The erythrocyte sedimentation rate in end-stage renal failure

The effect of end-stage renal failure and the dialytic process on erythrocyte sedimentation rate (ESR) is largely unknown. We prospectively studied 60 stable patients with end-stage renal disease to determine the prevalence of elevated ESR in this population. ESRs were also measured immediately pre- and postdialysis in 48 hemodialysis patients. ESR was found to be elevated (greater than or equal to 25 mm/h, Westergren method) in 93% of patients with end-stage renal failure. Fifty-seven percent of patients had marked elevation of ESR (greater than 60 mm/h), while 20% had extreme increases in ESR (greater than or equal to 100 mm/h). In a linear models analysis, aging (P less than .02), anemia (P less than .01), and hypocalcemia (P less than .0001) correlated significantly with ESR elevation. Midweek BUN and creatinine, type and duration of dialysis, cause of renal failure, and serum albumin and total protein measurements did not correlate with ESR. In 48 stable in-center hemodialysis patients, mean predialysis ESR of 70 +/- 4 mm/h was not significantly different from mean postdialysis ESR of 72 +/- 5 mm/h. Retrospective chart review of available ESRs prior to initiation of any dialysis treatment also revealed significant elevation of ESR, mean 82 +/- 9 mm/h, in patients with renal disease not yet on dialysis. An upward trend in ESR during acute illness (74 +/- 9 to 95 +/- 8, N = 10) was observed. In a subpopulation of patients, fibrinogen correlated significantly with ESR while gamma-globulins did not. We conclude that measurement of ESR in end-stage renal failure has little clinical utility. Possible explanations for acceleration of ESR in this population are discussed.     

Laser-induced changes of in vitro erythrocyte sedimentation rate

The study of the effects of low-level laser (LLL) radiation on blood is important for elucidating the mechanisms behind the interaction of LLL radiation and biologic tissues. Different therapy methods that involve blood irradiation have been developed and used for clinical purposes with beneficial effects. The aim of this study was to compare the effects of different irradiation protocols using a diode-pumped solid-state LLL (λ = 405 nm) on samples of human blood by measuring the erythrocyte sedimentation rate (ESR). Human blood samples were obtained through venipuncture into tubes containing EDTA as an anticoagulant. Every sample was divided into two equal aliquots to be used as an irradiated sample and a non-irradiated control sample. The irradiated aliquot was subjected to a laser beam with a wavelength of 405 nm and an energy density of 72 J/cm². The radiation source had a fixed irradiance of 30 mW/cm². The ESR change was observed for three different experimental protocols: irradiated whole blood, irradiated red blood cells (RBCs) samples re-suspended in non-irradiated blood plasma, and non-irradiated RBCs re-suspended in irradiated blood plasma. The ESR values were measured after laser irradiation and compared with the non-irradiated control samples. Irradiated blood plasma in which non-radiated RBCs were re-suspended was found to result in the largest ESR decrease for healthy human RBCs, 51%, when compared with RBCs re-suspended in non-irradiated blood plasma. The decrease in ESR induced by LLL irradiation of the plasma alone was likely related to changes in the plasma composition and an increase in the erythrocyte zeta potential upon re-suspension of the RBCs in the irradiated blood plasma.     

The erythrocyte sedimentation rate following exchange of infected total hips

Seventy-six patients without other diseases affecting the erythrocyte sedimentation rate (ESR) underwent exchange of an infected total hip. The ESR before the exchange arthroplasty averaged 53 mm/h. ESR values at 6 weeks, 3 and 6 months after the exchange operation were lower in 60 patients in whom the infection healed than in 16 patients whose infection had not healed. From 3 months after the exchange operation and onwards, the ESR averaged less than 20 mm in healed cases compared with more than 30 mm in still infected cases. An ESR equal or less than 30 mm after 6 months--observed in 48/53 healed cases--implied a good prognosis.     

The erythrocyte sedimentation rate following exchange of infected total hips

Seventy-six patients without other diseases affecting the erythrocyte sedimentation rate (ESR) underwent exchange of an infected total hip. The ESR before the exchange arthroplasty averaged 53 mm/h. ESR values at 6 weeks, 3 and 6 months after the exchange operation were lower in 60 patients in whom the infection healed than in 16 patients whose infection had not healed. From 3 months after the exchange operation and onwards, the ESR averaged less than 20 mm in healed cases compared with more than 30 mm in still infected cases. An ESR equal or less than 30 mm after 6 months — observed in 48/53 healed cases — implied a good prognosis.     

Correlation between erythrocyte sedimentation rate and C-reactive protein level in patients with rheumatic diseases

Objectives

Erythrocyte sedimentation rate (ESR) and serum level of C-reactive protein (CRP) are the acute phase reactants most commonly determined in patients with rheumatic diseases. The indices are affected by different factors, but both of them are applied for evaluation of the disease activity in patients with inflammatory disorders of the musculoskeletal system.

Material and methods

The authors compared the results of ESR and CRP, which were carried out during routine diagnosis in 200 patients admitted to the Department of Rheumatology.

Results

A significant correlation between ESR and CRP was found (ESR after 1 h/CRP: correlation coefficient 0.6944, ESR after 2 h/CRP: correlation coefficient 0.6126). There was no difference in ESR or CRP between male and female patients, and patients older than 40 years had higher ESR and CRP.

Conclusions

The obtained results support the usefulness of both indices in the clinical practice of rheumatologists.     

Asbestos related pleuropulmonary lesions and the erythrocyte sedimentation rate

Asbestos related lesions of the lung parenchyma and the pleura can be divided into three main types: parietal pleural plaques, diffuse interstitial fibrosis ("classical asbestosis"), and a third type of reaction affecting both the pleura and the lung parenchyma. The last type includes such lesions as acute pleurisy, diffuse pleural thickening, and rounded atelectasis. Among 1344 patients with asbestos related pleural lesions, 1190 had pleural plaques, 29 of whom also had pulmonary fibrosis (asbestosis); 83 had unilateral sequelae of pleurisy, of whom nine had asbestosis; and 71 had bilateral sequelae of pleurisy, of whom 23 also suffered from asbestosis. The erythrocyte sedimentation rate (ESR) was measured in 184 patients--79 with pleural plaques, 44 with unilateral sequelae of pleurisy, and 61 with bilateral sequelae. In patients with pleural plaques with or without asbestosis the ESR was usually normal, the mean being 9.6 mm in one hour. Among patients with sequelae of pleurisy, however, many had a raised ESR. The mean ESR was 25.7 mm in one hour in those with bilateral changes and 13.2 in those with unilateral changes. Statistical analysis showed that in this group of subjects the presence of sequelae of pleurisy was a highly significant determining factor for the ESR (p less than 0.0001). Asbestosis alone was not a significant determining factor but there was a low grade of significance for the combined effect of asbestosis and sequelae of pleurisy (p less than 0.05). These findings suggest that the pathogenesis of the various changes is different.     

C-reactive protein and erythrocyte sedimentation rate in patients with heterotopic ossification after spinal cord injury

BACKGROUND/OBJECTIVE: Formation of heterotopic ossification (HO) in soft tissue after spinal cord injury (SCI) is associated with various degrees of inflammation. Recent studies have shown that inhibition of inflammatory reaction with nonsteroidal anti-inflammatory drugs is an effective prevention of HO after SCI. The goal of this study was to monitor the activity of the most widely used indicators of acute inflammation--namely, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)--in patients with HO. METHODS: In a retrospective study, the results of 37 patients with HO were evaluated. There were 25 patients with tetraplegia and 12 with paraplegia. The age (mean +/- SD) of the patients was 28 +/- 8 years (range = 19-46 years). The patients were admitted to the rehabilitation center 2 to 5 weeks after SCI. HO was confirmed by bone scintigraphy. Blood samples were obtained from the patients at the time of diagnosis of HO and during the therapy. ESR was measured with the Westergren method, and serum CRP was determined by enzyme-linked immunosorbent assay. RESULTS: In the acute stage of HO, both tests were elevated in all patients. In the later stages when clinical signs and symptoms of inflammation were resolving, both tests showed a gradual decline. When clinical signs and symptoms of inflammation (fever, acute soft tissue swelling, and erythema) were not present, the concentration of CRP was normal in 91.2% of patients, whereas only 17.6% of patients had normal ESR. Mean serum concentrations of CRP were 8.9 +/- 5.6 mg/L in the inflammatory phase and 0.9 +/- 0.6 mg/L in the noninflammatory phase. CONCLUSION: The data indicate that serum CRP is a useful and more specific test than is ESR for monitoring the inflammatory activity of HO after SCI. The normalization of CRP was seen during the first 3 to 4 weeks of etidronate therapy, indicating a resolution of acute-phase inflammatory reaction.     

Changes in C-reactive protein and erythrocyte sedimentation rate after hip fractures

Summary Serial measurements of C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were performed during the week after operation in 140 patients with hip fractures. There was no selection, and patients with minor or major complications before or after operation were included. In uncomplicated cases, the ESR was variably raised during the first week, whereas the CRP showed a distinct pattern with a rapid increase on the second day; it then decreased by the 7th day. In cases with early postoperative bronchopneumonia and deep wound infection, the CRP was high, but minor infections did not influence the usual levels. Complications had no effect on the ESR during the 1st week.

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Résumé Cent-quarante patients opérés pour fracture de la hanche, par hémiarthroplastie ou par ostéosynthèse, ont été soumis la première semaine post-opératoire, à des mesures sériées du taux de C. réactive protéine (CRP) dans le sérum et de la vitesse de sédimentation (V.S). Nos mesures n'ont pas étés triées et ont inclus les patients présentant des complications mineures ou majeures pré- ou post-opératoires. Dans les cas sans complications, le taux de la V. S s'élève de façon variable durant la semaine, tandis que la CRP présente une courbe différente avec une augmentation rapide des valeurs de base jusqu'à un maximum, d'une valeur moyenne de 1452 nmol/l au deuxième jour post-opératoire. Dès lors, les taux régressent à une valeur moyenne de 352 nmol/l au septième jour. Du deuxième au cinquième jour les taux de CRP baissent de 61%, du deuxième au septième jour de 76%. Dans les cas de pneumonie post-opératoire et d'infection locale profonde, les taux de CRP sont restés significativement élevés, tandis que les infections mineures telles que simple cystite, bronchite ou infection superficielle de la plaie n'ont pas influencé les variations normales post-opératoires des taux de CRP. A l'inverse, les complications post-opératoires n'ont aucun effet sur la V. S durant la première semaine. Il semble donc que les mesures sériées de la CRP constituent un paramètre plus fiable que celles de la V. S dans le dépistage précoce des complications septiques majeures post-opératoires.

     

Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery.

C-reactive protein and erythrocyte sedimentation rate were prospectively measured after four types of uncomplicated spinal operations. In all patients, preoperative normal C-reactive protein (less than 10 mg/L) increased, reaching peak levels on the second day after microdiscectomy (46 +/- 21 mg/L) and anterior fusion (70 +/- 23 mg/L), and at the third day after conventional discectomy (92 +/- 47 mg/L) and posterolateral intercorporal fusion (173 +/- 39 mg/L), with normalization in 5-14 days. Peak levels were not related to bleeding, transfusion, operation time, administered drugs, age, or sex. Erythrocyte sedimentation rate increased to peak levels about 5 days after surgery, followed by a slow and irregular decrease, and at 21-42 days after surgery often remained elevated. The rapid decline in C-reactive protein will probably be interrupted by a second rise or persisting elevation if infection occurs. C-reactive protein is presumably a better test than erythrocyte sedimentation rate for early detection of postoperative infection.     

Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients

Purpose: Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients.

Methods: Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session.

Results: Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p?=?.013) and higher IL-6 (p?=?.032) and hsCRP levels (p?=?.011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan–Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p?=?.055). LTI inversely correlated with age and IL-6 and positively with IGF-1.

Conclusions: Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.     

The controversies of diagnosing and treating hypertension among hemodialysis patients

This review discusses 10 current controversies regarding the dialysis patient with hypertension. The clinician is faced with a dilemma at the bedside on how to evaluate blood pressure and treat this condition in a patient on long-term hemodialysis. The evidence base to give firm recommendations is thin, but the epidemiological evidence tells us to do nothing. This appears to be an incorrect strategy, at least based on what we know today. Evaluating home BP in every dialysis patient, evaluating volume status on a regular basis, and treating hypertension predominantly with nonpharmacological strategies are worthwhile.     

The relationship between hematocrit and erythrocyte magnesium concentration in patients on regular hemodialysis.

Plasma and erythrocyte magnesium (Mg) concentrations were measured in uremics on regular hemodialysis, in healthy persons and in patients with anemia due to causes other than renal failure. The mean plasma Mg concentration was found to be significantly higher in the uremic patients than in other subjects. The erythrocyte Mg concentration in anemic uremics and in nonuremic anemics was found to be higher than in normal subjects and a close inverse relationship was found between this figure and the hematocrit. It seems reasonable to argue that anemia, rather than renal failure, is related to the high concentration of Mg in erythrocytes.