透与腹透患者血清脂蛋白（a）的变化及意义

目的：观察血透（HD）与腹透（PD）患者之间脂蛋白（a)[lipoprotein(a),Lp(a)]及脂质水平影响的差别及其临床意义。方法：对68例HD患者及50例PD患者的临床及实验室资料作研究，比较两种透析方式对血Lp(a)及脂质水平影响的差别，分析血Lp(a）与其他相关因素特别是与心脑血管事件的关系。结果：HD与PD患者血Lp(a）水平均较对照组呈显著性升高（P＜0.05），其中PD组较HD组更高（P＜0.01）；HD组血Tch较对照组及PD组无呈显著性下降（P＜0.05）、血HDL－C较对照组呈显著性下降（P＜0.01）；PD组血TG较对照组及HD组均呈显生升高（P＜0.05）；血ApoA、ApoB100与对照组间无统计学差异。HD与PD患者血Lp(a)水平与超声心动图异常(（P＜0.05）、EG异常（P＜0.001）及心脑血管事件的发生（P＜0.01）、24h腹水蛋白质浓度（P＜0.01）、血Tch及LDL-C浓度（P＜0.05）、纤维蛋白原（P＜0.05）呈正相关；而与血浆白蛋白浓度（P＜0.05）、24h腹水Lp(a)浓度（P＜0.05）呈负相关。结论：HD与PD患者普遍存在严重的脂质代谢变化，其中以血Lp(a)、TG、HDL－C变化尤为显著，PD组由于长期吸收大量葡萄糖，因此脂质代谢紊乱更为明显。Lp(a）有可能是HD、PD患者并发心脑血管事件的危险因素之一。     

脑梗死病人血尿酸、脂蛋白(a)含量的研究

目的探讨脑梗死病人血尿酸(UA)、血清脂蛋白(a)[Lp(a)]含量的变化及其意义.方法对85例脑梗死病人测定其血总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、脂蛋白(a)及血尿酸水平.并与对照组(40例)进行对比观察.结果脑梗死病人TC、TG、HDL-C水平与对照组相比无统计学意义(P＞0.05),UA、LDL-C、Lp(a)水平较对照组明显升高(P＜0.01);其中脑梗死合并糖尿病者较无糖尿病者血UA、Lp(a)亦有明显升高(P＜0.05),两组与正常对照组比较有统计学意义(P＜0.05).结论血尿酸、Lp(a)含量增高与脑梗死存在一定关系,是脑梗死的重要危险因素.     

血液透析和腹膜透析患者死亡原因分析及比较

目的:分析血液净化患者的死亡原因,并比较血液透析(HD)和腹膜透析(PD)患者的死因差异.方法:纳入2005-01-01至2008-12-31期间新进入透析的患者,随访至2009-03-31.结果:460例透析患者中,247例起始采用HD治疗,213例起始采用PD治疗.HD组男性比例和血肌酐显著较高,而PD组基础疾病为高血压肾病比例显著较高,其余基线资料包括透始年龄、体重指数、透析前已知的肾功能不全病程、首次透析治疗前eGFR、平均动脉压、心脑血管事件、Charlson并发症指数等两组间均无明显统计学差异.共87例死亡患者,其中HD患者40例,PD患者47例.HD总体死亡率低于PD患者(0.102和0.171/患者年,P＜0.01).HD 1年死亡率与PD患者无显著差异(0.133和0.196/患者年,P＞0.05),HD 2年死亡率低于PD患者(0.101和0.170/患者年,P＜0.05),HD 3年死亡率低于PD患者(0.101和0.165/患者年,P＜0.05).透析患者的主要死亡原因为心血管疾病(31.0%)、脑血管疾病(21.8%)、感染(16.1%).PD患者心血管病因死亡率显著高于HD患者(0.064和0.022/患者年,P＜0.01),而两组的脑血管疾病、感染、多脏器衰竭和恶性肿瘤导致的死亡率均无显著差异.年龄＜65岁患者中,HD总体死亡率与PD无显著差异,两组患者的心血管疾病、脑血管疾病、感染、多脏器衰竭和恶性肿瘤死亡率均无显著差异.年龄≥65岁患者中,HD总体死亡率低于PD(0.179和0.378/患者年,P＜0.05),PD患者心血管疾病死亡率高于HD患者(0.164和0.004/患者年,P＜0.05),两组患者的脑血管疾病、感染、多脏器衰竭和恶性肿瘤死亡率均尤显著差异.透析龄≤1年患者中,HD总体死亡率与PD患者无显著差异;PD患者多脏器衰竭导致的死亡率显著高于HD患者(0.082和0.000/患者年,P＜0.05),而两组的心血管疾病、脑血管疾病、感染和恶性肿瘤导致的死亡率均无显著差异.透析龄＞1年患者中,HD总体死亡率与PD患者无显著差异;PD患者心血管病因死亡率高于HD患者(0.026和0.006/患者年,P＜0.05),感染导致的死亡率显著高于HD患者(0.013和0.000/患者年,P＜0.05),两组的脑血管疾病、多脏器衰竭、恶性肿瘤导致的死亡率均无显著差异.结论:透析患者最主要的死因为心、脑血管疾病和感染.HD总体死亡率可能低于PD,尤其是心血管疾病和感染导致的死亡率.应该强调透析患者的心脑血管并发症和感染的防治,以提高透析质量,改善长期预后.     

长期血液透析患者血清载脂蛋白(a)表型及其它脂质的测定分析

HD治疗的患者常导致脂质代谢异常,并有较高的心脑血管疾病发病率.我们检测了经HD治疗后72例慢性肾衰患者(CRF)血清载脂蛋白(a)及其它脂质水平,分析了脂质异常的原因。经与190例健康人比较,发现载脂蛋白(a)表型在HD组和对照组中的整体构成比差异不大(P>0.5),但表型B在HD组中出现的频率明显高于对照组(P<0.05).另外,HD组甘油三酯和脂蛋白(a)浓度亦明显高于对照组(P<0.001),高密度脂蛋白胆固醇和载脂蛋白Al,浓度明显低于对照组(P<0.001),其它脂质在两组间的差别不显著(P>0.5)。     

糖尿病肾病脂蛋白(a)质量浓度变化对尿白蛋白排泄率的影响

目的探讨血清脂蛋白(a)[Lp(a)]质量浓度变化与糖尿病肾病(DN)进展之间的关系以及降低血清Lp(a)质量浓度在防治DN进展中的意义。方法对广东省东莞市人民医院2002-04～2004-09门诊及住院270例糖尿病患者分为单纯糖尿病(SDM)组、早期糖尿病肾病(EDN)组和临床糖尿病肾病(CDN)组各90例,比较其与正常对照组的血清Lp(a)水平;两组DN患者在常规治疗基础上每晚服用氟伐他汀40mg。分析血清Lp(a)质量浓度变化与DN进展之间的关系。结果⑴SDM组血清Lp(a)质量浓度与正常对照组比较无显著性差异(P>0.05),EDN、CDN组血清Lp(a)质量浓度明显高于正常对照组和SDM组(P<0.01),CDN组血清Lp(a)质量浓度明显高于EDN组(P<0.01)。血清Lp(a)质量浓度与尿白蛋白排泄率(UAER)呈直线正相关(r=0.396,P<0.01)。⑵两组DN患者血清Lp(a)水平显著降低(P<0.01)。结论血清Lp(a)质量浓度升高与DN进展有关,降低血清Lp(a)质量浓度能有效减轻EDN患者的蛋白尿、改善肾功能,但对CDN患者无效。     

中老年尿毒症患者不同透析方案状态下C-反应蛋白与甲状腺功能的相关性

目的 探讨中老年终末期肾衰竭患者不同透析方案状态下C-反应蛋白(CRP)与甲状腺功能的变化及相关性.方法 将中老年尿毒症维持性透析患者分为两组:血液透析(HD)组(n=30),腹膜透析(PD)组(n=30);另外纳入30例健康者设为正常对照组.比较三组人群血清CRP、促甲状腺激素(TSH)、游离T3(FT3)、游离T4(FT4)之间的关系.结果 HD组和PD组FT3、FT4显著低于正常对照组(P＜0.05),CRP显著高于正常对照组(P＜0.05).FT3和FT4在HD组和PD组相比没有显著差异(P＞0.05).PD组TSH水平显著高于HD组与正常对照组(P＜0.05).HD组CRP与FT3呈负相关,但在PD组中没有发现相关性.结论 炎症反应可能与低FI3综合征有关,但在PD患者中没有发现此关联.     

脂蛋白(a)与2型糖尿病视网膜病变的关系

对DR患者38例,DM患者65例及正常组100例,检测Lp(a)、TC、TG、HDL-C、LDL-C、ApoA1、FPG、FINS、FC肽等.结果①DM患者Lp(a)水平较正常组高(P<0.01);②DR组比DM组Lp(a)升高(P<0.01);③DM患者的Lp(a)浓度与TC、LDL-c、ApoB、是否合并视网膜病变呈正相关,与空腹C肽水平呈负相关.多元回归分析发现ApoB对DMLp(a)浓度影响最大.结论脂蛋白(a)及其相关因素与视网膜病变的发生密切相关.     

未经治疗的非痴呆帕金森病患者记忆功能障与事件相关电位的分析

目的 研究未经治疗的非痴呆帕金森病(PD)患者记忆功能障碍和事件相关电位的特点及其相关性.方法 于2004年9月至2006年9月取第三军医大学大坪医院就诊的非痴呆PD患者共46例作为1组,所有的PD患者均未经过系统治疗;以年龄、性别及受教育程度相匹配的社区健康老年人为对照组(2组).进行整体认知功能、韦氏记忆量表和事件相关电位P300测验.结果 1组记忆商(MQ)下降,短时记忆和长时记忆明显下降,与正常对照组差异有极显著性(P＜0.01),瞬时记忆无损伤,差异无显著性(P＞0.05),Fuid物体记忆测验(FOM)和快速语词测验(RVR)都有损伤,差异有极显著性(P＜0.01),P300潜伏期延长(360.59±26.05)ms,与正常对照组差异有极显著性(P＜0.01).结论 未经治疗的早期帕金森病患者长时记忆和短时记忆均有损伤,P300潜伏期改变与记忆障碍相关.     

慢性肾脏病患者游离脂肪酸与细胞因子及颈动脉病变的关系

目的 研究慢性肾脏病(CKD)患者血清游离脂肪酸(FFA)水平的变化及其与细胞因子及颈动脉病变的关系.方法 对188例CKD患者[非透析治疗130例,血液透析(HD)58例]的临床及实验室资料作回顾性研究,采用酶比色法检测FFA,应用颈动脉超声检查颈动脉病变的程度,同时检测高敏C反应蛋白(hsCRP)、血清IL-1β、IL-6和TNFα水平,分析FFA水平与此细胞因子及颈动脉病变的关系.结果 CKD患者无论透析与否,FFA水平较健康对照组显著升高[(492.63±143.59)比(302.65±142.18)μmol/L,P＜0.01],在非透析CKD患者中,随着肾功能的逐渐减退,血FFA水平也逐渐升高,各组间比较差异有统计学意义(P＜0.05或P＜0.01),且HD组FFA水平较非透析CKD 5期更高(P＜0.05).CKD患者hsCRP、IL-1β、IL-6、TNFα水平均显著高于健康对照组(P＜0.05或P＜0.01),颈动脉内膜中层厚度(IMT)及斑块形成、颈动脉硬化的患病率较健康对照组显著升高(P＜0.05或P＜0.01),HD组上述指标较非透析CKD5期均更高(P＜0.05).直线相关分析显示,血FFA水平与hsCRP、IL-1β、IL-6、TNFα、TG及IMT、斑块形成、颈动脉硬化的患病率呈正相关(P＜0.05或P＜0.01),与GFR呈负相关(P＜0.05).多因素逐步回归分析显示,FFA、hsCRP和年龄是CKD患者颈动脉病变的独立危险因素.结论 非透析CKD及HD患者血清FFA水平均显著升高,且与hsCRP等微炎性反应的指标及颈动脉病变相关,提示高游离脂肪酸血症是CKD患者并发动脉粥样硬化的危险因素之一.     

冠心病患者血清脂蛋白(a)与纤溶功能的变化及其相关性

目的:观察冠心病(CHD)患者血清脂蛋白a[Lp(a)]、血浆组织型纤溶酶原激活剂(tPA)与纤溶酶原激活剂抑制物-1(PAI-1)活性的变化特点,并探讨它们之间的关系。方法:对124例CHD患者和26例正常人采用双抗体ELISA法测定Lp(a)浓度,发色底物法测定tPA、PAI-1活性。结果:CHD患者中,急性心肌梗死(AMI)和不稳定性心绞痛(UAP)组患者Lp(a),浓度和PAI-1活性均非常显著高于对照组(P<0.01):tPA活性显著低于对照组(P<0.01);陈旧性心肌梗死(OMI)和稳定性心绞痛(SAP)组患者Lp(a)浓度和PAI-1活性均亦高于对照组(P<0.05);tPA活性亦低于对照组(P<0.05)。124例CHD患者相关分析显示:Lp(a)与PAI-1活性呈显著正相关,与tPA活性呈显著负相关(P均<0.001)。结论:冠心病患者Lp(a)显著升高,且与tPA、PAI-1活性有密切相关关系。     

长期血液透析和腹膜透析患者血脂水平及其相关因素分析

目的：观察血液透析和腹膜透析对终末期肾衰竭患者血脂的影响及相关因素。方法：血透患者36例，腹透(CAPD)患者25例，对照组35例，分别检测开始透析时及透析后12个月时的血脂、血浆白蛋白、血清肌酐(Scr)水平。结果：腹透组患者12个月后血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、载脂蛋白B(ApoB)及脂蛋白(a)[Lp(a)]较透析前明显增高，HDL-C、ApoA1较透析前明显降低；血透组患者12个月后HDL-C明显降低；二组患者透析前ApoA1明显低于对照组，ApoB、Lp(a)明显高于对照组，二组患者透析前均有明显的低蛋白血症，透析后血浆白蛋白明显降低，腹透患者尤其显著。血浆白蛋白水平与血脂呈显著相关。结论：尿毒症患者透析前即存在血脂异常，透析治疗并不能消除高脂血症，甚至加重高脂血症，以腹透患者明显。营养不良、低蛋白血症是透析患者高脂血症的主要致病因素。     

Growth hormone, IGF-I and its binding proteins (IGFBP-1 and -3) in adult uraemic patients undergoing peritoneal dialysis and haemodialysis

OBJECTIVE: The GH/IGF axis is altered in chronic renal failure (CRF). CRF patients usually show normal or high serum concentrations of GH and IGF-I, whereas all IGF binding proteins (IGFBP-1 to -6), except IGFBP-5, considerably increase with declining renal function. The aims of the present study were to quantify serum concentrations of GH, IGF-I, IGFBP-1 and IGFBP-3 in a group of patients with CRF, and determine whether there were differences according to the type of dialysis, that is, peritoneal dialysis (PD) and haemodialysis (HD). DESIGN: A cross-sectional study in the setting of a dialysis unit of a general hospital. PATIENTS AND MEASUREMENTS: We studied 108 dialysis patients treated by PD (n = 54, 32 males and 22 females, mean age 61.0 +/- 1.4 years) or HD (n = 54, 31 males and 23 females, age 62.6 +/- 1.5 years). A group of 42 healthy subjects of similar age, sex and body mass index (BMI) served as the control group. Baseline serum concentrations of GH, insulin, IGF-I, IGFBP-1 and IGFBP-3 were measured in all patients and control subjects. RESULTS: Fasting serum concentrations of IGF-I and its binding proteins (IGFBP-1 and IGFBP-3) were significantly higher in dialysis patients than in subjects with normal renal function. IGF-I (248.9 +/- 23.4 vs. 205.5 +/- 15.5 micro g/l, NS), IGFBP-3 (5.6 +/- 0.4 vs. 5.5 +/- 0.2 mg/l, NS) and IGFBP-1 (36.1 +/- 5.9 vs. 44.1 +/- 6.5 micro g/l, NS) concentrations were similar in both groups of dialysis (PD vs. HD) patients. However, GH (2.3 +/- 0.3 vs. 1.1 +/- 0.1 micro g/l, P < 0.001) and insulin (40.4 +/- 4.5 vs. 30.1 +/- 3.1 micro U/ml, P < 0.05) levels were significantly higher in the PD group than in the HD group. Both groups of dialysis patients showed significantly higher levels of insulin than healthy subjects (14.7 +/- 1.9 micro U/ml, P < 0.0001 and P < 0.01 for PD and HD, respectively). In both groups of dialysis patients, IGF-I correlated inversely with IGFBP-1 (PD group r = -0.46, P = 0.0006; HD group r = -0.57, P = 0.0001) and directly with IGFBP-3 (PD group r = 0.44, P = 0.001; HD group r = 0.73, P = 0.001). No correlation between insulin and IGFBP-1 was found in any of the groups studied. CONCLUSIONS: These findings demonstrate that adult dialysis patients have elevated IGF-I, IGFBP-1 and IGFBP-3 serum concentrations compared with subjects with normal renal function. Only GH and insulin show statistically significant differences in relation to type of dialysis. Finally, the negative correlation between IGF-I and IGFBP-1 and the positive correlation between IGF-I and IGFBP-3 are maintained in both groups of adult dialysis patients.     

Peripheral artery disease in peritoneal dialysis and hemodialysis patients: single-center retrospective study in Taiwan

ABSTRACT: BACKGROUND: Peripheral artery disease (PAD) is a condition characterized by restricted blood flow to the extremities, and is especially common in the elderly. PAD increases the risk for mortality and morbidity in patients with end-stage renal disease (ESRD), especially those on hemodialysis (HD). METHODS: The records of 484 patients with end-stage renal disease who were on HD or peritoneal dialysis (PD) were reviewed. PAD was diagnosed based on the ankle-brachial pressure index (ABI). Demographic and clinical characteristics were analyzed. RESULTS: PAD had an overall prevalence of 18.2% and was significantly more common in HD patients (21.8%) than in PD patients (4.8%). Advanced age, diabetes mellitus, smoking, low parathyroid hormone level, elevated serum ferritin, elevated serum glucose, and low serum creatinine levels increased the risk for PAD. PAD was independently associated with advanced age, diabetes mellitus, duration of dialysis, low serum creatinine, and hyperlipidemia. PD patients had a significantly lower prevalence of PAD than HD patients, maybe due to their younger age and lower prevalence of diabetes mellitus in this present study. CONCLUSIONS: The prevalence of PAD was greater in the HD group than the PD group. Most of the risk factors for PAD were specific to HD, and no analyzed factor was significantly associated with PAD in PD patients.     

Serum and dialysate osteocalcin levels in hemodialysis and peritoneal dialysis patients and after renal transplantation

Serum osteocalcin (BGP), a vitamin K-dependent gamma-carboxyglutamic acid (GLA) containing bone protein, provides an index of bone turnover in patients with a variety of metabolic bone diseases. BGP increases with increasing age in both sexes, but more so in women. BGP rises above normal when the glomerular filtration rate falls below 30 ml/min. Because of its importance in bone disease, its low mol wt, and the effect of uremia, we measured BGP by RIA in serum and dialysate fluid in patients on hemodialysis (HD) or peritoneal dialysis (PD). In 32 HD patients (22 women and 10 men), serum BGP was not different pre- and postdialysis [67.5 +/- 4.4 (+/- SEM) ng/ml vs. 67.7 +/- 5.2), but was significantly elevated compared to the level in normal subjects (7.3 +/- 0.8 ng/ml). The sex difference previously reported in normal subjects was not found in patients with renal failure. The serum BGP level in 8 PD patients was 49.4 +/- 6.9 ng/ml, with a peritoneal fluid concentration of 27.6 +/- 9.3 ng/ml. The hemodialysate fluid concentration of BGP was 1.7 +/- 0.4 ng/ml, which was significantly lower than the serum BGP levels in the HD patients, the PD patients, and peritoneal fluid (P less than 0.01). A significant correlation existed among BGP, alkaline phosphatase, immunoreactive PTH, creatinine, and blood urea nitrogen. We conclude that BGP is markedly elevated in patients with renal failure, not altered in the serum by HD or PD, but very low in HD dialysate fluid. These findings may reflect a combination of impaired clearance and increased skeletal production. The difference in clearance between the peritoneal and hemodialysis fluid is compatible with the mol wt of BGP. In 15 patients who had successful kidney transplantation, serum BGP was normal despite an elevated serum PTH level.     

慢性肾衰竭患者血清脂蛋白（a）变化及其临床意义探讨

目的观察慢性肾衰竭（CRF）患者血清脂蛋白（a）[LP（a）]水平的变化及其与心脑血管疾病的关系。方法回顾分析102例慢性肾衰竭患者的临床及实验室资料,探讨患者血LP（a）水平与心脑血管疾病的关系。结果CRF患者无论透析与否,其血LP（a）水平均较健康对照组显著升高（P〈0．05）,血液透析组（HD组）LP（a）水平升高及高密度脂蛋白（HDL．C）水平下降比非透析组（ND）更明显（P〈0．01）,而HD组与ND组患者血总胆固醇（CHOL）、低密度脂蛋白（LDL-C）、三酰甘油（TG）浓度差异无统计学意义。CRF伴心脑血管疾病患者的血LP（a）水平比无心脑血管疾病患者明显升高（P〈0．05）。结论CRF患者存在严重的脂代谢紊乱,血IJP（a）水平升高可能伴随纤溶功能的低下,可能是CRF患者并发心脑血管疾病的危险因素之一。     

糖尿病终末期肾病患者透析方式的探讨

目的比较腹膜透析（PD）及血液透析（HD）对糖尿病终末期肾病患者长期预后的影响,以便为临床选取适当治疗方法提供参考。方法将131例糖尿病终末期肾病患者分为HD组（58例）和PD组（73例）,比较两组患者的血液生化指标、生存率和死亡原因。结果两组患者年龄比较无显著性差异,但大于65岁的老年糖尿病患者PD组明显增多（P〈0．01）。透析第1、第2年两组患者死亡率比较无显著性差异,第3、4年PD组死亡率大幅上升,显著高于HD组（P〈0．01）。HD组18例死亡患者中,年龄大于65岁者4例（22．2％）;PD组29例死亡患者中,年龄大于65岁者17例（58．6％）,两组比较有显著性差异（P〈0．01）。HD组死亡主要原因为脑血管病变（占38．9％）,PD组死亡主要原因为感染（占34．5％）。PD组空腹血糖、甘油三酯、胆固醇均高于HD组,两组比较差异有显著性（P〈0．01）。PD组患者血浆白蛋白、血钾明显低于HD组（P〈0．01）。结论糖尿病终末期肾病患者适于PD,但PD组患者2年以上远期生存率明显低于HD组,尤其是大于65岁高龄糖尿病患者PD死亡率明显上升。腹膜透析相对于血液透析仍存在局限性。     

Hepcidin/Ferritin Ratios Differ Among Non‐Dialyzed Chronic Kidney Disease Patients,and Patients on Hemodialysis and Peritoneal Dialysis

The serum levels of hepcidin generally increase in patients with chronic kidney disease (CKD) due to inflammation or a decline in the glomerular filtration rate. However, the differences in the ferrokinetics among dialysis modalities are unclear. We investigated the relationship between serum levels of hepcidin and ferritin among non‐dialyzed CKD (ND), hemodialysis (HD), and peritoneal dialysis (PD) patients. We recruited 285 CKD patients (117 ND, 80 HD, and 88 PD patients) and measured the serum levels of hepcidin‐25, ferritin, hemoglobin, iron, transferrin saturation (TSAT), albumin, and high sensitivity C‐reactive protein (hs‐CRP). Hepcidin‐25 levels were elevated in all CKD patients and were significantly higher in PD than in ND and HD patients. The hepcidin/ferritin ratio was significantly higher in PD patients independent of TSAT, hemoglobin, hs‐CRP, and serum albumin. Hepcidin/ferritin ratio, associated with both dialysis modality and inflammation, is expected to be a useful indicator of anemia in CKD.     

Serum ghrelin concentrations in patients with chronic renal failure undergoing dialysis

BACKGROUND: Ghrelin is a recently discovered protein hormone mainly synthesized in the gastric endocrine cells. This hormone not only is a potent growth hormone secretagogue but also is involved in the regulation of food ingestion and energy metabolism. Derangements in ghrelin secretion in patients with chronic renal failure (CRF) have not been fully evaluated. OBJECTIVE: Our aim has been to quantify serum concentrations of total ghrelin in a group of patients with CRF on chronic therapy with both haemodialysis (HD) and peritoneal dialysis (PD) in comparison with a group of patients on conservative management (predialysis). PATIENTS AND MEASUREMENTS: We studied 68 CRF patients treated by HD (n = 30, 16 men, age 61.2 +/- 1.8 years) and PD groups (n = 38, 21 men, age 54.4 +/- 1.7 years). A group of 19 uraemic patients on conservative management served as the control. Serum concentrations of ghrelin, leptin, insulin, IGF I and GH were measured in all subjects. RESULTS: Patients undergoing HD showed similar concentrations of ghrelin in comparison with the control group (9491 +/- 787 vs 9280 +/- 918 pg/ml, NS). However, PD patients exhibited baseline ghrelin concentrations significantly lower than those found in patients on conservative management (3230 +/- 216 pg/ml, P < 0.0001). Men and women showed similar serum ghrelin levels in both HD (9845.9 +/- 1071 vs 9085 +/- 1194 pg/ml) and PD patients (3214 +/- 297 vs 3250 +/- 324 pg/ml). Hypertension and diabetes mellitus did not influence ghrelin levels. Serum GH levels were positively correlated with serum ghrelin concentrations in both HD (r = 0.46, P < 0.05) and PD (r = 0.53, P < 0.001) patients; however, no relationships between ghrelin, leptin, insulin and IGF I were found. CONCLUSIONS: These results suggest that PD is accompanied by a striking decrement in baseline ghrelin concentrations in comparison with values found both in HD and control patients. Further studies are necessary to determine mechanisms involved in ghrelin regulation in uraemic patients.     

Effects of soy isoflavones on serum lipids and lipoprotein (a) in peritoneal dialysis patients

Background and aimLipid abnormalities are common in peritoneal dialysis (PD) patients and no effective treatment to decrease serum lipoprotein (a) [Lp(a)] in dialysis patients is known so far. Therefore, this research was designed to investigate the effects of soy isoflavone supplement on serum lipids and Lp(a) in PD patients.Methods & resultsIn this randomized, double-blind, placebo-controlled trial, 40 PD patients were randomly assigned to either the isoflavone or the placebo group. The patients in the isoflavone group received 100 mg soy isoflavone daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of the 8th week, 7 mL of blood was obtained from each patient and serum triglycerides, total cholesterol, low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and Lp(a) were measured. Serum Lp(a) reduced significantly up to 10% in the isoflavone group at the end of week 8 compared to baseline (P < 0.05), and the reduction was significant in comparison with the placebo group (P < 0.05). Serum HDL-C increased significantly up to 11.5% in the isoflavone group at the end of week 8 compared to baseline (P = 0.05), and the increment was significant in comparison with the placebo group (P < 0.05). There were no significant differences between the two groups in mean changes of serum triglycerides, total cholesterol, and LDL-C.ConclusionsThis study indicates that daily administration of 100 mg soy isoflavones reduces serum Lp(a) and increases HDL-C concentration which are two determinants of cardiovascular disease in PD patients.ClinicalTrials.govNCT03773029.Registration number and dateNCT03773029 - 2018.