Helicobacter pylori antibodies in hemodialysis patients and renal transplant recipients

In this cross-sectional, controlled study, Helicobacter pylori ( H . pylori ) infection, a probable factor in the development of gastrointestinal problems, was investigated in dialysis patients and renal transplant recipients. Forty-seven dialysis patients (22 male, 25 female, mean age of 36.6±15 yr (range 18–83 yr)), 57 renal transplant recipients (39 male, 18 female, mean age of 36.8±10 yr (range 19–60 yr)) and 55 healthy individuals (34 male, 21 female, mean age of 33.4±9.6 yr (range 21–58 yr)) were included and no significant difference was found in the study groups. The mean time spent on dialysis in the hemodialysis group was 32.5±27.7 months (range 1–100 months). H . pylori antibodies were detected in 22 of 57 (38.6%) patients in the transplantation group, 31 of 47 (65.9%) patients in the dialysis group and 39 of 55 (72.5%) in the control group. No correlation was found between H . pylori infection and age, sex, primary disease, frequency of dialysis, duration and type of transplantation and the immunosuppressive therapy. However, patients with H . pylori antibodies spent a shorter time on dialysis compared to patients without the antibodies (26.6±23.5 vs 44.1±32.1 months, p=0.038). The frequency of H . pylori infection in the transplantation group was significantly lower than the control and dialysis groups (p<0.01). This finding may be explained on the basis of decreased humoral antibody response to H . pylori infection, secondary to immunosuppressive therapy rather than decreased incidence of infection in the transplantation group. Finally, we concluded that the value of the serological test for diagnosis of H . pylori infection should be interpreted cautiously in these patient groups.     

Anxiety, depression and emotional profile in renal transplant recipients and healthy subjects: a comparative study

Background

Renal transplantation is a well established treatment for end-stage renal disease. However, recipients have been shown to develop emotional distress and affective disorders, such as anxiety and depression, associated with a compromised quality of life. Some accounts report an improvement of affective disorders after transplantation, others draw opposite conclusion.

Methods

The present cross-sectional study selected 42 transplant recipients and 42 control subjects matched for gender, age, educational background, and marital status. Symptoms of anxiety, depression and general emotional profiles were compared using the Zung Self-Rating Anxiety Scale, the Beck Depression Inventory (BDI), and the Affective Neuroscience Personality Scale (ANPS), a self-report inventory that evaluates 6 neurally based affective tendencies: seeking, caring, and playfulness (positive affects) and fear, anger, and sadness (negative affects).

Results

No significant differences were observed between transplanted patients and controls in scores for anxiety and depression, as evaluated with Zung and BDI scales. However, transplanted patients scored significantly lower than control subjects in fear and anger scales and in general negative emotions. Transplant recipients did not display any symptom of anxiety or depression, however, a significant reduction in negative affect, evaluated through the ANPS scale revealed psychological distress.

Conclusions

These findings suggest that affective profile in transplanted patients should be more extensively examined to review all facets in their mental and emotional assessment, especially regarding the role played by this emotional pattern in complying with medical treatment, which is well known to be a clinically critical feature of these patients.     

Treatment of mild hyperhomocysteinemia in renal transplant recipients versus hemodialysis patients

BACKGROUND: Mild hyperhomocysteinemia is common among maintenance hemodialysis (HD) patients and renal transplant recipients (RTR) and may contribute to the excess incidence of arteriosclerotic outcomes experienced by both patient groups. Relative to their RTR counterparts, the hyperhomocysteinemia of HD patients seems to be considerably more refractory to treatment with high-dose folic acid (FA)-based B-vitamin supplementation regimens, although controlled comparison data are lacking. METHODS: We compared the relative responsiveness of (n=10) RTR and (n=39) HD patients with equivalent baseline total homocysteine (tHcy) levels (i.e., RTR range=14.2-23.6 micromol/L; HD range=14.4-24.9 micromol/L) to 12 weeks of tHcy-lowering treatment. The RTR received 2.4 mg/day of FA, 50.0 mg/day of vitamin B6, and 0.4 mg/day of vitamin B12, while the HD patients received 15 mg/day of FA or an equimolar amount (17 mg/day) of the reduced folate, L-5-methyltetrahydrofolate, in addition to 50.0 mg/day of vitamin B6, and 1.0 mg/day of vitamin B12. RESULTS: The mean percent (%) reductions (+/-95% confidence interval) in tHcy were: RTR=28.1% (16.2-40.0%); HD=12.1% (6.6-17.7%), P=0.027 for comparison of between-groups differences by analysis of covariance adjusted for baseline tHcy levels. Moreover, (50.0%) of 10 of the RTR versus only (5.1%) of 39 of the HD patients had final on-treatment tHcy levels <12 micromol/L; P=0.002 for comparison of between-groups differences by Fisher's exact test. CONCLUSION: Relative to RTR with comparable baseline tHcy levels, the mild hyperhomocysteinemia of maintenance HD patients is much more refractory to tHcy-lowering B-vitamin treatment regimens featuring supraphysiological amounts of FA or the reduced folate, L-5-methyltetrahydrofolate. Accordingly, RTR are a preferable target population for controlled clinical trials testing the hypothesis that tHcy-lowering B-vitamin intervention may reduce arteriosclerotic cardiovascular disease event rates in patients with chronic renal disease.     

Endothelial function is more impaired in hemodialysis patients than renal transplant recipients

BACKGROUND: Endothelial dysfunction (ED) is a common precursor and denominator of cardiovascular events including development of atherosclerosis. In this cross-sectional, controlled study, we aimed to investigate ED measured by ischemia-induced forearm vasodilatation in chronic hemodialysis (HD) patients and renal transplant recipients (rTX). PATIENTS AND METHODS: Thirty-nine HD patients, 39 rTX and 38 normotensive healthy controls were included. There was no difference in age and gender distribution among the study groups. The mean time spent on dialysis and transplantation were 74 +/- 46 and 68 +/- 39 months. Serum high sensitive C-reactive protein (hs-CRP) and plasma fibrinogen levels were measured. Endothelium dependent post-ischemic vasodilatation of brachial artery was used to evaluate ED. RESULTS: The hs-CRP and plasma fibrinogen levels were significantly increased in HD patients when compared with rTX. On high resolution ultrasonographic examination, post-ischemic vasodilatation values in HD patients (9.55 +/- 6.47%) were significantly lower than rTX (14.39 +/- 8.06%, p = 0.007) and controls (20.42 +/- 6.10%, p < 0.001). Renal transplant recipients also had significantly lower post-ischemic vasodilatation values than controls (p = 0.001). The hs-CRP levels were negatively correlated with endothelium-dependent dilatations in TX (r = -0.59, p = 0.001), however, this correlation was not detected in HDp. CONCLUSION: Patients with end-stage renal disease have ED. Endothelial function is more impaired in HD patients than rTX. Different mechanisms might be responsible for ED in HD patients and rTX.     

Analysis of sexual functions in male nondiabetic hemodialysis patients and renal transplant recipients

Disturbance of sexual functions among hemodialysis patients and renal transplant recipients (RTRs) is controversial. Diabetes mellitus (DM) is known to have a significant negative impact on sexual functions. Most previous studies concerning the issue of disturbance of sexual functions among hemodialysis patients and renal transplant recipients have included diabetic patients also, which might have influenced their results. The aim of this study was to evaluate sexual functions of nondiabetic male (NDM) dialysis patients and RTRs, and to compare our findings with those of the others. Twenty‐five nondiabetic male RTRs, 25 age‐matched NDM hemodialysis patients, and 25 age‐matched NDM controls were the subjects of this study. Sexual functions of all subjects were assessed using the International Index of Erectile Function (IIEF) questionnaire. Statistical analysis was performed using appropriate statistical tests with the level of significance set at P < 0.05. Data were described using mean, standard deviation (SD), median and interquartile range (IQR). Renal transplant recipients (RTRs) and hemodialysis patients had depressed erectile function (EF) and Intercourse satisfaction (IS) function, but normal orgasmic (OF) function. Sexual desire (SxD) function of RTRs group, although subnormal, was better than that of hemodialysis patients. Overall satisfaction (OS) of RTRs, unlike that of hemodialysis patients, was normal. Sexual dysfunction is prevalent even in NDM hemodialysis patients and RTRs. Although ED is equally prevalent among these two groups, it is more profound among the former one. OF is spared in these patients. Renal transplantation seems to normalize OS and improve SxD function of nondiabetic male renal transplant recipients (NDM RTRs).     

Seasonal variations of blood pressure in hemodialysis and renal transplant recipients

Seasonal variations influence blood pressure (BP) in healthy persons. Its effects on BP in renal replacement therapy, especially after renal transplantation (RTX), have not been proven clearly. We studied 80 stable RTX and 82 hemodialysis (HD) patients for 4 years. Systolic and diastolic BP, body weight (BW), cholesterol (Chol), triglyceride (TG), fasting blood sugar (FBS), blood urea nitrogen (BUN), and creatinine (Cr) were measured monthly. Their relationship with environmental temperature and humidity changes were assessed by Pearson tests and Fourier analysis. Ambient temperature and humidity were between 2.5 degrees C to 25.4 degrees C and 68% to 31% in the winters versus summers, respectively. The mean systolic BP in HD patients was 144 +/- 18 mm Hg and 140 +/- 15 mm Hg during the winter and summer, respectively (P =.004). For the RTX recipients, it was 133 +/- 12 mm Hg in winter and 128 +/- 19 mm Hg in summer (P <.001). The decrement in diastolic BP in warmer seasons was even more significant than that in systolic BP in both HD and RTX groups. Also, BW in summer was significantly lower than winter among HD (61.1 +/- 10 kg vs 63.2 +/- 9 kg; P <.001) and RTX (64.4 +/- 8 kg vs 65.6 +/- 8.4; P <.001) groups. Serum Chol, TG, and FBS did not change significantly during summer and winter in the both groups. Among RTX recipients, BUN level was greater in summer than winter seasons (24.2 +/- 15 vs 39.4 +/- 20 mg/dL; P =.01), but serum Cr did not differ. The degree of humidity did not correlate with BP, BW, or the above biochemical markers. We conclude that BP and BW are decreased in warmer seasons in both HD and RTX patients. The changes are not accompanied by changes in biochemical markers except for BUN in RTX patients.     

Cause of death in renal transplant patients: a comparison between azathioprine and ciclosporin

The results of renal transplantation have improved due to advances in immunosuppression techniques of preservation, and pre- and postoperative treatments; however, both morbidity and mortality remain serious problems. To decrease the morbidity and mortality rates we analyzed the causes of death after renal transplantation in our hospital. Between 1972 and 1999, we performed 364 renal transplantations, 257 of which were living-related and 107, cadaveric. There were 178 patients given azathioprine and 186 given ciclosporin. The survival rate of the patients on ciclosporin therapy was much better than that of those on azathioprine therapy. Of the total 364 renal transplant patients, 59 (16.2%) died, and 28 (47.5%) of these 59 deaths occurred within 1 year after renal transplantation. The causes of death were infection in 19 (32.2%) patients, gastrointestinal diseases in 16 (27.1%), cardiovascular diseases in 11 (18.6%), cerebrovascular diseases in 6 (10.2%), suicide in 3 (5.1%), and other causes in 4 (6.8%). These findings reinforce that early diagnosis and treatment are essential to decrease the morbidity and mortality rates assoiated with renal transplantation. Received: May 23, 2000 / Accepted: November 20, 2000     

Comparing aortic stiffness in kidney transplant recipients, hemodialysis patients, and patients with chronic renal failure

Pan CR, Schmaderer C, Roos M, von Eynatten M, Sollinger D, Lutz J, Heemann U, Baumann M. Comparing aortic stiffness in kidney transplant recipients, hemodialysis patients, and patients with chronic renal failure.
Clin Transplant 2011: 25: E463–E468. © 2011 John Wiley & Sons A/S. Abstract: Background: The poor cardiovascular survival of patients with renal insufficiency is improved by transplantation. Carotid‐femoral pulse wave velocity (PWV) is able to predict independently overall and cardiovascular mortality. PWV is elevated in renal insufficiency. Consequently, PWV may change according to the improvement in renal function after kidney transplantation. Methods: In a cross‐sectional setting, PWV was determined in 40 renal transplant recipients (RTx) and compared to the PWV of 40 age‐ and gender‐matched patients with comparable renal insufficiency (CKD) and 40 age‐ and gender‐matched hemodialysis patients (HD). Results: RTx and CKD patients had comparable eGFR (RTx: 42.9 ± 18.4, CKD: 48.3 ± 29.1 mL/min/1.73 m²) and protein/creatinine ratio (RTx: median 172.5, 25th percentile 97.75, 75th percentile 344.5, CKD: median 183.272, 25th percentile 100.00, 75th percentile 470.00 mg/g creatinine). There was no significant difference in PWV between RTx 3–12 months post‐transplant and CKD or HD patients (RTx: 9.65 ± 1.57, CKD: 9.98 ± 3.91, HD: 10.27 ± 2.89 m/s; n = 20 pairs). Similarly, PWV in transplant patients >12‐month post‐transplant was similar to that of CKD and HD patients (RTx: 9.71 ± 2.23, CKD: 9.36 ± 2.74, HD: 9.84 ± 3.41 m/s; n = 20 pairs). Discussion: We could not detect significant differences in PWV comparing RTx with age‐ and gender‐matched CKD patients.     

Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients

This study analyzed the outcome of total hip arthroplasty (THA) from a single institution of patients with renal failure, including renal dialysis patients (9 patients, 9 hips) and renal transplant patients (28 patients, 36 hips). There were 12 revisions and a 61% complication rate in the transplant group. In the dialysis group, 1 patient was revised, and there was a 33% complication rate. Transplant patients were younger, more active, and lived longer, but had higher cumulative rates of revision and complications with longer follow-up. Dialysis patients, in contrast, had a short survival but a lower rate of complications and revisions. These data differ from previous reports of acceptable outcomes with low complication rates of THA in transplant patients. Efforts to minimize complications in these patients are justified.     

Clinical evaluation of serum albumin reductivity in patients with renal dysfunction: a comparison between conservative renal failure patients and hemodialysis patients

We examined the relationship between change in the redox state of the plasma albumin molecule and the metabolic disorder of sulfur amino acid observed being accompanied by reduction of renal function. Thirty-seven cases of pre-dialysis renal failure with conservative treatment and thirteen cases of chronic hemodialysis were selected as the subjects of this examination. The fraction of plasma albumin and the concentration of plasma cysteine and homocysteine were respectively measured by the HPLC and GC/MS (gas chromatography/mass spectrometry) methods. In the case of pre-dialysis renal failure with conservative treatment, the reduction rate of plasma albumin significantly decreased in correspondence with reduction of the glomerular filtration rate (GFR). It is well known that the reduction rate of plasma albumin also decreases with the aging process. However, in regard to chronic hemodialysis, a correlation with aging was not found, where the transient reduction rate of plasma albu- min increased after the hemodialysis session. However, in correspondence with the decrease in renal function, the concentration of plasma cysteine and homocysteine increased. This shows that there was a negative correlation with GFR in cases of pre-dialysis renal failure with conservative treatment. In cases of chronic hemodialysis, the concentration of free cysteine and free homocysteine rapidly decreased after a hemodialysis session. Therefore, a negative correlation was recognized between the reduction rate of plasma albumin and the concentration of plasma cysteine and homocysteine. The result of this examination shows the following mechanisms: plasma albumin plays an important role in the reaction of oxidation/reduction in blood plasma, and sulfur amino acid in blood plasma, especially the abnormality of cysteine concentration, plays an important role in changing the redox state of the blood plasma observed in the decrease in renal function.     

Homocysteine in renal transplant recipients: association with transplant duration and renal function

BACKGROUND: Hyperhomocystinemia is an established risk factor for cardiovascular events and has been identified as an important cause of morbidity and mortality in renal transplant recipients. This investigation was aimed to determine the effect of age and transplant duration on serum total homocysteine (tHcy) levels in renal transplant recipients. METHODS: We analyzed serum levels of tHcy, albumin, alkaline phosphatase, alanine transferase, bilirubin, calcium, corrected calcium, cholesterol, creatinine, folate, phosphate, potassium, sodium, triglycerides, urea and vitamin B12 in 88 transplant patients (ages, 14-67 years; transplant duration, 1-252 months) and 60 control subjects. RESULTS: Our results showed significant hyperhomocystinemia in transplant patients (19.92 +/- 0.72) as compared to controls (9.28 +/- 0.25), while male subjects in both groups had significantly higher tHcy than females. There was no correlation between patients' age and serum tHcy, whereas the time after transplantation was significantly correlated with tHcy (r=0.318, P<0.01). A significant correlation was observed between tHcy and serum urea, creatinine, vitamin B12 and potassium in renal transplant patients. CONCLUSION: This study clearly demonstrated significant hyperhomocystinemia and renal impairment in transplant recipients. A time-course increase in serum tHcy during posttransplant duration warrants long-term monitoring of patients for effective clinical management.     

Helicobacter pylori infection in haemodialysis patients and renal transplant recipients

Background. It is known that Helicobacter pylori (Hp) plays an important role in gastritis and peptic ulcer disease in the general population. Although dyspeptic complaints are frequent in haemodialysis (HD) patients and renal transplant recipients, there are few reports regarding the prevalence of Hp and its possible effects on this group of patients. This study was performed to examine the prevalence of Hp infection in patients on regular HD treatment and to detect its role in the pathogenesis of dyspepsia in this group of patients. Methods. Two hundred and one patients with dyspeptic complaints were included in the study. The groups consisted of 47 HD, 54 renal transplant recipients, and 100 non-renal disease patients. Upper gastrointestinal endoscopies were performed and gastric antral biopsies were obtained for urease test in all patients. Results. Twenty-eight (60%) of the 47 HD and 28 (70%) of the 54 RTR were positive for Hp. Sixty-four (64%) of the 100 patients with various gastrointestinal complaints and known to have no renal dysfunction were positive for Hp. The Hp prevalences among the three groups were not significantly different (P <0.05). The prevalence of Hp infection did not correlate with the haemodialysis duration nor the post-transplantation duration (P <0.05). There was no correlation between the prevalence of Hp infection and duration of haemodialysis therapy or time post-transplantation. Conclusion. These findings suggest that HD patients are not protected against Hp infection as the Hp prevalences are as high as that for the non-renal disease group. The increased dyspeptic complaints may be partly related to Hp infection.     

Examination of the semen quality of patients with uraemia and renal transplant recipients in comparison with a control group

To examine the semen quality of patients with uraemia and renal transplant recipients, 40 patients with uraemia and 40 renal transplant recipients were included. According to their interval of post-transplantation, renal transplant recipients were subdivided into group A (22) ≤2 years and group B (18) >2 years. A total of 40 healthy men with normal fertility were included as the controls. Semen samples from all subjects were collected and analysed. The fertility index (FI) value was calculated. The FI value of the normal fertility men was 13.02 (14.26), that of the renal transplant recipient groups A and B were 5.53 (8.30) and 9.27 (22.49) respectively, while the FI of the patients with uraemia was 0.23 (0.76). Compared with the uraemia group, the FI values of renal transplant recipient group either group A or group B were significantly better ( P  <   0.01). However, compared with the normal control group, the FI values of renal transplant recipient group A were lower ( P  <   0.01), while there was no significant difference between group B and the control group ( P  >   0.05). In conclusion, the FI of renal transplant recipients was recovered close to the level of healthy men with normal fertility 2 years after transplantation.     

Tuberculosis in renal transplant recipients

BACKGROUND: Tuberculosis is an important cause of morbidity and mortality in renal transplant recipients, but there are insufficient data regarding the efficacy and complications of therapy and of INH prophylaxis. METHODS: This study is a retrospective review of the records of 880 renal transplant recipients in two centers in Turkey. RESULTS: Tuberculosis developed in 36 patients (4.1%) at posttransplant 3-111 months, of which 28 were successfully treated. Eight patients (22.2%) died of tuberculosis or complications of anti-tuberculosis therapy. Use of rifampin necessitated a mean of 2-fold increase in the cyclosporine dose, but no allograft rejection occurred due to inadequate cyclosporine levels. Hepatotoxicity developed in eight patients during treatment, two of whom died due to hepatic failure. No risk factor, including age, gender, renal dysfunction, hepatitis C, or past hepatitis B infection, was found to be associated with development of hepatic toxicity. A subgroup of 36 patients with a past history of or radiographic findings suggesting inactive tuberculosis, was considered to be at high risk for developing active disease, of whom 23 were given isoniazid (INH) prophylaxis. None versus 1 of 13 (7.7%) of cases with and without INH prophylaxis, respectively, developed active disease (P>0.05). None of the patients receiving INH had hepatic toxicity or needed modification of cyclosporine dose. CONCLUSIONS: These data show that tuberculosis has a high prevalence in transplant recipients, that it can effectively be treated using rifampin-containing antituberculosis drugs with a close follow-up of serum cyclosporine levels, and that INH prophylaxis is safe but more experience is needed to define the target population.