Relationship of plasma Dendroaspis natriuretic peptide-like immunoreactivity and echocardiographic parameters in chronic haemodialysis patients

BACKGROUND AND AIMS: The Dendroaspis natriuretic peptide (DNP), which was recently isolated from the venom of the green Mamba snake, Dendroaspis angusticeps, is a 38 amino acid peptide containing a 17 amino acid disulfide ring structure. The purpose of this study was to evaluate the effect of haemodialysis (HD) on the plasma concentration of DNP, and to investigate the relationship between the 2-D echocardiographic parameters and the changes in the plasma DNP levels during HD. METHODS: Forty-five haemodialysis patients and 22 healthy individuals underwent a measurement of plasma DNP-like immunoreactivity, serum creatinine, haematocrit, blood pressure and bodyweight before and after each HD session. Echocardiography was performed before and after HD. The peak early diastolic transmitral flow velocity (E), peak late diastolic transmitral flow velocity (A), and E/A ratio were measured by using a pulsed Doppler echocardiogram. RESULTS: The plasma DNP-like immunoreactivity of those in the pre-HD state was significantly higher (235.6 +/- 45.8 pg/mL) than those of the healthy subjects (105.3 +/- 31.1 pg/mL). In addition, the plasma DNP-like immunoreactivity was significantly decreased after HD (204.4 +/- 55.4 pg/mL). The left atrial diameter, left ventricular diameter at end diastole and end systol, E velocity, A velocity, E/A ratio and inferior vena cava diameter were significantly decreased after HD. There were significant correlations between the changes of plasma DNP-like immunoreactivity and the changes in the bodyweight and inferior vena cava diameter, respectively. CONCLUSION: These results suggest that the plasma DNP-like immunoreactivity might be involved in the regulation of the blood volume in patients undergoing HD.     

Influence of ANF on the cardiovascular response to volume expansion in haemodialysis patients

Plasma ANF concentration in uraemic patients is very sensitiveto changes in extracellular volume. It is unknown, however,if the release of this vasoactive hormone has a compensatoryrole in the haemodynamic response to extracellular volume expansionin these patients. We investigated the effect of isolated ultrafiltrationfollowed by isovolumic re-expansion by saline in seven haemodialysispatients. The experiment was repeated on two occasions and theUF rate as well as the rate of volume re-expansion in the twostudies were accurately matched. During the phase of volumere-expansion, we infused either ANF (0.83 µg/mm) or aplacebo, in random order and cross-over. Central venous pressure,arterial pressure, haematocrit, and plasma ANF concentrationwere measured in baseline conditions, after ultrafiltration,and 0, 15, and 30 mm after isovolumic re-expansion. In the control experiment (placebo), isolated ultrafiltrationcaused a marked reduction in central venous pressure and inarterial pressure and a pronounced haematocrit increase. Thesechanges were reversed by volume re-expansion. In the activeexperiment, during the phase of volume re-expansion ANF infusiondoubled plasma ANF concentration as compared to control experimentbut it did not affect the ongoing haemodynamic response northe haematocrit changes. Doubling of plasma ANF concentration has no influence on thehaemodynamic and microcirculatory adaptations to acute volumeexpansion in haemodialysis patients. The data indicate thatit is unlikely that raised plasma ANF concentration has a majorrole in the cardiovascular response to acute extracellular volumeexpansion in these patients.     

Relationship between blood pressure during haemodialysis and ambulatory blood pressure in between dialyses

BACKGROUND.: Ambulatory blood pressure measurements in haemodialysis patientsare relevant in view of the high cardiovascular morbidity andmortality in chronic haemodialysis patients. METHODS.: Twelve normotensive patients were studied from the beginningof one dialysis until the end of the next (mean 64 h, SD 19h) using a Spacelabs oscillometric blood-pressure recorder. RESULTS.: A circadian blood pressure rhythm was present in six of the12 patients. In seven patients the lowest pressure recorded(including the dialysis sessions) occurred 5–6 h afterdialysis (late post-dialysis dip). Blood pressure did not increasesharply in the hours before dialysis although it increased slightlyin the interdialytic interval as a whole, at a mean rate of5.6 mmHg per 24 h (SD 4.1, P<0.001). We could not find ablood pressure measurement during dialysis (or combination ofmeasurements) which reliably reflects interdialytic blood pressure:the 95% confidence intervals were 25 mmHg or higher. CONCLUSION.: Ambulatory blood pressure measurements are needed for adequatemonitoring of the control of blood pressure in haemodialysispatients.     

Blood pressure during the interdialytic period in haemodialysis patients: estimation of representative blood pressure values.

The estimation of representative blood pressure (BP) levels is difficult in haemodialysis (HD) patients as it is not known whether pre- or postdialytic blood pressure are predictive for the average interdialytic BP. Furthermore, the day-night BP rhythm can be disturbed in HD patients. Therefore, in this study, BP was measured during the interdialytic period using non-invasive ambulatory BP measurements in four hypotensive, six normotensive, and 12 hypertensive HD patients. It was assessed whether pre- or postdialytic BP was representative for the average interdialytic BP. Furthermore, the nocturnal BP reduction was compared between HD patients, seven normotensive controls and eight treated subjects with essential hypertension. Postdialytic BP was superior to predialytic BP in predicting the average BP during the interdialytic period. BP did not differ significantly between day 1 and day 2 of the interdialytic period but increased rapidly in the hours before dialysis. Weight gain (corrected for actual body-weight) did not correlate significantly with the increment in systolic BP (r = 0.21; P = 0.2) or diastolic BP (r = -0.02; P = 0.5) during the interdialytic period. The nocturnal decline in systolic BP was significantly attenuated (P less than 0.001) in hypertensive HD patients compared with normotensive controls. The nocturnal reduction in diastolic BP was significantly less in hypotensive (P less than 0.001) and normotensive (P less than 0.001) HD patients compared with normotensive controls and in hypertensive HD patients compared with normotensive (P less than 0.001) and hypertensive (P less than 0.001) controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variability of relative blood volume during haemodialysis.

BACKGROUND: A decrease in blood volume is thought to play a role in dialysis-related hypotension. Changes in relative blood volume (RBV) can be assessed by means of continuous haematocrit measurement. We studied the variability of RBV changes, and the relation between RBV and ultrafiltration volume (UV), blood pressure, heart rate, and inferior caval vein (ICV) diameter. METHODS: In 10 patients on chronic haemodialysis, RBV measurement was performed during a total of one hundred 4-h haemodialysis sessions. Blood pressure and heart rate were measured at 5-min intervals. ICV diameter was assessed at the start and at the end of dialysis using ultrasonography. RESULTS: The changes in RBV showed considerable inter-individual variability. The average change in RBV ranged from -0.5 to -8.2% at 60 min and from -3.7 to -14.5% at 240 min (coefficient of variation (CV) 0.66 and 0.35 respectively). Intra-individual variability was also high (CV at 60 min 0.93; CV at 240 min 0.33). Inter-individual as well as intra-individual variability showed only minor improvement when RBV was corrected for UV. We found a significant correlation between RBV and UV at 60 (r= -0.69; P<0.001) and at 240 min (r= -0.63; P<0.001). There was a significant correlation between RBV and heart rate (r= -0.39; P<0.001), but not between RBV or UV and blood pressure. The level of RBV reduction at which hypotension occurred was also highly variable. ICV diameter decreased from 10.3+/-1.7 mm/m(2) to 7.3+/-1. 5 mm/m(2). There was only a slight, although significant, correlation between ICV diameter and RBV (r= -0.23; P<0.05). The change in ICV-diameter showed a wide variation. CONCLUSIONS: RBV changes during haemodialysis showed a considerable intra- and inter-individual variability that could not be explained by differences in UV. No correlation was observed between UV or changes in RBV and either blood pressure or the incidence of hypotension. Heart rate, however, was significantly correlated with RBV. Moreover, IVC diameter was only poorly correlated with RBV, suggesting a redistribution of blood towards the central venous compartment. These data indicate that RBV monitoring is of limited use in the prevention of dialysis-related hypotension, and that the critical level of reduction in RBV at which hypotension occurs depends on cardiovascular defence mechanisms such as sympathetic drive.     

Elevated concentrations of cardiac troponins are associated with severe coronary artery calcification in asymptomatic haemodialysis patients.

BACKGROUND: Elevated concentrations of cardiac biomarkers, such as troponins and natriuretic peptides, have been shown to be predictive of poorer long-term cardiovascular outcomes in stable patients with end-stage renal disease (ESRD). However, little is known about the relationship between elevated concentrations of these cardiac markers and underlying coronary artery pathology in these patients. The aim of the present study was to investigate associations between coronary artery calcification (CAC) and the concentrations of cardiac biomarkers in ESRD patients. METHODS: We conducted a cross-sectional study of 38 asymptomatic patients (median age, 54 years; 26 males, 12 females; diabetic, 39%) who were undergoing chronic haemodialysis. In these patients, pre-dialysis circulating concentrations of cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase-MB (CK-MB) and B-type natriuretic peptide (BNP) were measured. We quantified the level of CAC by multirow spiral computed tomography to obtain a CAC score. CAC scores > or = 400 were defined as being indicative of severe CAC. RESULTS: Severe CAC was detected in 17 patients (45%). The degree of CAC severity was positively associated (P < 0.05) with cTnT concentrations. Thus, 15% of patients had severe CAC in the lowest tertile of cTnT, 50% had severe CAC in the middle third, and 69% in the highest third. Similarly, the degree of severity of CAC was positively associated (P < 0.01) with cTnI concentrations across concentration categories. In contrast, there was no association between the degree of CAC severity and the concentrations of either BNP or CK-MB. A logistic regression analysis revealed that elevated concentrations of cTnT (> or = median vs or = 0.1 ng/ml vs 相似文献   

Blood pressure assessment in haemodialysis patients: Comparison between pre-dialysis blood pressure and ambulatory blood pressure measurement

Aim: Hypertension is common in haemodialysis (HD) patients. Determining the most appropriate method of blood pressure (BP) measurement, representative of target organ damage, is still an issue. BP variations between pre‐ and post‐HD treatment, or between on‐dialysis day and off‐dialysis day, are common. The aim of this study was to examine the possible differences between pre‐HD office BP (OBP) levels, inter‐HD (iHD) or HD day 24 h ambulatory BP measurement (ABPM) with 48 h ABPM, where the latter was considered the gold standard. Methods: 163 HD patients were studied. BP was monitored consecutively for 48 h with a Takeda TM2421 device, then sub‐analysed into two periods of 24 h: HD and iHD day. An average of 12 sessions pre‐HD OBP measurements was determined. Results: OBP significantly overestimates systolic (SBP) and diastolic BP (DBP) when compared with 48 h ABPM. SBP and DBP are significantly higher on iHD day than on HD day: 141.2 ± 20.8 versus 137.9 ± 20.9, and 77.1 ± 11.1 versus 76.1 ± 10.9 (P < 0.01). No differences of SBP night/day ratio were reported between 48 h ABPM and iHD 24 h ABPM or HD 24 h ABPM. The highest correlations were reported between 48 h SBP/DBP with iHD or HD 24 h ABPM (r² = 0.95, P < 0.001), while the lowest between 48 h SBP/DBP and OBP (r² = 0.40, P < 0.01, r² = 0.12, P < 0.01). The narrowest limits of agreement using the Bland and Altman test were reported between 48 h SBP or DBP and 24 h iHD or HD day ABPM. Considering 48 h ABPM, 80.5% of patients had BP higher than the norm, compared with 61.7% of patients in the case of OBP (χ² = 13.28, P < 0.001). The sensibility for detecting hypertension for iHD day 24 h ABPM was 98.4%, with specificity of 90%. The sensibility of 24 h HD day ABPM was 90.3%, with specificity 96.6%. In the case of OBP, sensibility and specificity were considerably lower, that is, 72.6% and 83.3% respectively. Conclusion: Significant differences are shown between OBP and 48 h ABPM in the recognition of a hypertensive state. OBP measurement has a lower sensibility and specificity than 24 h ABPM, which remains a valid alternative approach to 48 h ABPM in HD patients. Errors of OBP estimation should be taken into account, with possible negative impact on treatment strategies and epidemiology studies.     

Vanadium in patients undergoing chronic haemodialysis

The relationships between serum vanadium and serum aluminium, beta 2-microglobulin, silicon, phosphate, red blood cell count, haemoglobin and systolic blood pressure were studied in 80 chronic haemodialysis patients. Vanadium transfer during haemodialysis was also examined. Serum vanadium in 80 patients before haemodialysis was 18.4 +/- 7.6 ng/ml (normal values: 0.4 +/- 0.2 ng/ml). Significant correlations between serum vanadium and serum aluminium, silicon, beta 2-microglobulin, phosphate, red blood cell count, haemoglobin, and systolic blood pressure were found. As ultrafiltrate vanadium was greater than vanadium in the dialysate, vanadium transfers from blood to dialysate. Therefore, serum vanadium before haemodialysis significantly decreased from 18.4 +/- 7.76 ng/ml to 13.0 +/- 5.30 ng/ml, during a 5-h haemodialysis.     

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.     

Plasma endothelin in haemodialysis patients treated with recombinant human erythropoietin

Predialysis plasma endothelin (ET) values were followed duringthe first 8 weeks of rHuEpo treatment in 12 patients on routinehaemodialysis. Mean plasma ET was significantly increased inuraemic patients before rHuEpo (27.911.4 pmol/1), as comparedto 40 healthy controls (16.55.7 pmol/1) (p<0.0001). UnderrHuEpo treatment, predialysis values remained unchanged althoughdiastolic blood pressure increased after 2 and 6 weeks. We foundno correlation between ET and haemoglobin or blood pressurebefore or under rHuEpo treatment. These results confirmed thehigh levels of plasma ET in haemodialysis patients, but no increasewas observed during rHuEpo treatment.     

Relationship between obstruction of arteriovenous fistula and plasma level of endothelin-1 in long-term haemodialysis patients

Summary: The relationship between the patency status of the autogenous arteriovenous (A-V) fistula and the plasma level of endothelin-1 (ET-1) was studied in 41 patients who had been receiving routine longterm haemodialysis for more than 10 years. the ET-1 level in the haemodialysis patients (mean ± s.d.=2.1 ± 0.9 pg/mL) was significantly elevated compared with that in healthy controls ( n =16; 1.1 ± 0.4 pg/mL; P < 0.01). the patients were classified into two groups according to whether the original A-V fistula had remained patent for more than 10 years or had been repaired due to frequent (more than twice) obstruction. Among all 41 patients, 21 were receiving recombinant human erythropoietin (rHuEpo) intravenously (i.v.). In the rHuEpo-treated group, the plasma ET-1 ( n =21; 2.4 ± 0.8 pg/mL) was significantly elevated than that in the rHuEpo-untreated group ( n =20; 1.9 ± 0.9 pg/mL; P<0.05). After exclusion of the 21 rHuEpo-treated patients, the ET-1 level in the repaired fistula group ( n =11; 2.3 ± 0.9 pg/mL) was significantly higher than that in the patent original fistula group ( n =9; 1.3 ± 0.7 pg/mL; P <0.02). Based on these results, we conclude that ET-1 shows a close relation to venous stenosis of the A-V fistula which may be due to its vasoconstrictive and smooth muscle cell-proliferating effects.     

Relationships between blood pressure variability and left ventricular parameters in haemodialysis and renal transplant patients

SUMMARY: Blood pressure (BP) elevation and left ventricular hypertrophy (LVH) are important factors in the high cardiovascular mortality on the renal replacement programme. the relationship between these, predictable in essential hypertension, is less well defined in uraemia. We wished to examine the contribution of abnormal blood pressure variability (BPV) to the cardiovascular changes seen in uraemia and after renal transplantation. Twenty-four hour ambulatory blood pressure monitoring (ABPM), and simultaneous echocardiography, on a cohort of 35 long-term, long-hours haemodialysis survivors and 28 patients with stable renal transplants was undertaken. We also retrospectively compiled biochemical and clinical data. There were strong relationships between both diurnal and standard deviation measures of BPV and left ventricular cavity size and function: per cent fall in awake to asleep diastolic BP with fractional shortening index (FSI), r =0.28, P =0.039; with left ventricular mass index (LVMI), r =−0.35, P =0.011. This study suggests that reduced diurnal and short-term BP variability is cross-sectionally associated with a dilated, heavier left ventricle (LV) with worse systolic function. Thus, BPV may independently contribute to the abnormal LV structure and function commonly seen in uraemia.     

Relationships between blood pressure variability and left ventricular parameters in haemodialysis and renal transplant patients

Blood pressure (BP) elevation and left ventricular hypertrophy (LVH) are important factors in the high cardiovascular mortality on the renal replacement programme. The relationship between these, predictable in essential hypertension, is less well defined in uraemia. We wished to examine the contribution of abnormal blood pressure variability (BPV) to the cardiovascular changes seen in uraemia and after renal transplantation. Twenty-four hour ambulatory blood pressure monitoring (ABPM), and simultaneous echocardiography, on a cohort of 35 long-term, long-hours haemodialysis survivors and 28 patients with stable renal transplants was undertaken. We also retrospectively compiled biochemical and clinical data. There were strong relationships between both diurnal and standard deviation measures of BPV and left ventricular cavity size and function: per cent fall in awake to asleep diastolic BP with fractional shortening index (FSI), r =0.28, P =0.039; with left ventricular mass index (LVMI), r =−0.35, P =0.011. This study suggests that reduced diurnal and short-term BP variability is cross-sectionally associated with a dilated, heavier left ventricle (LV) with worse systolic function. Thus, BPV may independently contribute to the abnormal LV structure and function commonly seen in uraemia.     

Low-molecular-weight heparin (LMWH): influence on blood lipids in patients on chronic haemodialysis

A low-molecular-weight heparin (LMWH) has been compared to conventionalheparin in haemodialysis in a 12-month study. In a group of22 patients who had been on chronic haemodialysis for longerthan 12 months, the conventional, unfractionated heparin wasreplaced by a low-molecular-weight analogue (LMWH) (Fragmin,Kabi-Pharmacia Erlangen) for 6 months. Baseline values of lipoproteinprofile prior to the intervention were compared with resultsobtained after 2, 4 and 6 months of LMWH. Control values wereobtained 3 and 6 months after switching back to conventionalheparin. During the LMWH treatment total cholesterol decreasedsignificantly. This coincided with a significant decrease inLDL cholesterol and a minor decrease in total HDL cholesterol.There was no noticeable change in the HDL cholesterol subfractions.The decrease of LDL and HDL was accompanied by a distinct andcontinuous decrease of apolipoprotein B throughout the LMWHperiod while the apolipoprotein Al declined during the first2 months and then stabilized at this lower value. Triglyceridesincreased significantly during the first 2 months and then reboundedto the initial values by the end of the LMWH treatment period.After switching back again to conventional heparin the lipoproteinparameters returned to the starting values. We conclude thatthe long-term use of low-molecular-weight heparin instead ofconventional heparin for anticoagulation during dialysis maycontribute to a reduction of the cardiovascular risk factorsof haemodialysis patients.     

Changes in major blood components after adopting the supine position during haemodialysis.

BACKGROUND: In Japan, haemodialysis (HD) is usually performed with patients in the supine position. However, the effects of changing posture on major blood components have not been investigated in HD patients. It is possible that several fluid components change rapidly when patients change from the upright to the supine position. We therefore investigated the effects of posture on blood component analysis. METHODS: A first blood sample was taken from 10 HD patients 5 min after they adopted a supine position; HD was begun immediately after sampling. Additional blood samples were collected 15 and 30 min later while patients remained in the supine position. On an alternate day, blood samples were taken from these same patients in the supine position, but not during HD. The same procedure was performed in 10 healthy volunteers. RESULTS: Haematocrit significantly decreased in patients undergoing HD at 15 and 30 min into the HD session. Similar decreases were observed in HD patients not undergoing HD and in normal control subjects. Haematocrit changes at 15 min were not significantly different between the three groups. Serum albumin concentrations decreased in the same way as haematocrit. Consequently, the reductions in haematocrit and albumin concentrations in HD patients during the HD session were not attributable to the HD procedure or to end-stage renal disease, but rather were due to the supine position and consequent haemodilution caused by redistribution of water from the extra- to the intravascular space. Finally, WBC counts decreased significantly at 15 min in both HD patient groups and in normal controls. The relative decrease at 15 min was significantly greater in HD patients undergoing HD (61.4% of baseline) than in those not undergoing HD (88.0%) or in normal controls (94.7%). These differences were probably due to previously reported WBC sequestration in the lungs during the early phase of HD. CONCLUSIONS: This study suggests that the change from the upright to the supine positions during HD causes changes in blood components that are critical for quality control determinations.     

Anticardiolipin antibodies in children on chronic haemodialysis

IgG and IgM anticardiolipin antibody (Ab) concentrations weredetermined in serum samples of 48 children with end-stage renaldisease (ESRD) on haemodialysis using ELISA technique in anattempt to analyse their possible role in the occurrence ofthrombosis of the vascular access. Ten normal healthy childrenwere studied as a control group. The positivity of anticardiolipinAb isotypes both IgM and IgG was high in children with ESRDon haemodialysis. Children with positive anticardiolipin Abhad significantly higher incidence of prior thrombosis of vascularaccess. Also, these antibodies should be considered as markersof high risk for fistula thrombosis.     

Increased coated-platelet levels in chronic haemodialysis patients

Aim: To determine if levels of coated‐platelets, which are potentially pro‐thrombotic, are increased in end‐stage renal disease patients on haemodialysis, a condition associated with high cardiovascular disease risk. Methods: In a cross‐sectional observational study, coated‐platelet levels were measured by flow cytometry in 25 end‐stage renal failure haemodialysis patients and 25 controls without renal disease. Associations between coated‐platelet levels and clinical and biochemical factors relevant to renal and cardiovascular disease were evaluated. Results: Mean ± SD coated‐platelet levels were higher in the dialysis group than in the control group (39.3 ± 14.3% vs 30.9 ± 10.3%, P = 0.02). The number of subjects with high coated‐platelet levels (>40%) was larger in the dialysis than in the control group (13/25 vs 4/25, χ² test, P = 0.007). On univariate analysis, coated‐platelet levels correlated with serum C‐reactive protein levels in renal failure (r = 0.47, P = 0.02) and inversely with white cell count in the control group (r = ?0.60, P = 0.001). Coated‐platelet levels were higher in dialysis patients reporting alcohol abstinence than among those reporting ‘social’ drinking (44.3 ± 12.6 vs 28.8 ± 13.5%, P = 0.01). Age, gender, body weight, smoking, diabetes, lipid levels and lipid‐lowering drugs were not associated with coated‐platelet levels (all P > 0.05). Conclusion: Coated‐platelet levels are increased in haemodialysis patients relative to subjects with normal renal function, and are related to inflammation and alcohol abstinence. Other vascular risk factors, such as smoking, lipids and diabetes, were not related to coated‐platelet levels. Coated‐platelets may be implicated in the increased thrombosis and vascular risk in end‐stage renal disease.     

Relationship of ambulatory blood pressure monitoring data to echocardiographic findings in haemodialysis patients

BACKGROUND: The present study was performed to assess the value of ambulatoryblood pressure monitoring (ABPM) in determining the adequacyof blood pressure (BP) control, and its relationship to echocardiographicfindings in haemodialysis (HD) patients. METHODS: We studied 40 non-diabetic adult patients who had been on regularHD treatment for a median duration of 43 months. Twenty-four-hourABPM was performed using a non-invasive ABP monitor (Pressurescan,ERKA). Casual BP (cBP) was defined as the average of two measurementsobtained at two HD sessions, one preceding and one followingthe ABP recordings, and was calculated for both the predialysisand postdialysis phases. Two-dimensional and M-mode echocardiographywere performed in each patient to determine interventricularseptal thickness (IVS), left ventricular posterior wall thickness(LVPW), left ventricular fractional shortening (FS), and leftventricular mass index (LVMI) RESULTS: According to average 24-h BP levels, 50% of the patients hadsystolic hypertension (HT) (>139 mmHg), and 72.5% had diastolicHT (>87 mmHg), while only 25% had been diagnosed as HT bycBP measurements (P>0.01 and P>0.0001 respectively). Diurnalvariation in BP was not present in about 80% of the patients.Echocardiography was normal in only four patients (10%). LVMIand LV wall thickness were correlated to ABPM data better thanto cBP measurements. Using stepwise linear regression analysis,LVMI and FVS were positively correlated with systolic BP load(P> 0.0001 and P=0.0001 respectively), and LVPW was positivelycorrelated with night-time systolic BP level (P>0.001). CONCLUSIONS: ABPM is necessary to assess the adequacy of BP control, andis well correlated to end-organ damage of HT in HD patients.