Chronic Renal Disease Patients Research Articles

Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients

The investigators evaluated the impact of recombinant human erythropoietin ( r-HuEPO) therapy on health-related quality of life (HRQL) in predialysis chronic renal disease patients with anemia. Eighty-three patients were entered into a randomized, parallel-group, open-label clinical trial with follow-up evaluations over 48 weeks. Forty-three patients were assigned to r-HuEPO treatment, and 40 patients were assigned to an untreated control group. Hematocrit levels were measured at baseline and monthly. HRQL was assessed at baseline and at weeks 16, 32, and 48. The HRQL assessment included measures of physical function, energy, role function, health distress, cognitive function, social function, home management, sexual dysfunction, depression, and life satisfaction. Significant improvements in hematocrit levels were observed in the r-HuEPO-treated group ( P < 0.0001), and no changes were seen in the untreated group. Correction of anemia (hematocrit ≥ 36) occurred in 79% of r-HuEPO-treated patients and 0% of control patients. Significant improvements in assessments of energy ( P < 0.05), physical function ( P < 0.05), home management ( P < 0.05), social activity ( P < 0.05), and cognitive function ( P < 0.05) were found for the r-HuEPO-treated group. No changes were observed in the control group, except for a decrease in physical function ( P < 0.05). Between-group differences favoring the r-HuEPO-treated group were found for energy ( P < 0.05) and physical functioning ( P < 0.05). In patients receiving r-HuEPO, significant improvements were seen in hematocrit levels, and these increases resulted in improvements in HRQL.

Pulp narrowing in renal end stage and transplanted patients

A comparison of relative dental pulp size in chronic renal disease patients with dental pulp size in healthy controls revealed a significant pulp narrowing in the kidney disease group (n = 44). A strong correlation between the chronicity of the renal disease and the pulp narrowing was found in the premolar and molar teeth of the tested group. A review of the literature concerning pulp narrowing is also presented.

Suppression of Bone Marrow by Low-Density Lipoproteins in Renal Disease Patients

Patients with chronic renal disease in whom erythropoietin production is inadequate invariably experience moderate to severe debilitation-induced fatigue. Unlike the direct humeral control of erythropoiesis, neutropenia in the same cohort of patients appears to be under indirect control, very likely brought about by the suppressive effect of increased levels of low-density lipoprotein (LDL) on granulocyte-monocyte colony formation. Markedly elevated LDL levels were identified in plasma samples obtained from a study population of 179 chronic renal disease patients. The effect of the elevated LDL levels in the plasma of these patients resulted in a greater than 60% decrease in granulocyte-macrophage colony-forming unit in comparison with age-matched plasma from normal individuals. Careful review of all nutritional and therapeutic events in these patients did not offer any evidence, other than the elevated LDL levels, in support of the etiology of the chronically low absolute neutrophil counts.

Decreased Fractional Excretion of Urate as an Indicator of Prerenal Azotemia

Although the fractional excretion of uric acid (FEUA) is known to reflect extracellular fluid volume changes, the diagnostic significance of decreased FEUA in dehydration has not been previously reported. We studied the possible association between low FEUA and acute prerenal azotemia, and its diagnostic value, compared with other traditional indices, in discriminating prerenal azotemia from renal parenchymal causes of acute renal failure. In 65 chronic renal disease patients, 174 FEUA measurements were obtained from 24-hour urine collections. FEUA levels increased as reciprocal serum creatinine levels decreased. All 8 patients with prerenal azotemia showed significantly decreased FEUA values compared with chronic renal disease patients with a comparable degree of serum creatinine elevation, whereas all 7 patients with acute renal failure had FEUA values higher than those of chronic renal disease patients with comparable creatinine levels. FEUA values in prerenal azotemia were distinctly lower than those in acute renal failure (p less than 0.001). Patients with prerenal azotemia showed a lower fractional excretion of sodium, a lower fractional excretion of chloride and renal failure index, and a higher urine-to-plasma creatinine ratio than those with acute renal failure (p less than 0.05). However, these traditional indices were not useful in discriminating between the two conditions. The urine-to-plasma urea nitrogen ratio and the ratio of plasma urea nitrogen to creatinine showed no statistical difference between prerenal azotemia and acute renal failure. We conclude that, in acute azotemia, a decreased FEUA value may represent a reliable indicator of prerenal azotemia in the differential diagnosis of acute renal failure.

Red cell alloimmunization in chronic renal failure patients undergoing hemodialysis.

Posttransfusion alloimmunization to red cell antigens was studied in a group of 98 chronic renal disease patients treated solely with hemodialysis. Clinically significant red cell antibodies were formed in only 6.1% of transfused patients, and only 1 patient formed more than one antibody. We do not recommend extended red cell phenotyping, beyond ABO and Rh(D), in patients with end-stage renal disease who may require transfusion.

Prekallikrein, HMW-kininogen and factor XII in various disease states

The behaviour of prekallikrein (PKK), factor XII, high molecular weight kininogen (HMWK) and kallikrein-inhibitor (KK-I) in 367 patients with various diseases is described. Malignancies lead to elevation of factor XII and KK-I, and reduction of PKK. The effect is more pronounced in patients with metastases. In renal diseases also one or more of the above mentioned parameters are abnormal. Defects requiring dialysis treatment significantly impair the contact factors. In this group low levels of PKK, Factor XII and HMWK and increased KK-I are common. In chronic renal disease patients, only F XII and KK-I are elevated, whereas PKK and HMWK are normal. Kidney transplantation leads to a rise in KK-I and reduction of PKK and HMWK. The values almost normalize few days after the operation. Factor XII, slightly increased immediately after transplantation, remains high in long term transplant recipients, whereas HMWK falls below normal. In liver disease patients, acute and chronic hepatitis, cirrhosis of the liver and coma, PKK is reduced. In cases with acute hepatitis PKK raises with recovery. Cirrhosis and coma lead to low HMWK and factor XII concentrations. KK-I is mostly affected during acute hepatitis, and is then highly increased. Our results clearly demonstrate that the biologic activity of one or more of contact factors is affected in many diseases.

Paradoxical bilateral asymmetry in bone size and bone mass in the hand

Among 227 chronic renal disease patients, micrometer caliper radiogrammetric measurements of the second metacarpal at midshaft showed the right metacarpal to be larger (with greater bone area) and with a greater cortical area than the left second metacarpal, both in 208 right-handed individuals and in 19 left-handed individuals. This direction of asymmetry was individually characteristic of the majority of individuals, whether right-handed, left-handed or ambidextrous.

Hemoglobin Affinity for Oxygen in Chronic Renal Disease: The Effect of Hemodialysis

Abstract The affinity of hemoglobin for oxygen may increase significantly in subjects who are hypophosphatemic and alkalotic. We studied the organic phosphate content and oxygen binding by hemoglobin of red cells in subjects undergoing hemodialysis, during which time a decrease in plasma inorganic phosphate and an increase in blood pH may occur. Red cell 2,3-DPG was not correlated with plasma inorganic phosphorus, whereas red cell ATP was highly correlated with plasma inorganic phosphorus when analyses were made on predialysis samples. Predialysis red cell inorganic phosphorus was highly correlated with plasma inorganic phosphorus, supporting the concept that intraerythrocytic inorganic phosphorus is maintained by a gradient from plasma to cell. Plasma inorganic phosphorus decreased by 45% during the period of hemodialysis, whereas red cell inorganic phosphorus did not change. Red cell 2,3-DPG, ATP, and oxygen binding by hemoglobin at standard conditions of temperature, pH, and pCO2 were not altered after 6 hr of hemodialysis. Plasma pH and base excess increased during dialysis. The increase in base excess, an estimate of the non-pH-dependent effect of CO2 on oxygen binding by hemoglobin, counterbalanced a portion of the effect of elevated pH on hemoglobin— oxygen affinity under in vivo conditions. Hence, only a slight increase in oxygen binding by hemoglobin occurred. Moreover, late dialysis symptoms were not associated with the degree of alkalosis or with the extent of change in hemoglobin’s affinity for oxygen. Red cell 2,3-DPG content was lower and hemoglobin’s affinity for oxygen was higher in subjects with chronic renal disease than in nonazotemic subjects with similar hemoglobin deficits. Moreover, increased red cell ATP in chronic renal disease patients did not influence oxygen binding by hemoglobin.

Roentgenographic manifestations of chronic renal disease treated by periodic hemodialysis.

The roentgenographic abnormalities in 33 chronic renal disease patients undergoing periodic hemodialysis are presented. The principal findings are subperiosteal resorption, osseous hypomineralization, and metastatic soft tissue calcification. These are described and discussed in relation to pertinent clinical, laboratory, and reference information.Minor joint changes are also observed, and it is speculated whether these are additional manifestations of metabolic bone disease or might represent early gout.Study of illustrative case examples suggests that metastatic calcification is related to elevation of the serum phosphate level.Hemodialysis, as practiced at this Medical Center, appears to be relatively ineffective in combating these associated changes on chronic renal disease. The results obtained with supplementary forms of therapy are described.