Bromcresol Green Method Research Articles

The influence of various sample storage conditions and sample bacterial contamination on concentrations of routine biochemical parameters.

The pre-analytical (PA) phase is the most vulnerable phase of the laboratory testing procedure, with critical procedures-collection, handling, sample transport, and time and temperature of sample storage. This study aimed to examine the stability of basic biochemical parameters depending on the samples' storage conditions and the number of freeze-thaw cycles (FTCs). In parallel, the presence of sample bacterial contamination during routine laboratory work was examined. Two plasma pools (ethylenediaminetetraacetic acid (EDTA), and sodium-fluoride/potassium oxalate plasma (NaF)) were stored at +4 ˚C/-20 ˚C. Total chole - sterol (TC), glucose, triglycerides (TG), urea, and albumin concentrations were measured using BioSystems reagents (cholesterol oxidase/peroxidase, glucose oxidase/per - oxidase, glycerol phosphate oxidase/peroxidase, urease/ salicylate, and bromcresol green method, respectively) on Ilab 300+. Sample bacterial contamination was determined by 16S rRNA sequence analysis. The expe - riment encompassed a 5 day-period: Day 1-fresh sample, Day 2-1st FTC, Day 3-2nd FTC, Day 4-3rd FTC, Day 5-4th FTC. The appearance of bacteria in two consecutive samples was the experiment's endpoint.

Hematology and serum biochemistry variables in apparently normal Arabian Oryx (Oryx leucoryx).

Hematology and serum biochemical analyses are integral parts of the clinical evaluation of sick animals. This is especially true regarding the clinical care of wildlife species, where clinical signs and historical data relating to the particular illness are often not available. Therefore, this study was designed to report various hematology and serum biochemistry parameters in Arabian oryx (Oryx leucoryx). Various hematology and serum biochemistry parameters were determined in 49 Arabian oryx of various ages and sexes. Hematology parameters included total red blood cells (RBC), packed cell volume (PCV), hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin (MCH), MCH concentration, and total leukocyte count (white blood cell) using an automated hematology analyzer. Serum biochemistry variables included glucose (Trinder method), total protein (biuret method), albumin using the Bromcresol Green (BCG) method, and blood urea nitrogen (colorimetric method). In addition, serum electrolyte concentrations of calcium, magnesium, and phosphorus were determined using colorimetric methods. There was a significant difference in RBC count, PCV, and serum glucose concentration between adult and young Arabian oryx. The RBC count was significantly higher in males than in females, whereas the serum glucose concentration was significantly higher in females. Results of this study showed significant differences in RBC, PCV, and serum glucose concentration between apparently normal young and Adult Arabian oryx. Similar differences were also detected between normal males and females. Knowledge of these data could prove vital in the clinical evaluation of the health status of this wildlife species.

Comparison of bromcresol green and bromocresol purple methods for measuring serum albumin levels

Comparison of bromcresol green and bromocresol purple methods for measuring serum albumin levels

The Relationship Between Body Mass Index and Inflammatory Parameters in HIV Patients Treated with Antiretrovirals

Antiretroviral administration affects weight gain and inflammation in HIV patients. The purpose of the study was to assess the relationship of body mass index with inflamation parameters in HIV patients who ARV therapy. In 40 HIV patients (stage III-IV) treated with ARV (FDC 87%, Durival Efaviren 7.5%, Tenofovir, Huviral, Aluvia 2.5%, and Tenofovir, Huviral, Neviral 2.5%) conducted observational analytics with crosssectional design. CD4 examination was carried out flowcytometrically, BMI measured by formula weight (kg) divided by height squared (m2), waist circumference (WC) measured by ribbon between costae arcus and anterior superior iliac spine, albumin measurement with Brom Cresol Green (BCG) method. There is a significant correlation between BMI with WC and CD4 (r=0.61, p<0.001 and r=0.38, p<0.001, respectively). There is no correlation between BMI and duration of ARV treatment, albumin and leptin. ARV treatment in HIV patients will affect weight and inflammatory markers.

Serum albumin level is associated with the severity of neurological dysfunction of NMOSD patients

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is an inflammatory autoimmune disease of the central nervous system. Serum albumin (SA) has antioxidant, immunomodulatory and anti-inflammatory effects. However, the roles of SA in NMOSD have not been studied. The current study aimed to clarify the association of SA with disease severity and prognosis in NMOSD patients. MethodsSerum levels of albumin were measured by Bromcresol Green method. Serum level measurements of interleukins were performed using enzyme-linked immunoassay (ELISA) method. ResultsOf all the 130 NMOSD patients, 96 patients were in the acute phase while 34 patients were in the remission phase of disease at the time of sampling. SA concentration was significantly correlated with EDSS score in patients in the acute phase but not in remission phase (r = - 0.388, p < 0.001 and r = - 0.467, p = 0.809, respectively). Logistic analysis revealed that SA was the only significant factor to predict severe NMOSD (EDSS 8.0–9.5) OR = 0.698, 95%CI 0.563–0.865, p = 0.001) after adjustment of other confounding factors. Furthermore, SA was negatively correlated with the serum level of IL-33 (r = -0.438, p = 0.016) in the acute phase of NMOSD patients. ConclusionThe current study found that low level of SA was an independent indicator of more severe neurological deficit in patients in acute phase of NMOSD. SA concentration was negatively correlated with the serum level of IL-33 in the acute phase of the disease, which implies that SA might participate in the immunopathology of NMOSD partly through its interaction with IL-33.

METODE BROMCRESOL GREEN (BCG) DAN BROMCRESOL PURPLE (BCP) PADA SIROSIS HATI YANG MENDAPAT INFUS ALBUMIN

Albumin infusion is one of the therapeutic options in hypoalbuminemia patients. Serum albumin can be used to determine the albumininfusion therapy, prognosis and monitoring of liver cirrhosis. The time difference in measurement of serum albumin by bromcresol green(BCG) and bromcresol purple (BCP) methods can give different results. Serum albumin examination was done in 20 sera taken fromcirrhosis patients. Serum albumin was then evaluated before treatment, one (1) hour and 24 hours after the patient received an infusionof albumin and examined by bromcresol green (BCG) and bromcresol purple (BCP) methods. The serum albumin level by BCG methodincreased with a coefficient of 0.12 (p-value=0.022) with BCG method before (1.94±0.32 mg/dL) and after one (1) hour (2.06±0.32mg/dL) receiving intravenous albumin. The coefficient of albumin levels before and after 24 hours (2.12±0.38 mg/dL) was 0.18 (pvalue=0.07), whereas the increased levels of serum albumin after one (1) hour and after 24 hours of intravenous albumin, were notsignificant (p-value=0.467). The BCP method showed that serum albumin before, after one (1) hour and after 24 hours receivingintravenous albumin were 1.68±0.36 mg/dL, 1.87±0.36 mg/dL and 2.12±0.63 mg/dL respectively. The albumin levels showed asignificant increase before and after one (1) hour infusion of albumin (p-value=0.00), both levels shown before and after 24 hours(p-value=0.001), as well as one (1) hour and 24 hours after receiving intravenous albumin (p-value=0.04). The results of this studyshowed that increased serum albumin by BCG method could be detected after 1 (one) hour, whereas by BCP method could only be detectedafter 24 hours receiving intravenous albumin.

State of Harmonization of 24 Serum Albumin Measurement Procedures and Implications for Medical Decisions.

Measurements of serum and plasma albumin are widely used in medicine, including as indicators of quality of patient care in renal dialysis centers. Pools were prepared from residual patient serum (n = 50) and heparin plasma (n = 48) from patients without renal disease, and serum from patients with kidney failure before hemodialysis (n = 53). Albumin was measured in all samples and in ERM-DA470k/IFCC reference material (RM) by 3 immunochemical, 9 bromcresol green (BCG), and 12 bromcresol purple (BCP) methods. Two of 3 immunochemical procedures, 5 of 9 BCG, and 10 of 12 BCP methods recovered the RM value within its uncertainty. One immunochemical and 3 BCG methods were biased vs the RM value. Random error components were small for all measurement procedures. The Tina-quant immunochemical method was chosen as the reference measurement procedure based on recovery and results of error analyses. Mean biases for BCG vs Tina-quant were 1.5% to 13.9% and were larger at lower albumin concentrations. BCP methods' mean biases were -5.4% to 1.2% irrespective of albumin concentration. Biases for plasma samples were generally higher than for serum samples for all method types. For most measurement procedures, biases were lower for serum from patients on hemodialysis vs patients without kidney disease. Significant differences among immunochemical, BCG, and BCP methods compromise interpretation of serum albumin results. Guidelines and calculations for clinical management of kidney and other diseases must consider the method used for albumin measurement until harmonization can be achieved.

Optimization, Validation and Application of UV-Vis Spectrophotometric-Colorimetric Methods for Determination of Trimethoprim in Different Medicinal Products

Abstract Two simple, sensitive, selective, precise, and accurate methods for determination of trimethoprim in different sulfonamide formulations intended for use in human and veterinary medicine were optimized and validated. The methods are based on the trimethoprim reaction with bromcresol green (BCG) and 2,4-dinitro-1-fluorobenzene (DNFB). As extraction solvents we used 10 % N,N-dimethylacetamide in methanol and acetone for both methods, respectively. The colored products are quantified applying visible spectrophotometry at their corresponding absorption maxima. The methods were validated for linearity, sensitivity, accuracy, and precision. We tested the method applicability on four different medicinal products in tablet and powder forms containing sulfametrole and sulfamethoxazole in combination with trimethoprim. The results revealed that both methods are equally accurate with recoveries within the range 95-105 %. The obtained between-day precision for both methods, when applied on four different medicinal products, was within in the range 1.08-3.20 %. By applying the F-statistical test (P&lt;0.05), it was concluded that for three medicinal products tested both methods are applicable with statistically insignificant difference in precision. The optimized and validated BCG and DNFB methods could find application in routine quality control of trimethoprim in various formulation forms, at different concentration levels, and in combination with different sulfonamides.

Invalid Measurement of Plasma Albumin Using Bromcresol Green Methodology in Penguins (Spheniscus species)

The purpose of this study was to examine the validity of albumin determinations in penguin plasma by the bromcresol green (BCG) method and the gold standard of protein electrophoresis (EPH). Plasma from 96 clinically normal and abnormal penguins (Spheniscus species) was analyzed. The 2 methods did not yield equivalent results. The BCG method underestimated the albumin level in samples from normal patients (indicated by a normal albumin:globulin ratio) and overestimated the albumin level in samples from clinically abnormal penguins (indicated by a decreased albumin:globulin ratio). After EPH of plasma samples from clinically abnormal penguins samples was performed to separate albumin and globulin fractions, the globulins exhibited marked binding to the BCG dye. There were no significant differences between the variable reaction of paired serum and plasma samples when using the BCG method. These results demonstrated marked differences in the determination of albumin levels when using the BCG method and protein EPH. They further demonstrated that the BCG method can provide erroneous results, which have the potential to significantly impact clinical diagnosis and treatment. This study confirmed findings from previous studies in other avian species that the BCG method yields unreliable results in avian species. It is our conclusion that the BCG method, commonly found on automated analyzers in commercial laboratories and on point-of-care analyzers, should not be used to determine albumin concentration in avian samples.

Determination of Albumin Using the Chemiluminescence of Tb3+/K2S2O8 System

A new chemiluminescence system of Tb3+/K2S2O8 was developed for the determination of albumin. Some experimental conditions were examined and optimized. The linear ranges of the calibration curves are 5.0 × 10−9–5.0 × 10−6 mol/L for bovine serum albumin, 5.0 × 10−8–1.0 × 10−5 mol/L for human serum albumin and 2.5 × 10−7–1.0 × 10−5 mol/L for ovalbumin, and the corresponding detection limits are 1.9 × 10−9 mol/L, 1.5 × 10−8 mol/L, and 1.5 × 10−7 mol/L, respectively. The method was applied to the determination of albumin in human serum samples, and the results were in agreement with those obtained by the bromcresol green method. The relative errors for the analytical results were from −2.0% to 4.3%.

Directly Oxidized Chemiluminescence of 2-Substituted-4,5-di(2-Furyl)-1H -Imidazole by Acidic Potassium Permanganate and its Analytical Application for Determination of Albumin

In the paper, 2,4,5-tri(2-furyl)-1H-imidazole (TFI) and 2-phenyl-4,5-di(2-furyl)-1H-imidazole (PDFI), were chosen to investigate chemiluminescence (CL) properties of 2-substituted-4,5-di(2-furyl)-1H-imidazoles. The directly oxidized CL of analytes by potassium permanganate (KMnO(4)) was in detail studied. The KMnO(4) could directly oxidize TFI/PDFI to produce strong CL emission in acidic solution. The effects of experimental conditions were investigated. Under the optimal conditions, the effect of albumin on the TFI/PDFI-KMnO(4) system was investigated. It was found that the addition of albumin into the system could induce enhancement of CL signal, and the enhanced CL intensity is linearly related to the logarithm of concentration of albumin. Based on this study, a novel CL method has been developed for the determination of albumin with high sensitivity and good selectivity. The method was applied to the determination of albumin in human serum samples, and the results were in agreement with those obtained by the bromcresol green (BCG) method. The relative errors for the analytical results were from -5.8% to 4.2%. These new phenomena would further enable people to exploit more CL analytical application of the heterocyclic imidazole derivatives.

Nachevaluierung des Referenzbereiches für Albumin im Serum/Plasma mit Farbstoffbindungsmethoden (Bromkresolgrün und Bromkresolpurpur) / Update of reference values for albumin in serum/plasma with bromcresol green or bromcresol purple methods

Zusammenfassung Der gebräuchliche Referenzbereich für die Farbstoffbindungsmethoden von Albumin nach Tietze (3,5–5,0 g/dL) ist für die mit ERM DA470k restandardisierte Albuminmethode mit Bromkresolgrün (BCG) nicht anwendbar. Die Untersuchung eines Blutspenderkollektivs (120 Proben) zeigte eine wesentliche Verschiebung des Medians und des 95%-Vertrauensbereiches für die neue Methode gegenüber der gegen humanes Serumalbumin standardisierten Albumin BCG Methode. Die Übereinstimmung mit der Albuminmethode mit Bromkresolpurpur (BCP) ist gut. Als Referenzintervall für das restandardisierte BCG-Verfahren sowie für das BCP-Verfahren wird für die Altersgruppe von 20 bis 60 Jahren für gesunde Personen ein Intervall von 3,0 g/dL bis 5,0 g/dL empfohlen.

Determination of plasma albumin concentration in healthy and diseased turtles: a comparison of protein electrophoresis and the bromcresol green dye‐binding method

In reptile medicine, plasma chemistry analysis is widely used for the evaluation of an individual's health status. The standard method for the determination of plasma albumin concentration is protein electrophoresis combined with the determination of total protein concentration, but the bromcresol green (BCG) dye-binding method is also used. The reliability of the BCG method for the measurement of albumin concentration in reptiles is unknown. The aim of this study was to compare the plasma albumin values of turtles obtained by protein electrophoresis and the BCG method. Between March 2008 and September 2008, heparinized plasma samples from 16 clinically healthy and 10 diseased turtles of different species were collected. Plasma albumin concentrations were measured by protein electrophoresis and by the BCG method. The results of the 2 methods were compared using Passing-Bablok regression and Bland-Altman plots. Albumin concentration measured by BCG was weakly correlated with the corresponding protein electrophoretic values in all turtles (r(s)=.610, P<.001) and in healthy turtles evaluated separately (r(s)=.700, P=.003), whereas in diseased turtles no such correlation was found (r(s)=.374, P=.287). The albumin concentration measured with the 2 different methods differed significantly in all turtles (P=.009; Wilcoxon's test) and in healthy turtles (P=.005) but not in diseased animals (P=.241). In the Bland-Altman plot a systematic error was found between the 2 methods in diseased turtles. Measurement of albumin by the BCG dye-binding method may lead to inaccurate results for plasma albumin concentration, especially in ill turtles. Therefore, for health assessment in turtles, albumin should be measured by protein electrophoresis.

Origins of Dye-Binding Methods for Measuring Serum Albumin

Featured Article: Doumas BT, Watson WA, Biggs HG. Albumin standards and measurement of serum albumin with bromcresol green. Clin Chim Acta 1971;31: 87–96.2 Methyl orange and hydroxybenzeneazobenzoic acid (HABA),1 introduced in the 1950s, were the first dyes for measuring serum albumin (1). Methyl orange never gained acceptance in clinical laboratories because of its poor specificity, whereas HABA found limited use in the 1960s. In 1967, a trainee from Panama (Osvaldo Hernandez) at the Department of Clinical Pathology of the Medical College of Alabama wanted to present a report at the AACC annual meeting in Philadelphia and asked me (B.T.D.) to give him a “project.” I told him to adapt Bartholomew and Delaney’s bromcresol green (BCG) method for serum albumin (2) to the Technicon AutoAnalyzer. Bartholomew had changed the pH of Rodkey’s BCG reagent from 7.15, at which it had an absorbance of approximately 2.5 absorbance units (3), to a pH of 3.8. There were peaks on the AutoAnalyzer recorder, but repeatability was poor because the AutoAnalyzer coils became covered with a blue sediment—the product of the reaction of BCG with albumin, which was not water-soluble. Addition of the detergent Brij-35 to the BCG reagent (the cure for most problems with …

Activity of serum concentrations of daptomycin vs. vancomycin against vancomycin-susceptible and resistant Enterococcus faecium in the presence of albumin physiological concentrations: an in vitro pharmacodynamic simulation

Killing curves with daptomycin (56 μg/ml, the Cmax after 4 mg/kg) in media containing albumin physiological concentrations showed bactericidal activity against Enterococcus faecium, but due to its high protein binding (91.7%), cidal activity was delayed when compared to that in media without albumin [1]. This study explores the activity over 24 h of simulated serum concentrations of daptomycin (after 6 mg/kg od regimen) vs. vancomycin (1,000 mg bid regimen) against two vancomycin-susceptible but tolerant and one resistant E. faecium in an in vitro pharmacodynamic device using media containing albumin physiological concentrations. A one-compartment dynamic model was used to expose bacteria to changing study drug concentrations [2] using Mueller Hinton broth supplemented with albumin (4 g/dl). In daptomycin simulations, media was calcium-adjusted by adding 100 μg/ml of Ca [3]. Albumin concentrations were determined by the bromcresol green method, ionized calcium concentrations were measured using the AU2700 system (Olympus Diagnostic, Barcelona, Spain), and the total Ca by the Arsenazo III method (BioSystems, Barcelona, Spain). The distribution volume of vancomycin (66.5 ml) and daptomycin (100 ml) were calculated using the expression Vd=Cl/Ke to simulate the half-lives of vancomycin [4] and daptomycin [5]. Pharmacokinetic profiles in serum after 1,000 mg vancomycin [4] bid and 6 mg/kg daptomycin [5] od were simulated over 24 h. The target pharmacokinetic parameters [4, 5] were: Cmax=43.05 μg/ml, Cmin=10.8 μg/ml, and t1/2=6 h for vancomycin; and Cmax=86.4 μg/ml, Cmin=10.7 μg/ml, and t1/2=8 h for daptomycin. The initial inoculum was 8.9×10–1.8×10 cfu/ml. Samples (0.5 ml) were collected at 0, 1, 2, 3, 4, 6, 8, 10, 12, and 24 h, serially diluted in 0.9% sodium chloride, washed in normal saline, vacuum-filtered through 0.45-micron membranes to avoid the carry-over effect, and the filters plated for colony counting (detection limit=50 cfu/ml). Experiments were performed in triplicate. Differences between initial inocula and colony counts at the different timepoints (expressed as % reduction) and the times to obtain 90% (T90%), 99% (T99%), and 99.9% (T99.9%) reductions were determined. Aliquots (0.5 ml) were taken at 1, 2, 3, 4, 6, 8, 10, 12, and 24 h for the measurement of concentrations by bioassay [2] (detection limit: 0.5μg/ml daptomycin, 4μg/ml vancomycin). The total and extrapolated free-drug concentrations (adjusting by 91.7% protein binding of daptomycin and 36.9% of vancomycin) were analyzed by a non-compartmental approach using the WinNonlin Professional program (Pharsight, Mountain View, CA). The area under the concentration–time curve (AUCall) and AUC0–24h/MIC for the total and free drugs were calculated. Changes in viable colony counts at 12 h and 24 h were compared by the two-tailed t-test. The experimental pharmacokinetic parameters were: Cmax=44.5±2.6 μg/ml, Cmin=10.6±1.0 μg/ml, t1/2=6.0±0.5 h and AUCall=286.5±13.1 μg/ml×h for vancomycin; and Cmax=85.7±5.8 μg/ml, Cmin=9.4±1.1 μg/ml, t1/2=8.1±0.2 h and AUCall=852.7±15.8 μg/ml×h for daptomycin. The measured albumin concentrations were 3.9±0.21 g/dl, meaEur J Clin Microbiol Infect Dis (2008) 27:1009–1011 DOI 10.1007/s10096-008-0525-3

Lithium heparinised blood-collection tubes give falsely low albumin results with an automated bromcresol green method in haemodialysis patients

The aim of this study was to investigate the cause of markedly low albumin values determined by a bromcresol green (BCG) method in patients on haemodialysis. Serum and heparinised plasma from haemodialysis patients and normal controls were collected. Albumin was measured using Beckman bromcresol purple (BCP) and Roche BCG methods on the Beckman Synchron LX20. The albumin in heparinised plasma determined by a BCG method was 33.3% lower than that of the BCP method in a haemodialysis patient. The albumin values determined by the BCP method were comparable to those measured by immunonephelometric analysis for this patient. Significantly lower albumin levels were also observed in lithium heparin plasma by a BCG method compared to the BCP method in both non-renal patients (31.2+/-3.8 vs. 34.1+/-4.1 g/L, p<0.001, n=30) and haemodialysis patients (28.6+/-3.5 vs. 32.8+/-3.7 g/L, p<0.001, n=30). This negative bias was directly correlated with heparin concentrations in the plasma. The BCP method did not show this dose-dependent bias. Lithium heparin plasma can cause falsely low albumin values by an automated BCG method and the suitability of lithium heparin blood tubes should be carefully assessed for haemodialysis patients. The BCP method is free of this bias.

COMPARISON OF QUADRATIC AND CUBIC EQUILIBRIUM SOLUTIONS OF FREE CORTISOL FOR PREDICTION OF SALIVARY CORTISOL IN HEALTHY ELDERLY HUMAN SUBJECTS.

Purpose Free cortisol is released into the serum compartment where it is in equilibrium with serum binding proteins, corticosteroid-binding globulin (CBG), and albumin. The distribution of serum cortisol among free, CBG-bound, and albumin-bound compartments is influenced by association and disassociation rate constants for CBG and albumin, the number of unoccupied protein binding sites, and concentrations of CBG and albumin. Free cortisol in serum or plasma is difficult to assay; thus, salivary cortisol has been proposed as an alternative measure of free cortisol. In this study, we sought to assess and compare numerical methods, using both quadratic (Coolens et al, 1987) and cubic (Keenan et al, 2004) equations to calculate serum free cortisol and compare these findings with salivary cortisol in healthy elderly subjects. Methods Serum and saliva samples were collected from 45 healthy, elderly subjects at 0700 h as part of the New Mexico Aging study (UNM HRRC 01-023). The salivary cortisol and total cortisol were measured using radioimmunoassay and ultrasensitive chemiluminescence, respectively. Serum CBG was measured by radioimmunoassay and serum albumin was measured using a bromcresol green method (UNM RAC 51). The cubic equation implied by Keenan et al and the quadratic equation described by Coolens et al were used to calculate free cortisol using our measured values for total cortisol, total CBG, and total albumin. Calculated free cortisol, total cortisol, and CBG concentration were then compared to salivary cortisol using Pearson9s and Spearman9s correlations. Results There was a significant linear correlation between salivary cortisol and free cortisol calculated using the cubic equation (r = .377, p = .033) and Coolen9s quadratic equation (r = .416, p = .018). In addition, we noted a linear correlation between CBG concentration and total cortisol (r = .441, p = .0049). Conclusion Our data indicate that the free cortisol calculated using either quadratic or cubic equations is correlated significantly with salivary cortisol but that other variables appear to influence measured salivary cortisol concentration. We did not observe the previously reported correlation between total and salivary cortisol, which suggests that aging may influence the relative distribution of cortisol in serum or salivary compartments.

Relationship between Clinical Performance Measures and Outcomes among Patients Receiving Long-Term Hemodialysis

Patients receiving long-term hemodialysis have a yearly mortality rate of 15% to 20%. To determine whether attaining clinical performance measures for hemodialysis care is associated with favorable 12-month mortality and hospitalization rates. Cohort study. Outpatient hemodialysis centers in the United States. 15 287 patients who were selected from a 5% random sample of patients receiving long-term hemodialysis. The authors used data from the Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project from 1999 and 2000. The clinical performance measure targets were hemoglobin value of 110 g/L or greater; serum albumin value of 40 g/L or greater or 37 g/L or greater (bromcresol green and bromcresol purple laboratory methods, respectively); use of a fistula for vascular access; and measured single-pool Kt/V urea value of 1.2 or greater. The outcome measures were death or hospitalization during 1-year follow-up. 8364 patients (54.7%) were hospitalized and 3062 (20.0%) died during the 12-month follow-up period. Six percent of patients did not meet any clinical measure targets, 24% met 1 target, 39% met 2 targets, 24% met 3 targets, and 7% met all 4 targets. The unadjusted 12-month hospitalization and mortality rates for these 5 groups were 60%, 60%, 56%, 49%, and 43% (P < 0.001) and 29%, 25%, 21%, 14%, and 7% (P < 0.001), respectively. The risk for death increased for each additional guideline indicator that was not met: Adjusted hazard ratios were 4.6 (95% CI, 3.3 to 6.4), 3.5 (CI, 2.6 to 4.7), 2.6 (CI, 1.9 to 3.5), and 1.9 (CI, 1.4 to 2.6) for 0, 1, 2, or 3 targets met, respectively, compared with meeting 4 targets (referent). Similarly, the risk for hospitalization increased for each additional guideline indicator that was not met: Adjusted hazard ratios were 1.6 (CI, 1.4 to 1.9), 1.5 (CI, 1.3 to 1.7), 1.3 (CI, 1.1 to 1.5), and 1.1 (CI, 0.98 to 1.3), respectively. It was not possible to determine the roles of severity of illness, other patient factors, or suboptimal care in failure to meet performance measures. In patients receiving long-term hemodialysis, meeting multiple clinical measure targets is associated with a decrease in hospitalization and mortality rates.

Establishment of a Diabetic Mouse Model with Progressive Diabetic Nephropathy

Although diabetic animal models exist, no single animal model develops renal changes identical to those seen in humans. Here we show that transgenic mice that overexpress inducible cAMP early repressor (ICER Igamma) in pancreatic beta cells are a good model to study the pathogenesis of diabetic nephropathy. Although ICER Igamma transgenic mice exhibit extremely high blood glucose levels throughout their lives, they survive long enough to develop diabetic nephropathy. Using this model we followed the progress of diabetic renal changes compared to those seen in humans. By 8 weeks of age, the glomerular filtration rate (GFR) was already increased, and glomerular hypertrophy was prominent. At 20 weeks, GFR reached its peak, and urine albumin excretion rate was elevated. Finally, at 40 weeks, diffuse glomerular sclerotic lesions were prominently accompanied by increased expression of collagen type IV and laminin and reduced expression of matrix metalloproteinase-2. Nodular lesions were absent, but glomerular basement membrane thickening was prominent. At this point, GFR declined and urinary albumin excretion rate increased, causing a nephrotic state with lower serum albumin and higher serum total cholesterol. Thus, similar to human diabetic nephropathy, ICER Igamma transgenic mice exhibit a stable and progressive phenotype of diabetic kidney disease due solely to chronic hyperglycemia without other modulating factors.

Protein supplementation in patients using peritoneal dialysis

Protein-energy malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is a major contributing factor to morbidity and mortality. 1 Mittman N. Avram M. Oo K. et al. Serum prealbumin predicts survival in hemodialysis and peritoneal dialysis 10 years of prospective observation. Am J Kidney Dis. 2001; 36: 1358-1364 Abstract Full Text Full Text PDF Scopus (70) Google Scholar Low serum albumin (SA) levels in PD patients are associated with increased morbidity and mortality. 2 Garibotto G. Pastorino N. Dertenois L. Protein and amino acid metabolism in renal disease and renal failure Effects of PD on protein turnover. in: Kopple J. Massry S. Nutritional Management of Renal Disease. ed 2. Lippincott, Philadelphia, PA2004: 15-18 Google Scholar , 3 Heimburger O. Stenvinkel P. Lindholm B. Nutritional management of chronic peritoneal dialysis. in: Kopple J. Massry S. Nutritional Management of Renal Disease. ed 2. Lippincott, Philadelphia, PA2004: 478-511 Google Scholar Risk factors for poor nutritional status and decreased SA may include protein loss, abdominal distention, nutrient metabolism alterations, metabolic acidosis, endocrine disorders, drug-nutrient interactions, blood loss, socioeconomic status, and psychologic status. 3 Heimburger O. Stenvinkel P. Lindholm B. Nutritional management of chronic peritoneal dialysis. in: Kopple J. Massry S. Nutritional Management of Renal Disease. ed 2. Lippincott, Philadelphia, PA2004: 478-511 Google Scholar , 4 McCann L. Malnutrition Detection and intervention. Perit Dial Int. 1999; 19: S527-S532 PubMed Google Scholar , 5 Heimburger O. Stenvinkel P. Lindholm B. New strategies for management of malnutrition in peritoneal dialysis patients. Perit Dial Int. 2000; 20: 271-275 PubMed Google Scholar Although SA may not reflect the exact degree of malnutrition, it is often used for classifying nutritional status and recommending dietary protein intake. 6 Schoenfeld P. Albumin is an unreliable marker of nutritional status. Semin Dial. 1992; 5: 218-223 Crossref Scopus (10) Google Scholar The Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guideline states, “A stable or rising SA concentration that is equal to or greater than the lower limit of the normal range (approximately 4.0 g/dL for the bromcresol green (BCG) method) is the outcome goal.” 7 National Kidney Foundation 2000 K/DOQI Guideline 26. Clinical practice guidelines for peritoneal dialysis; measurement of albumin concentration in PD patients. Available at: www.kidney.org/professionals/kdoqi/index.cfm. Accessed January 7, 2004. Google Scholar The average SA level for PD patients is 3.7 ± 0.4 (standard deviation [SD]) g/dL. 6 Schoenfeld P. Albumin is an unreliable marker of nutritional status. Semin Dial. 1992; 5: 218-223 Crossref Scopus (10) Google Scholar The average SA for the Timpanogos Peritoneal Dialysis (TPD) program using BCG methodology was 3.6 g/dL for the years 2000 and 2001.