lowest concentrations of these parameters were observed 2–3 weeks after parturition. In this study, significant positive correlations were observed between the time of sampling (pre‐partum, parturition and post‐partum) and serum cholesterol (r=0.22; P < 0.01) and HDL‐cholesterol (r=0.25; P < 0.01).     

Caloric rather than protein deficiency predominates in stable chronic haemodialysis patients

BACKGROUND.: The monitoring of energy and protein intake is considered fundamentalin uraemic patients. However, in the clinical practice onlyprotein ingestion is indirectely evaluated by the protein catabolicrate. METHODS.: In a cross-sectional study we evaluated the relationship betweencaloric and protein intake of 29 stable chronic haemodialysispatients (18M, 11 F, mean age 49 ± 17 years, 68 ±6 months on maintenance haemodialysis), and the validity ofprotein catabolic rate determination. Normalized protein catabolicrate was obtained according to Sargent's formula, and Watson'sequation was used to calculate urea distribution volume. Caloricand protein intake were recorded during a 3-day period, andaverage daily ingestion of nutrients was calculated using acomputerized diet analysis system. RESULTS.: A greater reduction of daily energy intake (26.8±11.9Kcal/kg bw) than daily protein intake (1.02±0.4 g/kgbw) was observed. Fifty-nine percent of patients had low proteinintake while 86% of patients had lower caloric intake than recommended.An inverse relationship between age and protein (r=–0.65,P<0.00l) or caloric intake (r=–0.67, P<0.001) wasobserved. Negative relationships between daily protein (r=–0.60,P <0.01) and also caloric intake (r=–0.39, P<0.05)and the ratio between the urea generation rate and the totaldietary nitrogen were found, indicating that in patients withlow nutrient intake the nitrogen balance tends to be negative. Normalized protein catabolic rate was directly correlated withprotein intake (r=0.77, P<0.001). A protein catabolic ratecut-off of 1 g/kg bw correctly identified all patients withnormal daily protein intake, and 14 of 17 patients with deficientdaily protein intake (<1g/kg bw). Thus in only 10% of haemodialysispatients an imbalance between both parameters was observed.Moreover, patients with a daily protein intake lower than 1g/kg bw were older and showed lower BUN and protein catabolicrate values than their counterparts. CONCLUSIONS.: Nutritional abnormalities are frequently found, even in apparentlyclinically stable patients on chronic haemodialysis. Caloricrather than protein undernutrition is the major abnormalityof their wasting. Inadequate intake of proteins and caloriesappears more commonly in older patients, and in associationwith lower BUN and protein catabolic rate values. Although normalizedprotein catabolic rate shows a direct correlation with a dailyprotein intake, the identity line shows that when daily proteinintake was lower than 1 g/kg bw, it was overestimated by proteincatabolic rate. Conversely, when daily protein intake is higherthan 1 g/kg bw it is underestimated by the protein catabolicrate. This relationship should to be considered when interpretingthe protein catabolic rate in a clinical setting.     

Low-dose simvastatin is safe in hyperlipidaemic renal transplant patients

Hyperlipidaemia is common after renal transplantation, and becauseof its association with atherosclerosis, interest has increasedin the use of lipid-lowering drugs in transplant patients. Dietaryapproaches have not been consistently successful, and multiplepharmacotherapy and drug interactions have led to difficultiesin establishing lipid-lowering drug regimes. The statins reduceplasma cholesterol by inhibiting the rate-limiting step in cholesterolsynthesis, and although some side-effects have been reportedin their use after transplantation, the efficacy and safetyof low doses has not been formally established. A randomized single-blind placebo crossover study designed todetermine the safety and effectiveness of simvastatin in a singledaily 5-mg evening dose was therefore conducted in 26 stablerenal transplant patients, 14 of whom were receiving cyclosporinA. The results demonstrated no difference between total cholesterollevels in the baseline simvastatin and placebo periods: 7.97± 1.2 and 7.59±1.5 mmol/l respectively. After8 weeks of simvastatin, the total cholesterol declined significantlyto 6.72±0.87 mmol/l (P<0.001). A significant differencewas found when the placebo and simvastatin cholesterol levelswere compared at 4 and 8 weeks (P<0.01). LDL cholesterol decreased from 4.74 ± 0.87 to 3.78 ±0.78 mmol/l after 8 weeks on simvastatin (P<0.001), and apoB fell from 142 ± 31 to 112 ± 22 mg/dl (P<0.001).The difference in LDL cholesterol and apo B after 8 weeks ofsimvastatin when compared with the corresponding values on placebowas also significant (P<0.01). A slight but not significantincrement in HDL cholesterol from 1.10 ± 0.47 to 1.13± 55 mmol/l (NS) was seen after 8 weeks on simvastatin. Triglycerides and serum creatinine did not change during thestudy in any of the groups. Creatine kinase (CK.) remained inthe normal range (0–200 U/l), except for one patient nottaking cyclosporin who had a CK value slightly above the upperlimit of normal during the simvastatin period, without abnormalclinical signs. Repeated cyclosporin measurements remained withinthe therapeutic range (50–150 ng/ml). These results suggestthat low-dose simvastatin is effective and safe in reducingtotal cholesterol and LDL cholesterol in renal transplant patients.     

Effects of omega-3 on lipid profile and inflammation markers in peritoneal dialysis patients

Introduction: Cardiovascular complications are the main cause of mortality in patients with end-stage renal disease (ESRD). Peritoneal dialysis (PD) patients generally have a more atherogenic serum lipid profile. Although statins are the cornerstone of lipid-lowering therapy, there is an important role of fibrates in the treatment of hypertriglyceridemia. Fibrates increased the risk of rhabdomyolysis. ESRD patients are at risk for inadequate omega-3 intake as a result of renal dietary recommendations. In the general population omega-3 fatty acids play an important modulatory role in lipid regulation, immune and inflammatory responses, progression of arteriosclerosis, and cardiovascular disease. Aim: To evaluate the effect of oral omega-3 administration on plasma lipid levels and inflammatory markers in PD patients. Patients and methods: Fifteen adult and stable PD patients who did not receive omega-3 or fibrates treatment before were included in the study. All subjects followed the usual dialysis diet and regimen and continued with the same cholesterol-lowering statins. The patients were treated with daily oral 2.4 g docosahexaenoic acid and 1 g eicosapentaenoic acid supplementation in three divided doses with meals for 8 weeks. Triglycerides, LDL-C, HDL-C, and inflammation markers were evaluated before the administration of omega-3 and at 8 weeks. Results: Triglyceride levels were decreased significantly (p = 0.001). Total, HDL and LDL cholesterol levels were not affected. ESR, CRP, IL-6, TNF-α, 4-hydroxynonenal, and malondialdehyde levels reduced insignificantly. Conclusions: This short-term pilot study demonstrated the efficacy, safety, and well tolerability of omega-3 in the treatment of hypertriglyceridemia in PD patients.     

Kinetic modelling and underdialysis in CAPD patients

Kinetic analysis was performed in all 58 patients undergoingstandard CAPD. The urea distribution volume was estimated fromanthropomorphic measurements (Watson formulae). Normalized proteincatabolic rate (NPCR), daily protein leak (PL), urea and creatinineKt/Vs, clearances and peritoneal mass transfer coefficients(Kp) were calculated from measurements on serum, 24-h urineand PD fluid effluent. The mean total (renal+PD) daily creatinine and urea Kt/Vs (KT/V)were 0.31 (range 0.15–0.79) and 0.31 (0.18/0.65). Therewas no relationship between KT/V and serum urea or Kp. The strongestdeterminant of the urea KT/V was the residual renal urea clearance(KrU)(R=079, P<0.001) which decreased with time on dialysis(R=–0.38, P<0.005). There was a significant correlationbetween the hospital admissions per year and both the urea andcreatinine KT/V and KrU (R=–0.30, –0.32, P<0.05).Patients with urea KT/V<0.25 (n=22) had more hospital admissions/yearthan those with KT/V>0.25 (mean of 2.6 versus 1.5, P<0.05).NPCR correlated with urea KT/V (R=0.62, P<0.001) but notwith serum albumin or the PL. Patients identified by UKM to be less well dialysed have a lowerresidual renal function and are more likely to be hospitalized.Undernutrition in CAPD patients appears to be related to underdialysisrather than protein loss.     

Changes in bone mineral content during long-term CAPD. Indication of a sex-dependent bone mineral loss

Change in bone mineral content (BMC) was evaluated in a longitudinaltrial comprising 12 women and 11 men with chronic renal diseasetreated with CAPD and 1-alpha-OH-D3 for 2 years. The patientsserved as their own controls. No patients were treated withsteroids. Median age was 54 and 60 years for women and men respectively.No significant difference in 1-alpha-OH-D3 dosage or serum 1,25(OH)₂D3was found between the genders in the study period. Bone mineral content at the distal radius deteriorated significantlyin the females with a median decrease of 12% over 2 years, i.e.approximately 6% per year (P<0.001 and 95% confidence limits8–20%). No significant change was noted in the males.There was no correlation between age and BMC change. Serum total alkaline phosphatase decreased nonsignificantlyin both sexes. Total serum calcium increased significantly (P<0.05)and serum phosphate decreased significantly (P<0.05) in thewomen. Serum albumin and body weight decreased significantlyin the males (P<0.01 and P<0.05) while no change was seenin the females. The demonstrated decrease in BMC in the female patients of approximately6% per year exceeds the commonly observed loss of 1–2%per year in healthy women when measured with the same technique.Tentatively, the severe mineral loss in the women could indicatea sex-hormone-related disturbance in bone metabolism of uraemicfemales.     

Dietary Fish Oil Supplements Preserve Renal Function in Renal Transplant Recipients with Chronic Vascular Rejection

The effect of dietary fish oil supplements on renal failureand lipid abnormalities was studied in 14 adult renal transplantrecipients with chronic vascular rejection. The rate of declineof renal function (assessed by studying the slope of reciprocalplasma creatinine plots) slowed significantly during a 6-monthperiod on fish oil supplements compared with the preceding 6-monthcontrol period (slope 1/cr during supplementation –3.6x 10^–5 µmol/l per month compared with –13.5x 10^–5 before, the difference in slope being –9.8x 10^–5, 95% confidence interval (CI) –16.2 x 10^–5,–3.5 x 10^–5, P<0.05). Total plasma triglycerideconcentrations decreased during supplementation (mean change–1.15 mmol/l, 95% CI –1.84, –0.47, P<0.003),but there was no change in total plasma cholesterol concentrationor urinary protein excretion. Platelet function was studiedin nine patients. Platelet aggregation induced by adrenalineand collagen was reduced by fish oils (median change in percent aggregation), adrenaline 2 µmol/ –36% (95%CI –68%, –8%, P<0.05), collagen 1 mg/l, –13%(95% CI –44%, –2%, P<0.05). Platelet thromboxaneA₂ release in response to these agents was also significantlyreduced. These results demonstrate that fish oils preserve residualfunction in renal graft failure due to chronic vascular rejection.     

Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anaesthesia and tracheal intubation in the elderly

Background. We compared the effects of remifentanil and alfentanilon arterial pressure and heart rate at induction of anaesthesiaand tracheal intubation in 40 ASA I–III patients agedgreater than 65 yr, in a randomized double-blind study. Methods. Patients received either remifentanil 0.5 µgkg^–1 over 30 s, followed by an infusion of 0.1 µgkg min^–1 (group R) or alfentanil 10 µg kg^–1over 30 s, followed by an infusion of saline (group A). Anaesthesiawas then induced with propofol, rocuronium, and 1% isofluranewith 66% nitrous oxide in oxygen. Results. Systolic arterial pressure (SAP) and mean arterialpressure (MAP) decreased after the induction of anaesthesia(P<0.05) and increased for 3 min after intubation in bothgroups (P<0.05), but remained below baseline values throughout.Heart rate remained stable after induction of anaesthesia butincreased significantly from baseline after intubation for 1and 4 min in groups R and A, respectively (P<0.05). Therewere no significant between-group differences in SAP, MAP, andheart rate. Diastolic pressure was significantly higher in groupA than group R at 4 and 5 min after intubation (P<0.05).Hypotension (SAP <100 mm Hg) occurred in four patients ingroup R and three patients in group A. Conclusions. Remifentanil and alfentanil similarly attenuatethe pressor response to laryngoscopy and intubation, but theincidence of hypotension confirms that both drugs should beused with caution in elderly patients. Br J Anaesth 2002; 88: 430–3     

NON-INVASIVE MEASUREMENT OF CARDIAC OUTPUT DURING INDUCTION OF ANAESTHESIA AND TRACHEAL INTUBATION: THIOPENTONE AND PROPOFOL COMPARED

We have investigated the haemodynamic changes in response toinduction of anaesthesia and tracheal intubation in patientswho received either thiopentone 5 mg kg^–1 or propofol3 mg kg^–1 followed by atracurium 0.5 mg kg^–1 andfentanyl 1.5 µg kg^–1. Anaesthesia was maintainedwith 0.6% enflurane and 50% nitrous oxide in oxygen with assistedventilation. Cardiac output and heart rate (HR) were monitoredcontinuously with a transthoracic impedence monitor. Mean HRdid not change after induction in each group, but increasedafter tracheal intubation in both groups (P < 0.01). Meancardiac index (CI) decreased after induction (P < 0.05) anddecreased further after tracheal intubation in both groups (P< 0.05). There was no difference between the two groups withrespect to changes in CI and HR. Mean arterial pressure (MAP)and systemic vascular resistance (SVR) did not change significantlyafter induction in the thiopentone group. Both variables increasedfrom preinduction values 1 min after tracheal intubation (P< 0.001). In contrast, both MAP and SVR decreased after inductionin the propofol group (P < 0.001) and did not differ frompreinduction values 1 min after tracheal intubation. MAP andSVR were greater in the thiopentone group compared with thepropofol group after induction and tracheal intubation (P <0.01).