Genomic instability in chronic renal failure patients

Patients suffering chronic renal failure (CRF) exhibit a high incidence of cancer, as well as high levels of genetic damage. We hypothesized that these patients show genomic instability as measured by increased radiosensitivity to the induction of genetic damage. The background levels of genetic damage and the net genetic damage after in vitro irradiation with 0.5 Gy were analyzed using the micronucleus assay in peripheral blood lymphocytes of 174 CRF patients and 53 controls. The net radiation‐induced genetic damage was significantly higher in CRF patients with respect to controls. Among CRF patients, the levels of genetic damage were higher in those with prior incidence of cancer than in those without cancer; in addition, those CRF patients undergoing hemodialysis presented with higher levels of genetic damage than those in the advanced Stages (4–5) of the pathology. A positive association was observed between basal and net micronucleus frequency among CFR patients. However, no association was found between net genetic damage and parameters linked to the different stages of the pathology, such as urine creatinine levels and glomerular filtration rate. Our results indicate that CRF patients show increased radiosensitivity and that the degree of radiosensitivity is associated with the progression of the pathological stage of the disease. Environ. Mol. Mutagen., 2012. © 2012 Wiley Periodicals, Inc.     

Measurement of Cardiac Output and Blood Volume During Hemodialysis with Fluorescent Dye Dilution Technique

Intradialytic hypotensive events (IDH) accompanied by deleterious decreases of the cardiac output complicate up to 25% of hemodialysis treatments. Monitoring options available to track hemodynamic changes during hemodialysis have been found ineffective to anticipate the occurrence of IDH. We have assembled opto-electronic instrumentation that uses the fluorescence of a small bolus of indocyanine green dye injected in the hemodialysis circuit to estimate cardiac output and blood volume based on indicator dilution principles in patients receiving hemodialysis. The instrument and technique were tested in 24 adult end-stage renal failure subjects during 64 hemodialysis sessions. A single calibration factor could be used across subjects and across time. Intra-subject variability of the measurements over time was <10%. Stroke volume index (SVI) (mean ± SEM = 34 ± 1 vs. 39 ± 2 mL m^?2) and central blood volume (CBV) index (783 ± 36 vs. 881 ± 33 mL m^?2) were lower at the beginning of the sessions in which IDH eventually occurred. Cardiac index, SVI, and CBV index decreased with hemodialysis in all treatment sessions but the decrease was more intense in the IDH sessions. We conclude that hemodynamic monitoring can be implemented in patients receiving hemodialysis with minimal disruption of the treatment and could help understand intradialytic hypotension.     

Effect of hemodialysis schedules and membranes on hepatocyte growth factor and hepatitis C virus RNA levels

Hemodialysis induces production of the hepatocyte growth factor (HGF) and decrease of serum hepatitis C virus (HCV) RNA in patients with HCV infection, but it is not known if the hemodialysis schedule or type of membrane affect both the HGF production and HCV viremia. The effects on both parameters of alternate‐day intermittent hemodialysis and short‐daily hemodialysis and high and low flux membranes were investigated in 41 patients treated by hemodialysis. Sixteen (39%) patients were anti‐HCV positive and 11 (69%) had HCV RNA. Twenty‐six patients were on alternate‐day intermittent and 15 on short‐daily hemodialysis. High flux membranes were used for 29 patients and low flux membranes for 12 patients. A decrease in HCV RNA was observed at the end of hemodialysis (8.6 × 10⁵ ± 1.1 × 10⁶ IU/ml vs. 4.4 × 10⁵ ± 7.3 × 10⁵ IU/ml, P = 0.003). The proportion of HCV RNA decrease was similar in patients dialyzed with both schedules and with both types of membranes. The HGF levels increased from 2,605.9 ± 1,428.7 to >8,000 pg/ml at 15 min. At the end of the session, the HGF levels decreased to 5,106.7 ± 2,533.9 pg/ml. The HGF levels at the start of the next session were similar to those at baseline (2,680.0 ± 1,209.3 pg/ml). The increase and dynamics of the HGF levels were similar in patient's hemodialyzed with both schedules and with both types of membranes. These results suggest that changes in HCV RNA and HGF levels during hemodialysis are not influenced by the schedule or type of membrane used. J. Med. Virol. 82: 763–767, 2010. © 2010 Wiley‐Liss, Inc.     

Noninvasive investigation of blood pressure changes using the pulse wave transit time: a novel approach in the monitoring of hemodialysis patients

Severe blood pressure changes are well known in hemodialysis. Detection and prediction of these are important for the well-being of the patient and for optimizing treatment. New noninvasive methods for this purpose are required. The pulse wave transit time technique is an indirect estimation of blood pressure, and our intention is to investigate whether this technique is applicable for hemodialysis treatment. A measurement setup utilizing lower body negative pressure and isometric contraction was used to simulate dialysis-related blood pressure changes in normal test subjects. Systolic blood pressure levels were compared to different pulse wave transit times, including and excluding the cardiac preejection period. Based on the results of these investigations, a pulse wave transit time technique adapted for dialysis treatment was developed and tried out on patients. To determine systolic blood pressure in the normal group, the total pulse wave transit time was found most suitable (including the cardiac preejection period). Correlation coefficients were r = 0.80 ± 0.06 (mean ± SD) overall and r = 0.81 ± 0.16 and r = 0.09 ± 0.62 for the hypotension and hypertension phases, respectively. When applying the adapted technique in dialysis patients, large blood pressure variations could easily be detected when present. Pulse wave transit time is correlated to systolic blood pressure within the acceptable range for a trend-indicating system. The method's applicability for dialysis treatment requires further studies. The results indicate that large sudden pressure drops, like those seen in sudden hypovolemia, can be detected.     

高通量血液透析对维持性血液透析患者细胞免疫功能的影响

目的探讨高通量血液透析对维持性血液透析（MHD）患者细胞免疫功能的影响。方法收集2012年3月至8月于本院门诊行MHD治疗的患者40例,随机数字表法分为血液透析（HD）组（n=20）和高通量血液透析（HFHD）组（n=20）,分别接受HD和HFHD治疗,均为每周透析3次,每次4h。透析前、透析后4、24、48h,流式细胞术检测两组患者外周血CD4＋．CD8＋、CD25＋,记录CD47CD8＋比值,酶联免疫吸附测定（ELISA）检测血清IL-2、可溶性IL-2受体（sIL．2R）;另设健康对照组（C组）20例,清晨空腹抽血检测上述指标。结果与C组比较,透析前HD组和HFHD组患者外周血CD4＋、CD25＋、CD4＋／CD8＋水平下降,血清IL．2水平下降,sIL．2R升高（均P〈0．05）。与透析前比较,HD组患者透析后4h外周血CD4＋、CD25＋、CD47CD8＋水平升高,血清IL-2水平升高,sIL-2R降低（均P〈0．05）,CD8＋差异无统计学意义（P〉O．05）;与透析前比较,HD组患者透析后24、48h上述各指标差异无统计学意义（均P〉0．05）。与透析前比较,HFHD组患者透析后4、24、48h外周血CD4＋、CD25＋、CD4VCD8＋水平升高,血清IL．2水平升高,slL-2R降低（均P〈0．05）,而CD8＋差异均无统计学意义（均P〉O．05）。与同时点HD组比较,HFHD组透析后4h各指标差异均无统计学意义（均P〉O．05）;透析后24、48h,HFHD组外周血CD4＋、CD25＋、CD4＋／CD8＋水平升高,血清IL．2水平升高,sIL．2R降低[CD4＋：（38．73±6．25）％比（34．92±5．84）％,（37．03±5．41）％比（32．62±5．79）％;CD25＋：（21．36±4．65）％比（15．29±4．72）％,（18．19±4．27）％比（13．94±5．05）％;CD4＋／CD8＋：1．42±0．31比1．23±0．29,1．38±0．30比1．20±0．33;IL-2：（22．03±5．18）m±L比（19．03±4．87）m#L,（20．54±5．92）mL比（18．26±4．96）mL;sIL-2R：（672．96±159．36）U／ml比（787．32±143．27）u,ml,（720．24±143．92）u,（858,42±172．13）U／ml,均P〈0．05],而CD8＋差异无统计学意义（均P〉O．05）。结论HD可短暂改善MHD患者的细胞免疫功能,HFHD可持续改善MHD患者的细胞免疫功能。     

高通量透析对慢性肾病患者生物活性物质的影响

目的血清肌酐(Scr)、血管紧张素Ⅱ(Ang Ⅱ)、内皮素-1(ET-1)和一氧化氮(NO)水平升高是慢性肾病的主要标志。机体淋巴细胞和血管内皮细胞均可通过分泌上述活性分子,参与慢性肾病的发病过程。本实验通过观察高通量透析(HFHD)对维持性血液透析(MHD)患者血管活性物质的影响,从而探讨HFHD改善MHD患者体内这些生物活性物质分泌的作用,为临床治疗提供理论依据及新思路,也为进一步研究机体免疫系统参与慢性肾病的发生机制奠定基础。方法将MHD患者20例随机分为低通量血液透析(LFHD)组和高通量血液透析(HFHD)组各10例。选取尿毒症非透析患者20例,另选取20例正常健康体检者作为健康对照组。HFHD组改用可重复使用高通量透析器Polyflux17R,LFHD组继续采用可重复使用透析器Polyflux8LR。分别检测HFHD组及LFHD组患者单次治疗前后及3个月透析前检测的Scr、Ang Ⅱ、ET-1和NO;另抽取尿毒症非透析组和健康对照组各20例的清晨空腹肘静脉血标本同时检验。NO测定用硝酸还原酶法,ET-1、Ang Ⅱ检测均采用放免法。Cr的测定采用常规生化法。透析组患者同时监测血压变化。结果两组患者单次透析后HFHD组Ang Ⅱ、ET-1水平较LFHD组显著降低(P<0.05)。治疗3个月后,HFHD组患者NO、ET-1、平均动脉压与治疗前显著下降(P<0.05)。结论高通量血液透析可以提高上述生物活性物质的清除,使MHD患者高血压得到改善;本实验结果为将来进一步研究淋巴细胞和内皮细胞参与慢性肾病发病的机制提供临床实验依据。     

Seasonal variations of chronic hemodialysis dose in South Croatia

INTRODUCTION: The dialysis parameters are used for prescribing the dose of dialysis therapy. Delivered dialysis dose could be calculated from predialysis and postdialysis blood urea concentrations. Seasonal variations in some clinical and laboratory variables occur among chronic hemodialysis patients. Seasonal variations in chronic hemodialysis dose have not been investigated. We prospectively compared hemodialysis adequacy parameters in order to demonstrate its seasonal differences. SUBJECTS AND METHODS: Data were processed on 201 single dialysis treatments involving a group of 51 anuric chronic hemodialysis patients. The study period was 12 months. Four measurements per subject were obtained (in January, April, July, and October). RESULTS: We could not demonstrate seasonal variability in prescribed and delivered hemodialysis dose, in "delta" values (absolute differences between prescribed and delivered dialysis doses for the same hemodialysis treatment), or in ultrafiltration per hemodialysis. Seasonal differences were found in blood urea concentrations before and after hemodialysis (p = 0.001, p = 0.010). When the data were grouped into two groups: cold (January and October) and mild (April and July) months; we could not demonstrate significant differences in dialysis adequacy parameters, but there were differences in blood urea concentration before hemodialysis (26.06 +/- 14.73 vs. 24.35 +/- 4.50, p = 0.004), blood urea concentration alter hemodialysis (10.24 +/- 2.96 vs. 9.43 +/- 2.60, p = 0.019), and ultrafiltration per hemodialysis (3.36 +/- 1.13 vs. 3.10 +/- 1.11, p = 0.046). CONCLUSION: Based of the results of this investigation conducted on chronically hemodialyzed patients in the mild Mediterranean climate in South Croatia, Europe; we have concluded that clinicians should not pay attention to season when they prescribe hemodialysis dose or analyze delivered hemodialysis dose.     

Analysis of Mitomycin C-induced micronuclei in lymphocytes from malnourished infected children

The purpose of this study was to determine if peripheral blood lymphocytes from malnourished children with gastrointestinal or respiratory bacterial infection show increased frequencies of Mitomycin C (MMC)-induced micronuclei as compared to well-nourished, infected children. The results indicate that cells from malnourished, infected children had greater chromosome damage. This may indicate that such children would be more susceptible to environmental damage and malignant transformation. Micronucleus frequencies were analyzed in binucleate cells produced by the cytokinesis block method; the overall micronucleus frequency was significantly higher in binucleate cells from malnourished, infected children. The mean micronucleus frequency in MMC-free cultures was 4.3% in malnourished infected children and 1.0% in well-nourished infected children. In MMC-exposed cultures the mean induced micronucleus frequency was 32.6 ± 6.1 vs. 12.9 ± 2.3; 68.6 ± 12.1 vs. 21.0 ± 5.1, and 88.1 ± 16.2 vs. 41.7 ± 5.0 for malnourished and well-nourished children at 20, 40, and 60 ng/ml MMC, respectively. The number of binucleated cells with more than one micronucleus was also higher in malnourished, infected children at all doses tested, including cells with two micronuclei in MMC-free cultures from malnourished, infected children. This increase was not found in peripheral blood lymphocytes from well-nourished infected children. Environ. Mol. Mutagen. 30:363–370, 1997 © 1997 Wiley-Liss, Inc.     

Hepatitis C virus screening and clinical monitoring of biomarkers in patients undergoing hemodialysis

In this study, 395 volunteers were enrolled to investigate the seroprevalence of hepatitis C virus, the immunological and the alanine aminotransferase (ALT) biomarkers amongst hemodialysis patients, living in Manaus, Brazil. An overall seroprevalence of 13.9% was found in the hemodialysis patients. Analysis of seroconversion patterns demonstrated that most patients with HCV seroconverted up to 10 years following the first hemodialysis session. Anti‐NS5 antibody was detectable in 60.4% of patients with HCV. A lower percentage of circulating CD3⁺ and CD4⁺ T‐cells was found in patients seronegative for HCV, whereas a higher frequency of CD8⁺ T‐cells was the hallmark of patients with HCV. An overall low activation state of monocytes and eosinophils were observed in hemodialysis patients. In contrast, a higher frequency of activated neutrophils was observed in patients with HCV, selectively in the NS5+ subgroup. All hemodialysis patients had a higher percentage of activated lymphocytes, with the higher activation state in patients with NS5? reactivity. Higher ALT levels were observed in patients with HCV, especially in the NS5+ subgroup. Interestingly, the ALT levels were correlated negatively with the lymphocyte activation state, selectively in the NS5? subgroup, suggesting a protective role of these activated lymphocytes in patients with HCV. These findings reinforce the importance of the transmission of HCV among hemodialysis patients, suggesting that apart from the HCV screening, the serological and ALT biomarkers may represent important predictors of morbidity and/or mortality among patients undergoing hemodialysis. J. Med. Virol. 81:1220–1231, 2009. © 2009 Wiley‐Liss, Inc.     

Cardiac troponins: outcome predictors in hemodialysis patients

Cardiovascular diseases represent the main cause of death in hemodialysis (HD) patients. Cardiac troponins (cTnT and cTnI) are indicators of myocardial damage. The aims of this study were to assess the prevalence of increased serum cTn in the absence of acute coronary syndrome, to determine overall and cardiovascular mortality rates, and to investigate the possible predictive values of cTnT and cTnI on the outcome in HD patients over a 2-year follow-up period. The study included 115 patients (71 men and 44 women) with an average age of 53.30 ± 12.17 years who had undergone regular HD for 4.51 ± 4.01 years and had a mean HD adequacy (Kt/Vsp) of 1.17 ± 0.23. Increased serum cTnT concentration was found in 37.39% of patients and elevated serum cTnI concentration was present in 11.30% of HD patients without symptoms or signs of acute coronary syndrome. The average 2-year mortality rate was 13.74% and the average 2-year cardiovascular mortality rate was 8.51%. Patients with serum cTnT levels greater than 0.10 ng/ml had significantly lower overall and cardiovascular survival rates than patients with serum cTnT levels of less than 0.10 ng/ml. Patients with serum cTnI levels greater than 0.15 ng/ml had significantly lower overall and cardiovascular survival rates than patients with serum cTnI of less than 0.15 ng/ml. In patients on regular HD, cTn levels are significant outcome predictors.     

Oxidative stress on DNA in chronic renal failure: The influence of different hemodialysis membranes

It has been reported that uremia is a state of oxidative stress and may play an important role as a pathological cause of various uremic complications. Oxidative stress is known to increase conversion of deoxyguanosine to 8-hydroxy-2-deoxyguanosine (8-OHdG) in DNA, and 8-OHdG is used as a marker of oxidative DNA damage. We evaluated plasma and urinary concentrations of 8-OHdG in 49 patients (male 28, female 21; mean age 65 years; diabetic 27, nondiabetic 22) with chronic renal disease (CRD) and 22 patients (male 14, female 8; mean age 63 year; diabetic 7, nondiabetic 15) on maintenance hemodialysis (M-HD). Plasma concentrations of 8-OHdG were measured using a highly sensitive ELISA kit, and the urinary mean concentrations of 8-OHdG were measured using an ELISA kit. Plasma concentrations of creatinine (Cr), Urea nitrogen (UN), and β2-microgloblin (β2-MG) and 24-h creatinine clearance (CCr) were also measured in CRD patients. Furthermore, 8-OHdG was measured before the dialysis session in M-HD patients. The plasma concentration of 8-OHdG in patients on CRD was significantly correlated with serum-creatinine (S−Cr), serum-umea nitrogen (S-UN), and β-MG (P<0.0001) and also significantly negatively correlated with CCr (P<0.005), but was not significantly correlated with age, fasting blood suger (FBS), hemoglobin A1C (HbA1C), and urinary concentration of 8-OHdG were not correlated with S-Cr, S-UN, β2-MG, and CCr. The plasma mean concentrations of 8-OHdG in patients on CRD and M-HD were as follows: CRD (CCr>50 ml/min,n=12), 0.108±0.41 ng/ml; CRD (CCr<10 ml/min,n=9), 0.277±0.15 ng/ml; M-HD (n=22), 0.217±0.59 ng/ml (mean±SD). The mean plasma concentration of 8-OHdG was 0.296 ±0.75 ng/ml in patients on M-HD in the polysulfone mem-brane group, 0.304±0.122 ng/ml their cellulose membrane group, and 0.354±0.21 ng/ml their vitamin E-modified cellulose membrane group. This study showed that in CRD patients, oxidative stress on DNA increasesed with the progression of renal disease, and that end-stage CRD patients were already exposed to the same degree of oxidative stress on DNA as M-HD patients. In M-HD patients, oxidative stress on DNA was not related to the type of hemodialysis membrane.     

Expression of caspase‐3‐dependent apoptosis in mural thrombi leukocytes

Failure of arteriovenous access is mostly due to graft thrombosis and multifactorial, with medical and surgical etiologies. Apoptosis of blood cells, such as macrophages, lymphocytes and eosinophils, may play an important role in thrombus formation. We also investigated caspase‐3‐dependent apoptosis in thrombi. We recorded clinical parameters in 43 consecutive patients with vascular access failure (13 men, 30 women; mean age±SD, 64.6±14.2 years) who underwent surgical thrombectomy. Major presentations included absent (92%) and/or near near‐absent (16%) flow through the access during hemodialysis. Cardiovascular risk factors were hypertension (70%), hyperlipidemia (47%), diabetes mellitus (47%), chronic obstructive pulmonary disease (12%), heart failure (12%), coronary artery disease (21%), and stroke (16%). Laboratory data included hemoglobin level of 100±17 g/L, total white blood cell count of 7.65±2.14×10⁹/L, and platelet count of 205.6±57.9 1000/ìL. Abnormal biochemistry data included elevated blood urea nitrogen level of 63.5±24.4 mg/dL and creatinine level of 8.6±4.0 mg/dL (normal <1.4 mg/dL). Thrombi were characterized by apoptosis (32%) in a caspase‐dependent pathway in all types of leukocytes. Thrombi in arteriovenous access failure demonstrate apoptosis by means of the caspase‐3 pathway in white blood cells.     

传统心肌酶谱联合损伤相关蛋白IMA、TnI-Ultra检测对急性心肌梗死早期诊断的价值分析

目的 探讨肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、同型半胱氨酸(HCY)和乳酸脱氢酶(LDH)等心肌酶,联合血清缺血修饰清蛋白(IMA)和超敏肌钙蛋白I(TnI-Ultra)等心肌损伤相关蛋白检测在急性心肌梗死(acute myocardial infarction,AMI)早期诊断中的应用.方法 选取我院于2014年1月至2017年1月期间收治的AMI患者150例,病发后6h内采集静脉血,检测患者心肌酶谱(CK、CK-MB、HCY和LDH)及IMA和TnI-Ultra等生化指标.同期选取100例非AMI患者血液样本作为对照组.结果 150例AMI患者血清CK、CK-MB、LDH(U/L)和HCY(μmol/L)水平分别为:688.5±68.7、86.4±9.2、364.7±55.2和34.5±9.4.与对照组相比,CK和CK-MB水平明显升高(P<0.01),而LDH和HCY与对照组相比差异无统计学意义(P>0.05),但IMA(65.5±11.7 U/L)和TnI-Ultra(10.6±3.5μg/L)水平均明显升高,差异有统计学意义(P<0.01).结论 CK、CK-MB、HCY和LDH等心肌酶指标在AMI患者中有较高的阳性率,但某些非AMI类疾病也可能导致以上指标异常升高;IMA和TnI-Ultra等心肌损伤相关蛋白对AMI诊断有较高的特异性.心肌酶联合心肌损伤相关蛋白检测有助于AMI的早期诊断,对降低AMI风险具有重要意义.     

Intrafamilial transmission of hepatitis C virus in hemodialysis patients

The prevalence of hepatitis C virus (HCV) infection in chronic hemodialysis patients ranges from 20 to 50% and these patients may serve as a reservoir of infection for their household contacts. The aim of this study was to investigate the prevalence of anti-HCV in hemodialysis patients and their families, and to evaluate possible routes of infection. One hundred eighty-six family members of 84 hemodialysis patients and 529 healthy adults were enrolled. The family members consisted of 50 spouses, 96 children, 11 parents, 29 siblings, and other relatives living together with the patients. Serum samples were collected for testing anti-HCV. Exposure to risk factors was obtained by a questionnaire and an interview. The results showed that prevalence of anti-HCV in hemodialysis patients was 44%, whereas in family members it was 5.4%, not significantly different from that of age-matched healthy adults (standardized morbidity rate = 1.51, P = 0.390). The anti-HCV rate in family members tended to increase with age, and a spouse of an infected hemodialysis patient had a higher risk of HCV infection than other family members (15% vs. 2.6%, odds ratio 6.6, P = 0.058). Except for the age factor, no difference was found between seropositive and se-ronegative family members with respect to risk factors such as blood transfusion, surgery, frequent injections, dental procedures, or acupuncture. It was concluded that, although the anti-HCV positivity of hemodialysis patients is high, the risk of HCV infection for their family members is not higher than that of the general population. Among family members, spouses of seropositive hemodialysis patients have the highest risk of HCV infection. These data imply that long-term intimate contact between spouses plays a key role in the intrafamilial transmission of HCV. © 1995 Wiley-Liss, inc.     

待肾源移植透析者连续性肾脏替代治疗对顽固性高血压的影响

背景：维持性血液透析人群中有10%-49%的患者合并顽固性高血压,常规药物治疗效果差。连续性肾脏替代治疗可较好地清除患者血浆中的中、大分子毒素,理论上可通过降低相关毒素水平干预顽固性高血压形成机制。 目的：观察连续性肾脏替代治疗对维持性血液透析患者顽固性高血压的影响。 方法：45例维持性血液透析合并顽固性高血压患者,随机分为血液透析组22例与连续性血液净化组23例,血液透析组则行常规血液透析治疗,连续性肾脏替代治疗组在常规血液透析治疗基础上每周行连续性肾脏替代治疗1次。 结果与结论：治疗3个月后,连续性血液净化组肾素、内皮素、血管紧张素Ⅱ、C-反应蛋白、白细胞介素6、肿瘤坏死因子α水平均低于试验前水平,24 h平均血压下降,且差异均有显著性意义(P < 0.05),血液透析组上述各指标较试验前无变化(P > 0.05);试验后连续性血液净化组上述各指标均低于血液透析组,差异有显著性意义(P < 0.05)。结果显示在常规血液透析基础上行连续性肾脏替代治疗可明显降低合并顽固性高血压维持性血液透析患者的血压,其机制可能是降低了患者血浆中的中、大分子毒素以及炎症因子水平。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

Homeostasis of antioxidant status in hemodialysis patients]

Oxidative stress, which occurs when there is excessive free-radical production or low antioxidant levels, makes significant contributions to pathogenesis in many human diseases. Cardiovascular disease is the major cause of mortality in patients receiving hemodialysis. For these patients, oxidative stress and increased lipid peroxidation may contribute to increased risk of atherosclerosis. The aim of this study was to determine if hemodialysis patients were associated with disturbance of homeostasis of antioxidant status. In this experiment, total antioxidant status of serum is measured by its ability to inhibit generation of free radicals from 2,2'-amino-di-[3-ethylbenzthiazole sulphonate] by metmyoglobin and hydrogen peroxide. Status of radical scavengers, such as serum total protein, albumin, uric acid and total bilirubin, was also measured. Blood were collected from three different episodes of hemodialysis. In the first group (n = 29), blood were collected before and after hemodialysis. In the second group (n = 29), blood were collected after dialysis and before next hemodialysis. In the third group (n = 8), blood were collected before hemodialysis. After last hemodialysis, patients started ingesting vitamin C and blood were collected before next hemodialysis. There was a marked reduction of total antioxidant status after hemodialysis in the first group. There was a marked increase in total antioxidant status before next hemodialysis in the second group. High doses of vitamin C caused increase in total antioxidant status in the third group. In conclusion, disturbance of homeostasis of total antioxidant status were observed in patients receiving hemodialysis. This may play a role in the pathogenesis in these groups.     

Anemia in patients on chronic hemodialysis in Cameroon: prevalence,characteristics and management in low resources setting

BackgroundAnemia is a common complication of chronic kidney disease. We investigated the prevalence, characteristics and management of anemia in patients on chronic hemodialysis and assessed the response to blood-transfusion based management in Cameroon.MethodsThis was a cohort study of five months'' duration (August–December 2008) conducted at the Yaoundé General Hospital''s hemodialysis center, involving 95 patients (67 men, 70.5%) on chronic hemodialysis by a native arteriovenous fistula. A monthly evaluation included full blood counts, number of pints of red cell concentrates transfused, and vital status.ResultsAt baseline, 75 (79%) patients had anemia which was microcytic and hypochromic in 32 (43%). Anemia was corrected in 67 (70.5%) patients using blood transfusion only, while 28 (29.5%) patients were receiving erythropoietin (11 regularly, 39%). Only 77.2% of 342 pints (median 3.0, range 0–17 per patients) of red cell concentrates prescribed were effectively received during the follow-up at an unacceptably high cost to patients and families. Mean hemoglobin and mean corpuscular hemoglobin levels remained stable during follow-up, while mean corpuscular volume increased. Erythropoietin treatment was the main determinant of favorable trajectories of hematological markers.ConclusionsPatients on chronic hemodialysis have predominantly microcytic hypochromic anemia, with limited capacity for correction using blood transfusion.     

Low resistin level is associated with poor hospitalization-free survival in hemodialysis patients

Malnutrition and inflammation are related to high rates of morbidity and mortality in hemodialysis patients. Resistin is associated with nutrition and inflammation. We attempted to determine whether resistin levels may predict clinical outcomes in hemodialysis patients. We conducted a prospective evaluation of 100 outpatients on hemodialysis in a single dialysis center (male, 46%; mean age, 53.7 ± 16.4 yr). We stratified the patients into 4 groups according to quartiles of serum resistin levels. During the 18-month observational period, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival (log rank test, P = 0.016). After adjustment of all co-variables, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival, compared with reference resistin levels. Higher levels of interleukin-6 were an independent predictor of poor hospitalization-free survival. In contrast, serum resistin levels were not correlated with interleukin-6 levels. The current data showed that low resistin levels may independently predict poor hospitalization free survival in hemodialysis patients.     

Effects of hemoperfusion on serum cardiac troponin T concentrations using polymyxin B-immobilized fibers in septic patients undergoing hemodialysis

We investigated whether serum cardiac troponin T levels are altered in septic patients undergoing hemodialysis and whether polyinyxin B-immobilized fiber (PMX-F) treatment affects these levels. Fourteen heinodialysis patients with sepsis, 14 hemodialysis patients without sepsis, and 12 age matched healthy controls were included in this study. Cardiac troponin T levels in hemodialysis patients with sepsis (0.56+/-0.28 microg/L) were higher than levels in hemodialysis patients without sepsis (0.16+/-0.06 microg/L, p < 0.01) and healthy control subjects (0.03+/-0.01 microg/L, p < 0.001). The 14 hemodialysis patients with sepsis were randomly assigned to one of two treatment approaches: PMX-F treatment (n = 7) or conventional treatment (n = 7). Plasma endotoxin levels were significantly reduced from 46.6+/-17.8 pg/mI to 8.2+/-2.4 pg/ml, p < 0.01, in patients treated with PMX-F, and serum cardiac troponin T levels were also reduced from 0.62+/-0.30 microg/L to 0.26 = 0.12 microg/L, p < 0.05. Cardiac troponin T levels were unchanged in patients under conventional treatment. These data suggest that cardiac troponin T is indeed elevated in septic patients undergoing hemodialysis and niay reflect subclinical myocardial cell damage. PMX-F is effective in reducing myocardial damage, in part, due to reducing plasma endotoxin levels.