Influence of diabetes on homocysteine-lowering therapy in chronic hemodialysis patients

IntroductionThe effect of homocysteine (Hcy)-lowering therapy may be different in hemodialysis (HD) patients with and without diabetes mellitus (DM).MethodsStable HD patients with uremia were administered folic acid and vitamin B for 3 months. The impact of treatment was compared in patients with and without DM.ResultsA total of 61 patients (31 men and 30 women) aged 56 ± 13 y completed the study. Among these, 44 patients (72%) did not have DM and 17 (28%) had DM. At baseline, total Hcy and high-sensitivity C-reactive protein (hsCRP) levels were similar. After treatment, the levels of total Hcy and hsCRP were significantly decreased in the nondiabetic group (total Hcy level decreased from 33.63 ± 14.13 μmol/l to 18.94 ± 8.46 μmol/l, p < 0.001; hsCRP level decreased from 0.58 mg/dl [range, 0.21–1.05 mg/dl] to 0.22 mg/dl [range, 0.11–0.53 mg/dl], p < 0.001) but not in the diabetic group (total Hcy level decreased from 34.97 ± 17.12 μmol/l to 29.53 ± 11.36 μmol/l, p = 0.057; hsCRP level decreased from 0.80 mg/dl [range, 0.24–1.47 mg/dl] to 0.49 mg/dl [range, 0.45–0.98 mg/dl], p = 0.28). Serial monitoring of total Hcy level showed a more sustained effect of therapy on patients without DM.ConclusionFolic acid and vitamin B administration significantly lower total Hcy and hsCRP levels in HD patients without DM but not in those with DM.     

Correlation of haloperidol levels between saliva and plasma of acutely ill schizophrenic patients

ObjectiveClinical usefulness of monitoring haloperidol in salivary samples based on plasma:saliva correlation.Design and MethodsPlasma and saliva samples of schizophrenic patients [N = 105] were analyzed by highly sensitive reverse phase liquid chromatographic method to measure haloperidol at 240 nm using UV-PDA detector. Mobile phase consist of acetonitrile and water [50:50], pH 2.5 (0.1% acetic acid and 0.05 M KHPO₄) at flow rate 1.4 mL/min. Method was linear over 3–200 ng/mL.ResultsObserved therapeutic range was 5–19 ng/mL [11.66 ± 3.97] and 17–54 ng/mL [27.52 ± 11.51] for plasma and saliva respectively. Mean S:P was found to be 2.36.ConclusionCurrent study showed significantly high correlation [r = 0.93, p < 0.0001] between haloperidol levels in saliva and plasma with linear relationship. It is therefore concluded that monitoring of salivary concentration can be a clinically beneficial substitute. Patients showing clinical improvement [N = 90] were within salivary concentration range of 17–54 ng/mL, which can be an appropriate steady state monitoring range for haloperidol in saliva.     

Association of high sensitivity C-reactive protein (hsCRP) and tumour necrosis factor-alpha (TNF-alpha) with carotid intimal medial thickness in subjects with different grades of glucose intolerance--the Chennai Urban Rural Epidemiology Study (CURES-31)

ObjectiveTo assess the association of high sensitivity C-Reactive Protein [hsCRP] and Tumour Necrosis Factor-α [TNF-α] with IMT in Asian Indians with different grades of glucose intolerance.Design and methodsSubjects with normal glucose tolerance [NGT](n = 150), impaired glucose tolerance [IGT] (n = 150) and type 2 diabetes (DM) (n = 150) were recruited from the Chennai Urban Rural Epidemiology Study [CURES], in south India. hsCRP was estimated by nephelometry and TNF-α by enzyme linked immunosorbent assay. Carotid IMT was assessed by high resolution B-mode ultrasonography.ResultshsCRP and TNF-α levels were higher in those with DM [p < 0.001] and IGT [p < 0.001] compared to NGT. In linear regression analysis, both hsCRP [p = 0.003] and TNF-α [p =0.001] showed an association with IMT among NGT subjects even after adjusting for age and gender. Among IGT subjects, TNF-α was associated with IMT [p < 0.001], while no association was observed either with hsCRP or TNF-α in diabetic subjects. In NGT subjects, mean IMT was highest in those with high values [III tertile] of both TNF-α and hsCRP [0.83 ± 0.1 mm; p < 0.001] followed by those with high TNF-α + low hsCRP [0.74 ± 0.09 mm; p < 0.001], high hsCRP  low TNF-α [0.67 ± 0.09 mm; p < 0.001], and lowest in those with both low TNF-α and hsCRP [I tertile] [0.63 ± 0.05 mm.ConclusionWe conclude that in Asian Indians 1. Levels of hsCRP and TNF-α increase with increasing severity of glucose intolerance 2. Both hsCRP and TNF-α are associated with IMT in NGT subjects while TNF-α alone is associated with IMT in IGT subjects 3. hsCRP and TNF-α have a cumulative effect on mean IMT values in NGT subjects.     

Total and bone-specific alkaline phosphatases in haemodialysis patients with chronic liver disease

ObjectiveThe Kidney Disease: Improving Global Outcomes “KDIGO” recommends regular sampling of bone turnover markers (BTMs) such as total alkaline phosphatases (t-ALP) and bone-specific alkaline phosphatase (b-ALP) in the case of haemodialysis (HD) patients.Design and methodsWe present our results of the regular assessment of t-ALP, b-ALP, and PTH, obtained for existing HD patients with chronic liver disease (LD).Results76 prevalent HD patients were examined. Linear regression showed that b-ALP and t-ALP levels were closely related (r²: 0.6; p < 0.0001), even when the serum PTH level was < 250 pg/mL (r²: 0.56; p < 0.001). The b-ALP/t-ALP ratio was 0.07 ± 0.12 and correlated poorly with PTH levels (r²: 0.03; p = 0.01). Both b-ALP and t-ALP levels did not correlated with PTH levels.ConclusionOur results did not confirm the KDIGO recommendation for using b-ALP as BTM in the special cases of HD patients with LDs.     

Evaluation of methadone absorption after topical administration to hospice patients

ContextIncreased use of methadone (MTD) applied topically as an extemporaneously compounded gel was documented on routine review of medication profiles of hospice patients. A literature search did not identify any published clinical studies assessing the systemic absorption or clinical efficacy of MTD administered topically to intact skin for systemic pain.ObjectivesTo compare serum MTD levels achieved after topical and oral administration to hospice patients.MethodsTo assess the absorption of MTD administered topically, two steady-state serum levels were determined in 10 patients administered MTD topically (10–45 mg/day as powder dissolved in ethoxydiglycol added to the calculated volume of pluronic lecithin organogel [PLO]), five patients administered MTD orally (PO) (15–40 mg/day), and one subject administered placebo topically.ResultsMTD levels from the subject administered placebo were <10 ng/mL. Eighteen of 20 serum MTD concentrations from nine patients administered topical MTD were identical to those in the placebo control. Only one of 10 patients administered topical MTD achieved measurable serum MTD levels. This patient was on the highest topical dose administered (45 mg/day) and achieved a mean serum concentration of 25.8 ng/mL (18–35 ng/mL). All MTD serum concentrations from patients administered oral MTD exceeded the lower limit of the reference range (10 ng/mL). The range of concentrations in the oral group ranged from 62 to 393 ng/mL (mean = 150.9 ng/mL).ConclusionThe topical application of an MTD-PLO gel in doses <45 mg/day did not result in trough MTD serum concentrations associated with analgesia. An observer placebo response may explain the perceived benefit of MTD applied topically as a PLO gel in doses <45 mg/day. The evaluation of systemic absorption of MTD-PLO gel in doses >45 mg/day is warranted.     

Analytical evaluation of the new Abbott Architect 25-OH vitamin D assay

ObjectivesValidation of the Architect 25-OH vitamin D assay.Design and methodsDetermination of repeatability, reproducibility, accuracy profile and 25(OH)-vitamin D2 recovery on native samples. Comparison with DiaSorin Liaison and RIA.Results and conclusionCoefficients of variation: < 6% (13.6 ng/mL) and 2.2% (78.1 ng/mL). Functional sensitivity: 5 ng/mL. Accuracy profile shows that the method is validated between 13.6 and 78.1 ng/mL. Recovery of 25(OH)D2: 75,8%( 95% CI: 61.9–89.7%). Good correlation with DiaSorin RIA and Liaison < 50 ng/mL; above this threshold a systematic positive bias was observed.     

Cox proportional hazard model analysis of survival in end-stage renal disease patients with small-sized high-density lipoprotein particles

ObjectiveDyslipidemia is commonly seen in patients with end-stage renal disease (ESRD). This prospective study investigates whether small-sized high-density lipoprotein (HDL) particles alone or in combination with high sensitivity C-reactive protein (hsCRP) are independent determinants of ESRD mortality.Design and methodsWe performed 36 months follow-up study in 122 haemodialysis (HD) patients. HDL size and subclass distribution were determined by gradient gel electrophoresis. Baseline characteristics of the patients were evaluated for the prediction of mortality.ResultsCox regressions analysis showed that patients with small-sized HDL particles had 2.8-fold higher risk of lethal outcome (P < 0.05). Concomitant presence of small-sized HDL particles and increased hsCRP concentration were significantly associated with reduced survival rate (HR = 3.907; P < 0.05). Observed relationships persisted after adjustment for serum lipid and lipoprotein concentrations.ConclusionsOur results indicate that small-sized HDL particles alone and combined with elevated hsCRP concentrations are independent predictors of reduced survival in HD patients.     

Serum levels of vaspin and visfatin in patients with coronary artery disease—Kozani study

BackgroundThe association of novel adipokines, vaspin and visfatin, with atherosclerosis is still obscure. The present study aimed to investigate the relationship of those adipokines with the existence as well as the extent of coronary artery disease (CAD), suggesting a link between adiposity and atherosclerosis.MethodsWe enrolled a total of 108 patients with angiographically proven stable, asymptomatic CAD and 65 healthy controls (HC) without cardiovascular diseases. The severity of CAD was assessed using coronary angiography by the Gensini score. Clinical parameters, glycemic and lipid profile, high-sensitivity CRP (hsCRP), vaspin and visfatin levels were assayed.ResultsSerum levels of vaspin were significantly lower in subjects with CAD [0.91 (0.44–1.29) ng/ml] than healthy controls [1.42 (0.96–2.42) ng/ml] (p = 0.009). Inversely, visfatin (p = 0.016) and hsCRP (p < 0.001) levels were considerably up-regulated in CAD vs HC group. Multivariate analysis demonstrated decreased vaspin and increased visfatin levels to correlate with CAD presence, independent of other cardiovascular risk factors (p < 0.05). Standard multiple regression revealed HDL, LDL-C and vaspin to be independent determinants of Gensini score (R² = 0.189, p = 0.019). Notably, statin-free patients had even lower vaspin levels compared to statin users (p = 0.018).ConclusionsDecreased vaspin and increased visfatin serum levels were observed in asymptomatic patients with CAD. Low vaspin concentrations seemed to correlate with CAD severity.     

Peripheral blood level alterations of MMP-2 and MMP-9 in patients with chronic kidney disease on conservative treatment and on hemodialysis

ObjectivesData concerning the levels of metalloproteinase-2 (MMP-2) and MMP-9 in uremia and dialysis are conflicting and incomplete.Design and methodsWe measured the serum MMP levels in patients with chronic kidney disease (CKD) and undergoing maintenance hemodialysis (HD), and we tried to identify factors that could affect their levels.ResultsMMP-2 and the high sensitivity C-reactive protein (hsCRP) were inversely correlated with hematological parameters in the whole CKD group. CKD patients with stages 3 + 4 showed a significant increase in the MMP-9 levels compared to the other studied groups; this metalloproteinase was inversely correlated with lymphocyte count, and positively correlated with the hsCRP. The MMP-2 levels were higher in pre and post HD patients compared to the control group and CKD stage 1 + 2. In contrast, there was no difference in the MMP-9 levels. Both MMP-2 and MMP-9 were associated with the leukocyte count in pre HD group.ConclusionsThis study suggests a connection between an inflammatory state, biochemical response and the MMP levels in uremic and dialysis patients.     

Clinical and prognostic implications of circulating pentraxin 3 levels in non ST-elevation acute coronary syndrome

ObjectivesPentraxin 3 (PTX3) is the prototype of the long pentraxin family. PTX3 is involved in inflammatory processes affecting the cardiovascular system, and PTX3 levels have been shown to be elevated and independently prognostic in ST-elevation myocardial infarction. Data on PTX3 levels in non-ST-elevation acute coronary syndrome (NSTE-ACS), in contrast, are limited. The aim of the present analysis was to investigate the implications of PTX3 levels in a fairly large sample of NSTE-ACS patients and in comparison to levels of C-reactive protein (CRP).Design and methodsWe measured levels of PTX3 and CRP in both 82 healthy controls and 401 NSTE-ACS patients from the GUSTO IV study, and studied the associations of these biomarkers to clinical data and 1-year mortality.ResultsNSTE-ACS patients had significantly higher median PTX3 levels compared to healthy controls (3.8 vs. 1.9 μg/L; p < 0.001). PTX3 levels in patients with NSTE-ACS were independently related to female sex and cardiac troponin T levels, but not to age or cardiovascular risk factors. PTX3 levels were higher in patients who died within 1 year but did not emerge as an independent predictor of 1-year mortality (adjusted OR 1.2 [95% CI 0.6–2.3]). This was in contrast to CRP (adjusted OR 1.5 [95% CI 1.1–2.3]). Neither PTX3 nor CRP yielded significant discriminative value regarding mortality prediction.ConclusionsPTX3 levels are elevated in NSTE-ACS. However, the prognostic information provided by PTX3 levels is limited and inferior compared to CRP. Our data, thus, do not support the measurement of PTX3 in patients with NSTE-ACS.     

Red cell distribution width, C-reactive protein, the complete blood count, and mortality in patients with coronary disease and a normal comparison population

BackgroundRed cell distribution width (RDW) is associated with morbidity and mortality in coronary artery disease (CAD), but the connection of RDW with chronic inflammation is equivocal.MethodsIn 1,489 patients with CAD and 8.4–15.2 years of follow-up all-cause mortality and RDW were studied using Cox regression. RDW and its associations with inflammation, liver function, renal function, and body mass were assessed. A population of 449 normal (No-CAD) patients also was evaluated.ResultsRDW predicted all-cause mortality in a step-wise manner (HR = 1.37 per quintile; 95% CI = 1.29, 1.46; p-trend < 0.001). A significant but meaningless correlation between RDW and high-sensitivity C-reactive protein (hsCRP) was identified (r = 0.181; p < 0.001). With full adjustment, RDW remained significant (p-trend < 0.001) and the strongest predictor of mortality among all factors included in the model. RDW also strongly predicted all-cause mortality in the normal control population (HR = 1.33 per quintile, CI = 1.15, 1.55; p-trend < 0.001), but hsCRP did not predict mortality among normal controls.ConclusionsRDW was associated with mortality in patients with CAD and may provide clinically useful prognostication. Although RDW was correlated with hsCRP, they were independent predictors of mortality. RDW has been incorporated into risk prediction tool using data from basic chemistries available at: http://intermountainhealthcare.org/IMRS.     

Plasma ceruloplasmin as a biomarker for obesity: a proteomic approach

ObjectivesThis study aimed to investigate new biomarkers of obesity particularly in relation with inflammation-associated proteins using protein differential display techniques.Design and methodsComparison of protein expression in plasma between non-obese (n = 109, body mass index, BMI < 25 kg/m²) and obese (n = 32, BMI ≥ 25 kg/m²) groups was carried out using two-dimensional gel electrophoresis (2-DE) analysis. ELISA was also performed for validation.ResultsAmong six differentially expressed protein spots, ceruloplasmin (Cp) and fibrinogen were over-expressed in obese group. Plasma Cp levels were significantly higher in obese group than non-obese group (34.0 ± 8.6 vs. 41.3 ± 12.7 mg/dL, p < 0.001) and positively correlated with age (r = 0.253, p < 0.005), BMI (r = 0.265, p < 0.001) and hsCRP (r = 0.385, p < 0.001). In stepwise multiple linear regression analysis, plasma Cp along with hsCRP were found predictors for obesity (adjusted β-coefficient = 0.266, p < 0.01).ConclusionElevated plasma Cp levels were significantly associated with obesity, which may be suggested to be a marker of obesity.     

Estimated glomerular filtration rate for drug dose adjustment: Cockcroft and Gault or abbreviated MDRD equation?

ObjectivesEvaluate if Cockcroft and Gault (CG) estimated glomerular filtration rate (eGFR) might be replaced by abbreviated MDRD eGFR for drug dose adjustment.Design and methodseGFR was determined in 140 hospitalized patients (median: 68 years, 65 kg) treated by nephrotoxic and/or renally cleared drugs.ResultsCG eGFR was 61 mL/min vs. 78 mL/min/1.73 m² for MDRD (p < 0.0001). CG-MDRD difference ranged from ? 93 to + 34 mL/min, influenced by patient age, weight, and gender (p < 0.001).ConclusionsCG eGFR cannot be easily replaced by abbreviated MDRD eGFR for drug dose adjustment.     

Soluble serum Klotho in diabetic nephropathy: Relationship to VEGF-A

ObjectivesBoth kidney expression and soluble serum Klotho are influenced by chronic kidney disease (CKD) and diabetes. Serum Klotho is a yet poorly explored biomarker. We describe, for the first time to our knowledge, serum Klotho in diabetic patients with CKD and its relationship to vascular endothelial growth factor A (VEGF-A).Design and methodsWe included 43 controls and 146 diabetic patients with different stages of CKD. Laboratory evaluation, urinary albumin/creatinine ratio (UACR), Klotho (ELISA), VEGF-A (ELISA) were performed.ResultsKlotho was 0.40(0.10–1.30) ng/mL in diabetic patients without CKD and 0.80(0.30–1.30) ng/mL in controls, p = 0.20; VEGF-A was higher in diabetic patients 73.85(57.32–119.00) pg/mL than in controls 43.20(30.1–65.9) pg/mL, p < 0.0001. Klotho increased with CKD stage: 0.2(0.10–0.40) ng/mL in CKD 1/2, 0.60(0.20–1.1) ng/mL in CKD 3/4 and 1.45(0.425–2.90) ng/mL in dialysis patients, p < 0.0001; it also increased with decreasing glomerular filtration rate (GFR). Klotho was lower in albuminuric (UACR > 30 mg/g) patients 0.20(0.10–0.70) ng/mL than in normoalbuminuric (UACR < 30 mg/g) ones 0.50(0.20–1.30) ng/mL, p = 0.03; lowest Klotho was found in microalbuminuric (UACR 30–300 mg/g) patients, p = 0.07. VEGF was lower in microalbuminuric patients but was not influenced by GFR. In diabetic patients but not in controls, Klotho correlated to VEGF-A (r = 0.29, p = 0.0003); in multiple regression VEGF-A was the only significant predictor of Klotho: b = 0.27, 95%CI (0.01–0.04), p = 0.001.ConclusionsIn diabetic patients, Klotho is decreased in early CKD and increases thereafter, paralleling reduced GFR. VEGF-A is higher in diabetic patients than in controls. Both Klotho and VEGF-A are decreased in the presence of microalbuminuria. In diabetes, Klotho strongly correlates to VEGF-A.     

Proguanylin and prouroguanylin--assay evaluation and clinical analyte characterization

BackgroundThe biomarkers proguanylin and prouroguanylin are members of the natriuretic peptide family. The aim of this study was to evaluate two commercially available assays for proguanylin and prouroguanylin and to further characterize both analytes in terms of important clinical features.MethodsWe evaluated precision and linearity of the BioVendor human proguanylin and prouroguanylin ELISAs. In order to characterize both analytes, we tested in vitro analyte stabilities at ? 80 °C, and determined biological variability and reference values for proguanylin and prouroguanylin.ResultsWithin-run and total coefficients of variation were < 10% for the BioVendor proguanylin and prouroguanylin assays. Both methods were linear across the tested measurement ranges. The analytes proguanylin and prouroguanylin were stable for at least 2 months at ? 80 °C. With respect to biological variability, the reference change values (RCV) were 27% and 59% for proguanylin and prouroguanylin, respectively. For proguanylin, age-independent reference values were 4.0–13.4 ng/mL in males and 4.6–16.3 ng/mL in females. For prouroguanylin, age- and sex-independent reference values were 2.1–11.2 ng/mL.ConclusionThe BioVendor human proguanylin ELISA and the BioVendor human prouroguanylin ELISA meet the needs of quality specifications of laboratory medicine. The results of the characterization of both analytes provide essential information for further clinical studies.     

Development and preliminary validation of the Chinese version of the Sleep-Associated Monitoring Index

ObjectiveTo examine the psychometric properties of the Chinese version of the Sleep-Associated Monitoring Index (SAMI) in Taiwanese haemodialysis patients.DesignAn instrument translation and validation study.SettingA haemodialysis (HD) unit in a university-affiliated medical centre in northern Taiwan.Participants206 patients who were 18 or above, diagnosed with end-stage renal disease and under maintenance HD twice or thrice a week, 3 h or more per session for more than 3 months.MethodsA principal component analysis was used to examine the construct validity of the SAMI. The participants were classified into poor (n = 160) and good sleepers (n = 46) using a cut-off value of 5 on the Pittsburgh Sleep Quality Index (PSQI). All participants filled out the Beck Depression Inventory (BDI) and Back Anxiety Inventory (BAI) along with the SAMI. Internal consistency was examined by the Cronbach's α. To assess test–retest reliability, the participants were asked to fill out the SAMI on a second occasion at a 2-week interval.ResultsEight subscales emerged from the principal component analysis. Individual with insomnia had significantly higher total SAMI scores (p < 0.001). The SAMI total score significantly correlated to the PSQI, BDI, and BAI (r = 0.65, 0.67, 0.67; all p < 0.001). Cronbach's α was 0.95 for the entire scale. The intra-class correlation coefficient between the initial and retest SAMI total score was 0.72 (p < 0.001). The SAMI-Chinese demonstrated an area under the receiver operation characteristic curve of 0.771 (SE = 0.044; 95% CI: 0.685–0.857; p < 0.001) in detecting individuals with poor sleep. A cut-off value of 51 indicated a sensitivity of 0.86 and a specificity of 0.63 in distinguishing between poor and good sleepers.ConclusionsThe SAMI-Chinese demonstrated excellent construct validity, contrast group validity, external validity, internal consistency, and satisfactory test–retest reliability. It also demonstrated satisfactory diagnostic ability for insomnia.     

Circulating fetuin-A predicts early mortality in chronic hemodialysis patients

ObjectivesThe purpose of this study was to assess whether low serum levels of fetuin-A are potential biochemical predictor of early and/or late survival in chronic hemodialysis (HD) patients.Design and methodsWe measured serum levels of fetuin-A in 67 patients on chronic HD, and correlated it to 3, 12, and 24 months mortality.ResultsCumulative death rate was 7%, 19%, and 37% deaths at 3, 12, and 24 months. Serum fetuin-A was significantly lower in 3 months and 12 months non-survivals (p < 0.001), but not in 24 months non-survivals. Kaplan–Meier analyses based on fetuin-A tertiles showed statistically significantly increased probability of death up to 12 months of follow-up for decreasing fetuin-A concentrations (p < 0.008).ConclusionsFetuin-A as a circulating inhibitor of vascular calcification was significant predictor of early mortality in chronic HD patients but did not appear as a fair marker for later survival.     

Is serum transthyretin a reliable marker of nutritional status in patients with end-stage renal disease?

ObjectiveTo test the value of serum transthyretin (TTR) concentration as a nutritional marker in renal patients.MethodsThe study included 115 renal patients, out of which 35 are on conservative treatment, 50 on hemodialysis and 30 renal transplant recipients, and 31 healthy control subjects. Serum TTR, albumin, transferrin, C-reactive protein (CRP) and α1 anti trypsine (AAT) were assessed by immunoturbidimetry, and vitamin A by HPLC. Linear regression models were applied to test the association between serum TTR and body mass index (BMI).ResultsSerum TTR concentrations were normal, but serum vitamin A, CRP and AAT concentrations were significantly higher in patients. In renal patients, serum TTR was positively and independently related to BMI and was significantly lower in malnourished than well-nourished patients (367 ± 91 vs. 417 ± 130 mg/L; p = 0.05). The risk of serum TTR < 300 mg/L was higher in malnourished patients [OR, 4.82 (1.78–13.2); p = 0.001].ConclusionSerum TTR concentrations were at normal range in renal patients despite evidence of malnutrition and inflammation. However, they were related to BMI and were significantly lowered in malnourished patients. Thus, serum TTR would reflect nutritional status in renal patients. However, the cutoff of malnutrition should be raised to 300 mg/L.     

The relationship between insulin-like growth factor-1 and metabolic syndrome, independent of adiponectin

BackgroundInsulin-like growth factor-1 (IGF-1) is associated with obesity and aging, and was recently linked to metabolic syndrome (MetS) and insulin resistance. However, little is known about the relationship between IGF-1 and adiponectin (adiponectin), another marker of MetS.MethodsWe measured the plasma IGF-1 and adiponectin levels of 3099 subjects (1869 males, 55.9 ± 10.8 y). We applied the Korean-modified International Diabetes Foundation (k-IDF) criteria for determination of, and risk assessment for, MetS.ResultsK-IDF criteria-based MetS occurred in 37.0% (n = 1146) of patients. IGF-1 (91.5 vs. 97.3 ng/ml, p < 0.001) and adiponectin (3.95 vs. 4.23 μg/ml, p < 0.001) were significantly lower in MetS patients than without MetS. Lower IGF-1 was associated with increasing numbers of MetS abnormalities, independent of adiponectin (p for trend < 0.001, F = 12.615, p < 0.001 in ANCOVA). MetS prevalence in individuals with both high IGF-1 and adiponectin levels (6.7%, n = 206) was significantly lower than in other groups. Both high IGF-1 and adiponectin group was associated with reduced MetS risk after adjusting for other confounding factors (OR 0.694, 95% CI 0.493–0.977, p = 0.036).ConclusionsIGF-1 was associated with MetS independent of adiponectin in our study. The independent relationship between IGF-1 and MetS provides insight into the pathophysiologic mechanisms of MetS.     

Bone morphogenetic protein-2 will be a novel biochemical marker in urinary tract infections and stone formation

ObjectivesTo investigate the role of bone morphogenetic protein-2 (BMP-2) in patients with urinary tract infection (UTI) and renal stone in relation to Tamm–Horsfall protein (THP) and osteopontin (OPN).Design and methodsELISA kits were used to determine these markers in serum and urinary samples of 20 patients with UTI, 15 with renal stone and 10 controls.ResultsBMP-2 significantly increased in serum of patients who had UTI (P = 0.05) and renal stone (P = 0.01). In the case of UTI, serum BMP-2 at cutoff 44 pg/mL had sensitivity and specificity (92%, 80%), while cystatin C at cutoff 525 ng/mL showed sensitivity and specificity (85%, 91%). THP is a good predictor of renal diseases (P < 0.001) by regression analysis. It is also the most sensitive urinary marker for UTI with sensitivity and specificity (94%, 75%) at cutoff 305 ng/mL.ConclusionCombination of serum BMP-2 and cystatin C are more sensitive and accurate for early diagnosis of renal infection and damage.