The relationship between brain-derived neurotrophic factor levels,oxidative and nitrosative stress and depressive symptoms: a study on peritoneal dialysis

Abstract

Background: Depression is one of the most commonly encountered psychiatric problems in peritoneal dialysis (PD) patients. Our aim was to investigate the associations between oxidative and nitrosative stress (O&NS) and brain-derived neurotrophic factor (BDNF) in PD patients with elevated depressive symptoms (EDS). Methods: Eighty-three patients with PD and 84 healthy controls were enrolled in this study. In PD patients, two subgroups were formed: 28 with and 55 without EDS. EDS were defined as a Beck Depression Inventory (BDI) score ≥17 in patients. Serum malondialdehyde (MDA) erythrocyte, glutathione (GSH) levels measured spectrophotometrically. Serum superoxide dismutase (SOD) activity, nitric oxide (NO) and BDNF levels were determined by ELISA. Results: While MDA and NO levels were higher, levels of SOD, GSH and BDNF were lower in PD patients compared to controls (p?<?0.001). The patients with EDS had higher levels of MDA and lower levels of BDNF as compared to those without EDS (p?<?0.005). In linear regression analysis, the BDNF levels were dependently associated with SOD levels in PD patients (B: 0.274, p: 0.043). In addition, while a negative correlation existed between BDI scores with BDNF levels (r?=?–0.312, p?=?0.004), a positive correlation was present between BDI scores and MDA levels (r?=?0.320, p?=?0.005) in PD patients. Conclusion: Our results suggest the presence of high O&NS and low antioxidant capacity accompanied with decreased levels of BDNF in PD patients, especially those with EDS were deeper. These may represent the risk factors for cellular injury and might reveal part of the mechanism causing the depressive state in PD patients.     

Treatment of Acute Rejection

Abstract

Background: Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in patients with end stage renal disease (ESRD). Apelin expressed in endothelial and other tissues including brain and kidney is an adipocytokine defined recently and is emerging an important mediator of cardiovascular homeostasis. The aim of this study was to test whether apelin levels might be associated with carotid artery atherosclerosis and left ventricular mass index (LVMI) in peritoneal dialysis patients. Patients and methods: Fifty peritoneal dialysis patients (25 female, mean age 41.4?±?11.9 years, mean dialysis vintage 65.0?±?35.4 months) and 18 healthy individuals (9 female, mean age 41.7?±?6.8 years) were included in this cross-sectional study. Serum apelin 12 levels, echocardiographic findings and carotid intima media thickness (CIMT) were recorded as well as clinical and laboratory data. Results: There were no differences between the patient and the control groups with regard to demographic characteristics. In patient group, LVMI, CIMT, CRP and apelin levels were elevated compared to control group. However there was no association between apelin, LVMI and CIMT. There was a positive correlation between apelin and CRP, which was not statistically significant. When patients were divided into two groups according to the mean serum apelin levels, LVMI, CIMT and CRP were higher in the high apelin group but this difference did not reach statistical significance. Conclusion: We observed an increased inflammation and CVD risk in peritoneal dialysis patients. However, serum apelin levels seem not to be associated with cardiovascular risk in this group of patients.     

Stroke-free status and depression scores among Saudi dialysis patients

Abstract

Background: To assess the prevalence of stroke symptoms and depression among Saudi dialysis patients and related factors. Methods: This is a cross-sectional multicentre study of Saudi dialysis patients. Demographics, clinical and laboratory’s data were collected. Freedom from stroke symptoms was assessed using the Questionnaire for Verifying Stroke-Free Status and depression using the Geriatric Depression Scale. Results: Five-hundred and forty-nine patients (77.3% response rate); 94.6% were receiving hemodialysis and 5.4% peritoneal dialysis were included in the study. Freedom from stroke was reported in 76.6% of patients, was higher in females (p?=?0.07), and was not affected by the presence of diabetes mellitus coronary artery disease or peripheral vascular disease. However, it was significantly lower in hypertensive patients (p?=?0.035) and was not affected by age, dialysis duration, Kt/V, albumin or hemoglobin levels. It was, however, more prevalent in the non-depressed patients compared to depressed patients (p?=?0.036). Mild and major depression scores were noted in 45.2% and 6.1%, respectively; the depression score being significantly higher in HD than in PD patients (6.3?±?3.4 vs. 5.0?±?3.2 p?=?0.049) but was not related to sex, employment, vascular access type, age, dialysis duration, Kt/V or serum albumin or hemoglobin levels. Conclusion: A quarter of the patients were not stroke symptom-free and these were more likely the depressed patients, in females, but significantly less in hypertensive patients. Almost half of the patients were depressed with 6.1% having major depression. The depression score was significantly higher in HD than in PD patients.     

Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

Background: End-stage renal failure (ESRF) and dialysis have been identified as a risk factor for lower limb amputations (LLAs). High rate of ESRF amongst the Australian population has been reported, however till date no study has been published identifying magnitude and risk factors of LLA in subjects on renal dialysis.

Objective: The study aims to document trends in the prevalence and identify risk factors of non-traumatic LLA in Australian patients on dialysis.

Methods: A retrospective review of all patients (218) who attended the regional dialysis center between 1st January 2009 and 31st December 2013 was conducted. Demographic, clinical and biochemical data were analyzed.

Results: We identified a high prevalence of 13.3% of LLAs amongst Australian patients with ESRF on dialysis at our center. The associated risk factors were the presence of diabetes (OR 1.67 [1.49–1.88] p?<?0.001), history of foot ulceration (OR 81 [18.20–360.48] p?<?0.001), peripheral arterial disease (OR 31.29 [9.02–108.56] p?<?0.001), peripheral neuropathy (OR 31.29 [9.02–108.56] p?<?0.001), foot deformity (OR 23.62 [5.82–95.93] p?<?0.001), retinopathy (OR 6.08 [2.64–14.02] p?<?0.001), dyslipidemia (OR 4.6 [1.05–20.05] p= 0.049) and indigenous background (OR 3.39 [1.38–8.33] p= 0.01). 75% of the amputees had aboriginal heritage. We also identified higher HbA1c and CRP levels as well as low serum albumin, hemoglobin and vitamin D levels to have a strong association with LLAs (p?<?0.05).

Conclusion: There is high prevalence of LLAs amongst Australian indigenous patients with diabetes on dialysis in North Queensland. Other strongly associated risk factors include history of foot ulceration, foot deformity and peripheral neuropathy as well as high HbA1c levels and low serum albumin levels.     

Important determinants of quality of life in a peritoneal dialysis population in Turkey

Background: Patients' health-related quality of life (HRQoL) is an important indicator for predicting the effectiveness of treatment, morbidity, and mortality. The aim of this study was to determine the level of HRQoL and the most important factors affecting HRQoL in patients receiving peritoneal dialysis (PD). Methods: This cross-sectional study was performed with 156 patients, 30 of whom (19.2%) had automated PD (APD), were over 18 years of age, and were followed up at the Erciyes University Continuous Ambulatory Peritoneal Dialysis (CAPD) Unit during the previous year. HRQoL, depression, and fatigue were measured by means of the Short Form-36 (SF-36), Beck Depression Inventory (BDI), and Fatigue Severity Scale (FSS), respectively. Results: The mean mental component summary (MCS) score was 42.1 ± 11.9 and physical component summary (PCS) score was 39.1 ± 11.2, which was lower than MCS. Depression was the strongest predictor for both diminished mental (β = ?24.4, p < 0.001) and physical (β = ?16.5, p < 0.001) HRQoL. Fatigue was the next strongest predictor for diminished physical HRQoL only (β = ?7.74, p < 0.001). Depression and fatigue accounted for 37% of physical HRQoL impairment. Depression as a sole factor was responsible for 31% of mental HRQoL impairment. Age, hospitalization, total cholesterol, serum albumin levels, and Kt/V urea had affected the SF-36 in some domains score but not in all. Conclusion: HRQoL in our PD patients can be evaluated at a slightly poor level compared to the results of previous studies. Impaired HRQoL is more closely associated with depression and fatigue. Depression was the strongest predictor of both mental and physical HRQoL. Fatigue was the next strongest predictor for physical HRQoL only.     

The role of adipocytokines on depressive symptoms of patients with chronic kidney disease

Abstract

Objective: The aim of this study is to evaluate depression and anxiety scores among chronic kidney disease (CKD) patients and to search the changes of serum concentrations of adipokines with respect to emotional disturbances of CKD patients. Patients and methods: 150 patients recruited into this cross-sectional analytic study. Study groups were control, hemodialysis, predialysis, peritoneal dialysis and kidney transplantation groups. Fasting morning serum leptin, ghrelin, acylated ghrelin, neuropeptide Y, adiponectin, resistin levels of all of the groups were measured using ELISA (Sandwich) method. A screening interview based on the Structured Clinical Interview for DSM-IV and self-report scales (The Beck Depression [BDI] and The Beck Anxiety Inventory [BAI] and Brief Symptom Inventory [BSI] which is self report scales) were administered and conducted by a trained interviewer. Results: BDI scores were significantly higher in hemodialysis and predialysis groups compared to control group (p?=?0.009). Somatization sub scores of BSI were significantly higher in hemodialysis and peritoneal dialysis groups compared to control group (p?=?0.041). Also positive symptom distress index scores of BSI were significantly higher in hemodialysis and transplantation groups compared to control group (p?=?0.047). BDI score were significantly negatively correlated with duration of education (r?=??0.165, p?=?0.045), positively correlated with presence of protein energy wasting (r?=?0.198, p?=?0.016), and resistin levels (r?=?0.233, p?=?0.004). Conclusion: CKD patients had higher BDI, BSI-somatization, BSI-positive symptom distress index scores compared to control group. High serum resistin levels, presence of protein energy wasting might have a role in development of depressive disorders of patients with chronic kidney disease.     

Does Tacrolimus Use Have a Sexual Dysfunctional Effect in Women After Renal Transplant?

BackgroundTacrolimus, one of the immunosuppressive agents, is used to prevent tissue rejection in renal transplant recipients, but the relationship between the plasma concentrations of tacrolimus and female sexual dysfunction has not yet been elucidated. The aim of this study was to determine the effect of tacrolimus use on sexual dysfunction of women after renal transplant.MethodsTwenty-one female patients who successfully underwent transplant and were treated with tacrolimus were enrolled as the patient group, while 21 patients presented to the obstetrics and gynecology clinic for different reasons were included in the study as the control group. The Beck Depression Inventory, Beck Anxiety Inventory, and Female Sexual Function Index were applied. Plasma concentrations of tacrolimus were simultaneously measured in transplant recipients.ResultsThe scores of all scales did not differ among groups in terms of depression, anxiety, and sexual dysfunction. All transplant recipients had a plasma concentration of tacrolimus in the range of 3 to 7 ng/L. When the patients were compared by the scores of depression and anxiety scales, the drug levels showed no effect on the depression, anxiety, and female sexual functions.ConclusionsSexual dysfunction appears to be ameliorated in women because of the hormone levels after renal transplant at the end of the dialysis process, hence enhancing the quality of life. Normal plasma levels of tacrolimus, which is known to cause sexual dysfunction, could not change this result.     

High mobility group box 1 and tumor growth factor β: useful biomarkers in pediatric patients receiving peritoneal dialysis

Background: Peritonitis, the most important limitation of peritoneal dialysis (PD), could be detected by biomarkers in dialysate effluent, representing a noninvasive method to indirectly assess the peritoneum status. The aim of our study was to test high mobility group box 1 (HMGB1) in PD patients, evaluating its role as precocious marker of peritoneum damage during peritonitis. Transforming growth factor (TGF)-β was correlated with peritoneal transport characteristics.

Methods: Six patients, treated by ambulatory PD, were enrolled. Samples were collected at the onset of peritonitis (T1) and every day until its resolution (T-end). Serum (s) and peritoneal (p) white blood cell (WBC) count was also evaluated. Peritoneal Equilibration Test evaluated the filter activity of peritoneum.

Results: In patients with acute peritonitis, the highest serum and peritoneal HMGB1 values (64?±?3.6 and 70?±?5.3?ng/mL, respectively) were assessed, with a progressive decrease of their levels at the resolution time (T-end: sHMGB1:36?±?2.5; pHMGB1:30.5?±?7.0?ng/mL). While no differences of sWBC and pWBC were observed between baseline and T-end values, pHMGB1 levels remained higher at T-end than those observed at T0 (pHMGB1:30.5?±?7.0 versus 6.9?±?3.6; p?p?=?0.01). An inverse correlation was found between TGF-β levels and dialysate/plasmatic creatinine values (r = ?0.83; p?=?0.03).

Conclusion: HMGB1 represents a useful biomarker for peritoneum evaluation in PD patients. A prognostic role of this alarmin, as a marker of response to therapy, could be hypothesized. TGF-β could predict the peritoneal transport status and dialysis technique adequacy.     

Increased serum renalase in hemodialysis patients: is it related to left ventricular hypertrophy?

Introduction: Left ventricular hypertrophy (LVH) is one of the most common cardiac abnormalities in patients with end stage renal disease (ESRD). Hypertension, diabetes, increased body mass index, gender, age, anemia, and hyperparathyroidism have been described as risk factors for LVH in patients on dialysis. However, there may be other risk factors which have not been described yet. Recent studies show that renalase is associated with cardiovascular events. The aim of this study was to reveal the relation between renalase, LVH in patients under hemodialysis (HD) treatment.

Methods: The study included 50?HD patients and 35 healthy controls. Serum renalase levels and left ventricle mass index (LVMI) were measured in all participants and the relation between these variables was examined.

Findings: LVMI was positively correlated with dialysis vintage and C-reactive protein (CRP) (r?=?0.387, p?=?0.005 and r?=?0.597, p?r?=??0.324, p?=?0.022 and r?=??0.499, p?r?=?0.263, p?=?0.065). Serum renalase levels were significantly higher in HD patients (212?±?127?ng/mL) compared to controls (116?±?67?ng/mL) (p?r?=?0.677, p?r?=?0.625, p?Discussion: In our study, LVMI was correlated with dialysis vintage, residual diuresis, CRP, and hemoglobin. LVMI tends to correlate with renalase and this correlation may be significant in studies with more patient numbers. The main parameters affecting renalase levels are dialysis vintage and serum creatinine.     

Female Sexual Dysfunction in Peritoneal Dialysis and Hemodialysis Patients

Background. Sexual dysfunction (SD) is a common problem in end-stage renal disease (ESRD). In contrast to basic and clinical research in the field of male SD, the sexual problems of women have received relatively little attention and are often under-treated. We evaluated sexual function in female ESRD patients using the validated Female Sexual Function Index (FSFI) and relation with QOL, depression, and some laboratory parameters. Methods. 117 ESRD patients (85 peritoneal dialysis [PD], 32 hemodialysis [HD], mean age 48.5 ± 13.9 years) were enrolled. All patients had been dialyzed (PD or HD) for more than three months. In addition, an age-matched married control group of 48 subjects (mean age 47.1 ± 12.7 years) were enrolled in the study. All patients were asked to complete three questionnaires of the FSFI, Beck Depression Index (BDI) and SF-36. Results. Female sexual dysfunction was found in 80 of the 85 peritoneal dialysis patients (94.1%) and all of the HD patients (100%), but in only 22 subjects of the control group (45.8%). A significant negative correlation was found between total FSFI score and age (r = ?0.288, p = 0.002), BDI score (r = ?0.471, p < 0.001), mental-physical component score of QOL (r = ?0.463, p < 0.001 and r = ?0.491, p < 0.001, respectively) in PD and HD patients. The rates of depression were 75.3, 43.8, and 4.2% in the PD and HD patients and control subjects, respectively. Conclusion. Female sexual dysfunction is common problem ESRD. This problem especially related with depression and QOL. Thus, sexual function should be evaluated in female subjects to determine its impact on quality of life.     

Severe depression and anxiety in women with overactive bladder

Aim

Depression and anxiety are prevalent psychiatric conditions and are associated with overactive bladder. The objective of this study was to determine prevalence and severity of anxiety and depression associated with overactive bladder (OAB) in women.

Methods

274 women with clinical diagnosis of OAB were recruited from 2012 to 2015. They were submitted to the International Consultation on Incontinence Questionnaire‐Overactive Bladder (ICIQ‐OAB), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

Results

Severe or moderate depression was present in 59.8% of women and severe or moderate anxiety was identified in 62.4%. Higher scores of depression and anxiety were associated with higher scores of ICIQ‐OAB (P = 0.0031 and 0.0049). Women with severe depression had higher nocturia score than those with mild depression (P = 0.0046). Also, women with severe depression had higher urgency incontinence score than those with minimal depression (P = 0.0261). Patients with severe anxiety had higher nocturia score than those with minimal anxiety (P = 0.0118) and women with moderate anxiety had higher urgency incontinence score than with minimal anxiety (P = 0.0300).

Conclusions

Moderate or severe depression and anxiety are prevalent in women with OAB. There is a correlation between intensity of OAB symptoms with depression and anxiety. Anxiety and depression levels are mainly related with urgency incontinence and nocturia.     

Influence of endothelin-1 and nitric oxide on left ventricular remodelling in patients on peritoneal dialysis

Background: Left ventricular hypertrophy is the most common structural cardiac alteration in chronic dialysis patients. The aim of this study was to determine the possible association of endotelin-1 (ET-1) and nitric oxide (NO) with parameters of echocardiography in order to assess their participation in left ventricular (LV) remodeling in patients on peritoneal dialysis (PD). Methods: This prospective longitudinal study included 40 PD patients. Serum levels of ET-1 and NO baseline and after 12 months of PD treatment were measured and compared with echocardiography parameters done at the same time of PD treatment. Linear regression analysis was used to detect independent correlations of variables. Results: Mean ET-1 serum concentration decreased significantly after 12 months of PD treatment compared to baseline values (p?p?p?Conclusions: According to our data ET-1 and NO are independently related to the process of left ventricular remodeling in PD patients     

Serum indoleamine 2,3 dioxygenase and tryptophan and kynurenine ratio using the UPLC-MS/MS method,in patients undergoing peritoneal dialysis,hemodialysis, and kidney transplantation

Background: The level and activity of indoleamine 2,3-dioxygenase (IDO) and the concentrations of L-tryptophan and its metabolite L-kynurenine were determined in association with various renal diseases. However, there have been no data regarding these parameters in patients on peritoneal dialysis compared to those undergoing hemodialysis or kidney transplantation.

Methods: This study investigated the level and activity of IDO and determined oxidative balance by calculating the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). We enrolled 60 kidney disease patients, including 20 on peritoneal dialysis (PD group), 19 on hemodialysis (HD group), and 21 with kidney transplantation (KT group), as well as 21 control group.

Results: IDO levels were increased in the PD, HD, and KT groups compared to the control group. The concentration of kynurenine was significantly increased in the PD group compared to the other groups (p?p?p?Conclusion: The results showed that IDO levels were increased in peritoneal dialysis and hemodialysis patients and in renal transplant recipients, while oxidative stress was found to be related to IDO activity and was most increased in the patients on peritoneal dialysis.     

Leptin and plasminogen activator inhibitor-1 levels in children on chronic dialysis

Abstract

Purpose: In this study, it is aimed to compare the serum leptin and PAI-1 levels and evaluate their relationship in children on hemodialysis (HD) and peritoneal dialysis (PD). Method: Thirty-six patients on HD (mean age: 15.0?±?2.8 years), 19 patients on PD (mean age: 13.0?±?3.5 years) and 15 healthy subjects (mean age: 14.5?±?2.7 years) were included in the study. Laboratory investigations included blood count, biochemical parameters, serum iron, iron binding capacity, parathormone, erythrocyte sedimentation rate, C-reactive protein (CRP), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, serum leptin and PAI-1 levels. Results: Serum leptin levels were significantly higher in HD group than in control group when the effects of BMI and sex were controlled, while PD and control groups had similar leptin levels. PAI-1 levels were also significantly higher in HD group than in control group, while there was no statistically significant difference in PAI-1 levels of PD and control group. PAI-1 levels and leptin levels were significantly correlated, which was independent of the effect of BMI in both HD and PD groups when they are evaluated separately. Conclusion: Results of our study showed that HD patients had higher leptin and PAI-1 levels and leptin and PAI-1 levels were correlated significantly in both patient groups. The effect of elevated serum leptin and PAI-1 levels on the cardiovascular complications remains to be established.     

Apelin and nutritional status in children on dialysis

Background: We aimed to evaluate whether serum apelin could reflect the nutritional status of children on dialysis. Methods: Twelve patients on peritoneal dialysis (PD) and 20 patients on hemodialysis (HD) were enrolled. Patients received individualized diet for six months. Anthropometric and laboratory indices were measured at onset and the end of the study. Results: The anthropometric indices were all significantly lower in patients than in controls whereas similar in PD and HD patients. The protein catabolic rate (nPCR), height, mid-arm circumference (MAC), triceps skinfold thickness (TSF), arm muscle area (AMA) and arm fat area (AFA) z scores were significantly increased in dialysis patients after nutritional intervention. Weight z scores statistically increased in HD group whereas did not statistically change in PD group. Serum albumin levels were significantly improved in PD and HD patients. Apelin levels were similar in PD, HD and control groups. Post nutritional apelin values did not differ in each dialysis groups. On multivariate analysis, apelin was independently associated with age, weight, ESR and TG. Conclusions: Apelin seems to be not a useful indicator for monitoring the nutritional status in children on dialysis. However, the close link of apelin with inflammatory and lipid parameters suggested that apelin might be a novel target for slowing the atherogenic process in pediatric dialysis patients.     

Investigação do estresse,ansiedade e depressão em mulheres com fibromialgia: um estudo comparativo

IntroductionDepression has emerged as the most prevalent mental disorder in patients with fibromyalgia. Stress, whose stages are alarm, resistance, near-exhaustion and exhaus- tion, constitutes a physical reaction to a threatening situation.ObjectiveTo investigate the levels of stress, anxiety and depression in women with fibromy- algia, comparing them with those of healthy women.Patients and methodsParticipants were 50 women, 25 with a diagnosis of fibromyalgia ac- cording to the criteria of the American College of Rheumatology, and 25 without this diag- nosis, matched for age. Instruments used: Lipp Inventory of Stress Symptoms for Adults (LISS), State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI).ResultsThe mean age was 49.36 years for the group with fibromyalgia (FM) and 49.20 years for the group without fibromyalgia (non-FM). FM showed a higher incidence of stress (96%) compared with non-FM (5%). The resistance phase was predominant in both groups, FM (42%) and non-FM (100%). In FM there was distribution of the four stages (alarm, resistance, near-exhaustion and exhaustion). The differences between phases in the analyzed groups were significant (p < 0.001). FM showed predominance of psychological symptoms (54%); non-FM did show the same frequency of psychological and physical/psychological (40%) symptoms. Symptoms of state and trait anxiety and of depression in FM were significantly higher, when compared with non-FM (p < 0.01).ConclusionStress index (96%), trait anxiety (over 50) and clinically relevant depression (greater than 20) in FM were relevant. The understanding of the emotional variables in- volved in fibromyalgia is important to define the therapeutic strategy.     

Depression, anxiety and adjustment in renal replacement therapy: a quality of life assessment.

OBJECTIVES: To measure the quality of life (QOL) of patients on RRT with regard to depression, anxiety, and adjustment to illness. MATERIAL: The study was conducted between 1996 and 1998 at a teaching hospital in Porto Alegre, Brazil. The study population included 125 patients (transplant n = 64, hemodialysis n = 42 and continuous ambulatory peritoneal dialysis [CAPD] n = 19). METHODS: The Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and the Psychosocial Adjustment to Illness Scale (PAIS) were used for patient assessment. Results were analyzed using the Kruskall-Wallis, Mann-Whitney and ANOVA tests. RESULTS: Depression scores were higher for hemodialysis patients compared with transplant patients (H = 15.22; p < 0.005). CAPD patients had intermediate scores (no statistical difference). As far as anxiety was concerned, no statistical difference was observed when the groups were compared. In terms of adjustment to illness, hemodialysis patients were significantly less well adjusted than transplant patients (H = 23.34; p < 0.001). Patients on CAPD had intermediate scores, with no significant difference compared with the other two groups. CONCLUSION: The overall quality of life of transplant patients is higher than that of hemodialysis patients.     

Midkine release during hemodialysis is predictive of hypervolemia and associates with excess (cardiovascular) mortality in patients with end-stage renal disease: a prospective study

Background

In end-stage renal disease, a high cardiovascular risk profile and endothelial damage prevails. The heparin-binding growth factor midkine stimulates neo-angiogenesis in ischemic diseases, coordinates neutrophil influx, and raises blood pressure through stimulated angiotensin synthesis.

Methods

We determined changes of midkine serum levels during hemodialysis sessions under the assumption that endothelial cell-derived midkine is released. Periprocedural differences (?midkine) were calculated and correlated with cardiovacular biomarkers and fluid status (clinical assessment, V. cava collapse, comet tail phenomenon), cardiovascular morbidities, mortality rates. Blood was collected before and after dialysis from hemodialysis patients (n?=?171; diabetes: n?=?70; hypervolemia: n?=?83; both: n?=?32).

Results

Baseline midkine levels were?~?fourfold elevated compared to healthy controls (n?=?100). Further, on average a tenfold rise was detected during dialysis, the extent of which was partially related to non-fractionated heparin application (r²?=?0.17). Inter-individual differences were highly reproducible. Hypervolemic patients responded with a less than average rise in midkine levels during dialysis (p?<?0.02), this difference became more obvious with co-existing diabetes (p?<?0.001 for long dialysis-free interval) and was confirmed in an independently enrolled dialysis cohort (n?=?88). In Kaplan Meier survival curves, low delta midkine levels correlated with cardiovascular/overall mortality rates, similar to elevated uPAR levels, whereas other markers (NTproANP, galectin, tenascin-C) were less predictive. Following intervention with successful fluid removal in hypervolemic dialysis patients to optimize fluid homeostasis, midkine values increased (p?<?0.002), which was not observed in patients that failed to decrease weight.

Conclusion

Thus, for dialysis patients inadequate periprocedural midkine upregulation is linked with hypervolemia and associates with cardiovascular events.

     

The impact of diabetes mellitus on peritoneal dialysis: the Turkey Multicenter Clinic Study

Purpose: It is well established that diabetic peritoneal dialysis (PD) patients have a higher mortality rate than the other PD population. This study was designed to determine the overall predictors of survival and compared mortality and morbidity between diabetic and non-diabetic Turkish PD patients. Methods: We conducted a multicenter retrospective study with 915 PD patients [217 had diabetes mellitus (DM)]. Serum albumin, PTH, HbA1c, co-morbid diseases, dialysis adequacy (Kt/V), and peritoneal transport characteristics as well as peritonitis episodes and ultrafiltration failure during the follow-up period were recorded. Results: DM patients were older and had more co-morbidities than non-DM patients. Peritonitis rates were higher in DM patients (one episode per 35.9 patient months) compared to non-DM patients (one episode per 41.5 patient months) (p?p?=?0.022), age (HR 1.03, p?p?p?=?0.038), peripheral artery disease (HR 1.83, p?=?0.025) and amputation (HR 4.1, p?=?0.009) at baseline were significant predictors of overall mortality. Conclusions: Patient survival is lower in diabetic compared to non-diabetic patients on PD. Peritonitis rates were also higher in diabetic PD patients. DM, older age, albumin level and cardiovascular co-morbidities are predictors of mortality     

Serum albumin changes and mortality risk of peritoneal dialysis patients

Purpose

Initial or single time point serum albumin levels have been shown to be important in predicting the prognosis of peritoneal dialysis (PD) patients. However, we assume the dynamic change and trend of albumin after PD are essential. We aimed to investigate the association between baseline albumin levels, albumin trajectories, and patient mortality in a retrospective cohort study.

Methods

In this retrospective cohort study, 547 incident PD patients were enrolled from Peking University Third Hospital. Date were collected by medical records review, including age, gender, body mass index, primary disease, comorbidities, and laboratory tests. A joint model for longitudinal data and time-to-event data was used to establish the relationship between serum albumin trajectories and mortality risk of PD patients.

Results

The albumin trajectories was negatively correlated with risk of death. The increase in the current value of albumin trajectories at time points t after PD was associated with decreased risk of death (HR?=?0.881, p?<?0.0001). There was no statistical association between initial albumin and risk of death (HR?=?1.030, 95% CI 0. 995–1.066). The results showed that increased age, higher albumin-corrected Ca levels, and higher eGFR values were risk factors for death. In addition, predictors of low albumin levels are increased PD time, increased age, increased albumin-corrected Ca, and decreased BMI as well as initial albumin levels.

Conclusion

This study demonstrates that albumin trajectories after PD is better than initial serum albumin level in predicting mortality risk. Increasing albumin level over time can improve the prognosis of PD patients.