Function In End-stage Renal Disease Patients Research Articles

Global iterative optimization framework for predicting cognitive function statuses of patients with end‐stage renal disease

AbstractThe existing methods to determine the cognitive function level of end‐stage renal disease (ESRD) are not only inaccurate but also susceptible to the influence of the patient's education level, emotional state, and examination environment. We proposed a global iterative optimization framework (GIO) to accurately predict cognitive function statuses of ESRD patients without being affected by the above factors. First, the functional magnetic resonance imaging (fMRI) data preprocessed and the time series were extracted to construct brain functional networks. Secondly, the areas under curve (AUC) of topological attribute parameters in the brain functional networks were extracted as features. After statistical analysis, the global efficiency, the characteristic path length, and the shortest path length in the small‐world network were selected as features for linear fusion. Finally, the support vector regression (SVR) was used as the basis of GIO framework, and the global iterative search strategy was introduced to find out the most appropriate penalty factor and radial basis function parameters. Achieving the objective of accurately predicting the cognitive function status of patients with end‐stage renal disease. Since this framework uses SVR which has special advantages in processing small sample data, and introduces appropriate parameter selection method, the prediction ability of GIO framework has been significantly improved. Experimental results demonstrate that the final prediction accuracy of the proposed framework is significantly better than those of SVR, LSSVR, GMO‐SVR, GMO‐LSSVR, and PSO‐SVR. The mean absolute error (MAE) and the mean absolute percentage error (MAPE) of the proposed framework are 0.55% and 2.58%, respectively. It is suggested that this framework is more convenient to determine the current level of cognitive function in ESRD patients and is conducive to the early prevention of cognitive dysfunction in ESRD patients.

MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE

You have accessJournal of UrologyCME1 May 2022MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE Serdar Karadag Serdar KaradagSerdar Karadag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002590.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient to allow satisfactory sexual performance. In end-stage renal disease (ESRD), ED is an important problem that impairs quality of life. The incidence of ED may increase up to 84%, especially in ESRD patients receiving hemodialysis. Our aim is to determine the effect of renal transplantation on erectile functions in ESRD patients and patient-related factors affecting this change. METHODS: Data of patients with ESRD who had a renal transplant at our center from January 2015 to August 2020 were reviewed retrospectively. All male patients who had a kidney transplant for any reason and whose data were not missing were included. The patients were screened for erectile functions before kidney transplantation and at the 1st, 3rd and 12th months after transplantation. The International Index of Erectile Function (IIEF-5) evaluation questionnaire was used as a measure of erectile functions. The total scores were calculated, with normal erectile function defined as a score of 22 to 25; cases of ED were classified as mild (12–21), moderate (8–11), or severe (5–7). RESULTS: The mean age of 55 patients included in the study was 39.7±10.9 years. Mild ED was detected in 21 patients (38.2%), moderate ED in 19 patients (34.5%), and severe ED in 10 patients (18.2%). Preoperative mean IEFF-5 score was calculated as 13.8±5.5, 14.3±5.7 at 1st month, 16.9±6.8 at 3rd months, and 18.4±6.9 at 12th months. In the evaluation of erectile function, no significant improvement was observed in erectile functions at post-transplant 1st month (p>0.05), while significant improvements were noted at postoperative 3rd and 12th months (p=0.03, p=0.02, respectively). When the change in IEFF-5 score was evaluated between 3rd and 12th months, there was a statistically significant difference (p=0.04). Age, diabetes, hypertension, coronary artery disease, transplantation time and preoperative IEFF-5 score were found to be significantly associated with postoperative IEFF-5 score changes at the 3rd and 12th months. (p<0.05). CONCLUSIONS: Our data show that kidney transplantation improves erectile function in ESRD patients. Age, diabetes, hypertension, coronary artery disease, transplantation time and pre-transplant erectile function status were found to be significantly associated with postoperative erectile function changes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e602 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Serdar Karadag More articles by this author Expand All Advertisement PDF DownloadLoading ...

Use of SD-OCT to quantitatively evaluate peripheral congestion in diastolic dysfunction with a role model in hemodialysis patients with end-stage renal disease.

Background: There is no practical quantitative tool to assess peripheral congestion in patients with congestive heart failure. In this study, we aimed to evaluate peripheral congestion by measuring the choroidal thickness with SD-OCT in patients with end-stage renal disease (ESRD). In addition, volume management by hemodialysis (HD) is often difficult in patients with ESRD. Volume overload or hypovolemia may increase morbidity and mortality in long-term HD patients. Therefore, it is important to determine the ideal ultrafiltration rate (UFR) for each patient. Also, we aimed to find data to help determine the ideal UFR. Material and methods: Fifty HD patients with ESRD were divided into 3 groups according to diastolic functions. Patients with mild diastolic dysfunction were enrolled in Group1, those with moderate diastolic dysfunction were enrolled in Group 2, and those with severe diastolic dysfunction were enrolled in Group 3. The choroid was used to evaluate peripheral congestion, and choroidal thickness (CT) was measured by optical coherence tomography (OCT) before and after HD. Results: The average CT before HD in Group 3 (259.3 ± 7.5 μm ) was significantly higher than in Group 1 (249.6 ± 9.4 μm) (p = 0.015). The average CT after HD in Group 3 (224.1 ± 5.2 μm ) was significantly higher than in Group 1 (232.4 ± 9.3 μm) (p = 0.033). The mean of DCT was significantly higher in Group 3 than in Group 1 (p &lt; 0.001). Conclusion: DCT was correlated with diastolic function in ESRD patients undergoing HD, and further evaluation of diastolic function before HD may play a role in finding the ideal UFR.

Quality and quantity culture effectively restores functional and proliferative capacities of endothelial progenitor cell in end-stage renal disease patients

BackgroundEndothelial cell dysfunction plays the crucial role in initiation and propagation of obstructive arteriosclerosis which ultimately causes arterial obstructive syndrome. Additionally, severe endothelial progenitor cells (EPC) dysfunction is always found in those of end-stage renal disease (ESRD) patients. This study tested the hypothesis that a novel method, named “quality and quantity (QQ) culture”, could successfully improve the EPC proliferation and function in ESRD patients. Materials and methodsPeripheral blood mononuclear cells (PBMNCs) were isolated from age-matched control subjects (i.e., normal renal function) (group 1) and ESRD patients (group 2), followed by culture in either conventional EPC culture for one month or in QQ culture for 7 days, respectively. The result showed that as compared to the conventional EPC culture method, the EPC population and M2-like population/ratio (M2/M1) were significantly enriched in QQ culture both in groups 1 and 2 (all p < 0.001), but these parameters did not differ between the groups. As compared with conventional EPC culture, the angiogenesis capacity and colony formation were significantly increased in QQ culture (all p < 0.001), but they showed no difference between groups 1 and 2. In RAW264.7 macrophages treated by liposaccharide, the gene expressions and ELISA findings of pro-inflammatory cytokines (IL-1β/IL-6/TGF-β) and inflammatory mediator (iNOS) were significantly reduced in QQ culture than in conventional EPC culture in groups 1 and 2 (all p < 0.001), but they showed no difference between the groups. ConclusionsThis study demonstrated that QQ culture enhanced number, proliferation, and angiogenesis of EPCs and anti-inflammatory capacity in ESRD patients.

Structural and Functional Brain Changes in Hemodialysis Patients with End-Stage Renal Disease: DTI Analysis Results and ALFF Analysis Results.

IntroductionThe current study aimed to depict intrinsic structural changes and the spontaneous brain activity patterns in voxel level in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) by using diffusion-tensor imaging and resting-state functional magnetic resonance (MR) imaging with an amplitude of low-frequency fluctuations (ALFF) algorithm and their clinical relevance.Materials and MethodsIn the study, the diffusion-tensor imaging and resting-state functional MR imaging were performed in forty-two hemodialysis patients with ESRD and 42 healthy control subjects. Neuropsychological and laboratory tests were performed in all subjects. ALFF, fraction anisotropy (FA), and mean diffusivity (MD) values were compared between the two groups. Correlations between ALFF, FA or MD values, and clinical markers were analyzed.ResultsWe found that ESRD patients exhibited significantly lower ALFF values in multiple areas, including medial frontal gyrus, limbic lobe, superior frontal gyrus, bilateral lingual gyri, occipital lobe, parahippocampal gyrus, precuneus, while increased ALFF values in medial frontal gyrus than healthy controls. FA values were decreased in medial frontal gyrus, parietal lobe, and left precuneus regions in the ESRD group compared with controls. Importantly, FA for the frontal and parietal lobes was negatively associated with the dialysis duration of ESRD patients, ALFF z-scores for the medial prefrontal cortex (MPFC) were positively correlated with the dialysis duration of ESRD patients and Serum calcium of ESRD patients negatively correlated with FA values in the frontal and parietal lobes (p<0.05).ConclusionOur study revealed that both impaired brain structure and function in ESRD patients with routine hemodialysis distributed mainly in the parietal, temporal, and frontal lobes. ESRD patients have cognitive impairment and declined memory ability. Serum calcium and dialysis duration might be associated with the impairment of brain structure and function in patients with ESRD.

Impact of parathyroidectomy on left ventricular function in end stage renal disease patients

BackgroundSecondary hyperparathyroidism (SHPT) is a common complication in end-stage renal disease (ESRD) patients, and parathyroidectomy (PTX) is an effective treatment intervention of SHPT. However, the curative impact of PTX on left ventricular function still remains incompletely understood. To evaluate the impact of parathyroidectomy on left ventricular function in ESRD patients, we conducted this retrospective study.MethodsBetween Oct 1, 2010 and Oct 1, 2016, ESRD patients presented with SHPT who underwent parathyroidectomy were enrolled. We retrospectively collected the ultrasonic cardiogram parameter pre- and 1-year post-PTX, and analyzed the influence factor for the overturn of left ventricular hypertrophy (LVH) and the improvement of ejection fraction% (EF%).ResultsIn all the patients (135), the main ultrasonic cardiogram parameter dramatically improved after PTX. Compared with pre-PTX, the left ventricular mass (LVM) (172.82 (135.90, 212.91) g vs. 192.76 (157.56, 237.97) g, p<0.001) and the left ventricular mass index (LVMI) (107.01 (86.79, 128.42) g/m2 vs. 123.54 (105.49, 146.64) g/m2, p<0.001) significantly declined after 1 year of the PTX. Further, 43.75% patients diagnosed with LVH before the PTX have recovered from LVH. In the subgroup analysis of 35 patients with EF% ≤ 60% pre-PTX, EF% and fractional shortening% (FS%) significantly improved after 1 year of the PTX compared with pre-PTX (EF%: 64.90 ± 7.90% vs. 55.71 ± 4.78%, p<0.001; FS% 35.48 ± 6.34% vs. 29.54 ± 2.88%, p<0.001), and 82.86% patients underwent an improvement of left ventricular systolic function post 1year of the PTX.ConclusionstPTX+AT is an effective curative intervention of secondary hyperparathyroidism and can significantly overturn the LVH and increase the left ventricular systolic function.

The relationship between abnormal cortical activity in the anterior cingulate gyrus and cognitive dysfunction in patients with end- stage renal disease: a fMRI study on the amplitude of low- frequency fluctuations.

End-stage renal disease (ESRD) patients often have cognitive dysfunction. The abnormal changes in the brains of ESRD patients are difficult to detect with routine imaging examination. Cognitive performance scales are also not an ideal tool because assessments using these scales can be subjective and might be difficult to administer in some ESRD patients. Functional magnetic resonance has the advantages of non-radiation, multidirectional imaging, good repeatability. Using resting-state functional magnetic resonance imaging (rs-fMRI) and an amplitude of low-frequency fluctuation (ALFF) algorithm, this study characterized spontaneous brain activity and explored its relationship with cognitive function in ESRD patients. The aim of this study was to provide objective functional imaging evidence to reveal the pathophysiological mechanism of cognitive dysfunction in ESRD patients. This study recruited 35 ESRD patients and 25 healthy controls (HC) who were matched to the ESRD group by age, sex, and years of education. All study subjects were examined by Montreal Cognitive Assessment (MoCA) and rs-fMRI. Data Processing & Analysis of Brain Imaging (DPABI) V4.3 software was used to preprocess the data to obtain ALFF maps. The ALFF value of the cingulate gyrus was compared between the ESRD and HC groups. Subsequently, the correlation between the ALFF value of the cingulate gyrus and the MoCA score was analyzed in ESRD patients. Compared with the HC group, the ESRD group had a significantly lower MoCA score (P<0.05). The ALFF values of the anterior and middle cingulate gyri were significantly lower in the ESRD patients (Gaussian random field (GRF) corrected, voxel-level significance: P<0.001, cluster-level significance: P<0.05). No increased ALFF was observed in any brain regions. The ALFF values of the bilateral anterior cingulate gyri were positively correlated with the MoCA scores (r=0.768, 0.625, GRF corrected, voxel-level significance: P<0.01, cluster-level significance: P<0.05). Patients with ESRD showed impaired spontaneous brain activity in the bilateral anterior and middle cingulate gyri, suggesting that ALFF of the anterior cingulate gyrus may be an imaging indicator of cognitive dysfunction in ESRD patients.

Effect of Ultrafiltration on Sleep Apnea and Cardiac Function in End-Stage Renal Disease

Rationale: End-stage renal disease (ESRD) patients have high annual mortality mainly due to cardiovascular causes. The acute effects of obstructive and central sleep apnea on cardiac function in ESRD patients have not been determined. We therefore tested, in patients with ESRD, the hypotheses that (1) sleep apnea induces deterioration in cardiac function overnight and (2) attenuation of sleep apnea severity by ultrafiltration (UF) attenuates this deterioration. Methods: At baseline, ESRD patients, on conventional hemodialysis, with left ventricular ejection fraction (LVEF) >45% had polysomnography (PSG) performed on a non-dialysis day to determine the apnea-hypopnea index (AHI). Echocardiography was performed at the bedside, before and after sleep. Isovolumetric contraction time divided by left ventricular ejection time (IVCT/ET) and isovolumetric relaxation time divided by ET (IVRT/ET) were measured by tissue doppler imaging. The myocardial performance index (MPI), a composite of systolic and diastolic function was also calculated. One week later, subjects with sleep apnea (AHI ≥15) had fluid removed by UF, followed by repeat PSG and echocardiography. ­Results: Fifteen subjects had baseline measurements, of which 7 had an AHI <15 (no–sleep-apnea group) and 8 had an AHI ≥15 (sleep-apnea group). At baseline, there was no overnight change in the LVEF in either the no-sleep-apnea group or the sleep-apnea group. In the no-sleep-apnea group, there was also no overnight change in MPI, IVCT/ET and IVRT/ET. However, in the sleep-apnea group there were overnight increases in MPI, IVCT/ET and IVRT/ET (p = 0.008, 0.007 and 0.031, respectively), indicating deterioration in systolic and diastolic function. Following fluid removal by UF in the sleep-apnea group, the AHI decreased by 48.7% (p = 0.012) and overnight increases in MPI, IVCT/ET and IVRT/ET observed at baseline were abolished. Conclusions: In ESRD, cardiac function deteriorates overnight in those with sleep apnea, but not in those without sleep apnea. This overnight deterioration in the sleep-apnea group may be at least partially due to sleep apnea, since attenuation of sleep apnea by UF was accompanied by elimination of this deleterious overnight effect.

Comparative Study Between Hemodialysis and Hemodiafiltration Regarding Effect on Cognitive Function

Objective: Cognitive impairment (CI) is very common in chronic kidney disease (CKD) and is strongly associated with increased mortality. Hemodiafiltration (HDF) is a dialysis modality that is thought to offer better clearance of middle molecules, more stability of intradialytic blood pressure and better cognitive state of end stage renal disease (ESRD) patients. So, we aim to compare cognitive function in hemodialysis (HD) versus HDF patients.Materials and Methods: In a cross sectional study, 100 patients were divided as: 50 patients maintained on HD 3 regular sessions per week, 50 patients maintained on 3 regular sessions of HDF per week. Patients with dementia or delirium, Patients with psychosis or bipolar disorder, Patients who are under the influence of a substance or alcohol, Patients with previous history of cerebrovascular stroke were excluded. History including demographic data, etiology of ESRD and comorbidities was taken. Cognitive assessment was done using Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). Blood samples were taken to measure kidney function tests, metabolic profile, complete blood count, thyroid and parathyroid function tests.Results: Cognitive assessment using MoCA showed that in HD group: 12 patients were found to have CI and 38 patients were normal, while in HDF group only 4 patients were found to have CI and the other 46 patients had normal cognitive function.Conclusions: Our study shows that the MoCA test is a valid screening test for CI in both HD patients and HDF patients. It demonstrated higher sensitivity for screening patients with mild CI than MMSE. CI is often under-diagnosed due to the patients’ unawareness of their cognitive deficits. Therefore, screening tests would be more appropriate for these patients. The MoCA test which is sensitive to executive dysfunction seems to be more adaptable to assess CI in both groups of this study; HD patients and HDF patients; HDF is a modality of dialysis with better outcome regarding cognitive function in ESRD patients.

Mucosal-Associated Invariant T Cells Are Depleted and Exhibit Altered Chemokine Receptor Expression and Elevated Granulocyte Macrophage-Colony Stimulating Factor Production During End-Stage Renal Disease.

End-stage renal disease (ESRD) is associated with an increased susceptibility to infectious diseases, including infection with Mycobacterium tuberculosis (Mtb). Mucosal-associated invariant T (MAIT) cells recognize vitamin B metabolites produced by many bacterial species, including Mtb, and may play an important role in providing protective immunity against tuberculosis infection in the lung. To date, little is known about MAIT cell frequency, phenotype, or function in ESRD patients. MAIT cells, identified by surface marker expression or MR1 tetramer binding, were characterized in 20 ESRD and 20 healthy control participants by multicolor flow cytometry. Ex vivo MAIT cell phenotype and cytokine production following PMA/ionomycin, IL-12/IL-18, or Escherichia coli stimulation were determined. Monocyte phenotype and plasma C-reactive protein/inflammatory cytokine levels were quantified by flow cytometry, ELISA, and multiplex bead array. Peripheral blood MAIT cells were significantly depleted among ESRD patients compared to controls by both phenotypic and tetramer analysis and exhibited a loss of CXCR3 expression coupled to increased expression of CCR6 and CXCR6. ESRD was also associated with a shift in MAIT PMA-induced cytokine production away from IFNγ production and toward granulocyte macrophage-colony stimulating factor (GM-CSF) secretion, and a loss of E. coli-stimulated tumor necrosis factor α expression. Loss of IFNγ expression was associated with a combination of age, alterations in Tbet and Eomes expression, and inflammatory plasma cytokine levels. The loss of peripheral blood MAIT cells and associated shifts in tissue homing receptor expression and GM-CSF production may contribute to an immune environment that is permissive to bacterial replication, particularly in the lungs.

Reduced White Matter Integrity With Cognitive Impairments in End Stage Renal Disease.

Background: End-stage renal disease (ESRD) is a serious public health problem, which can often lead to multiorgan dysfunction, such as cerebrovascular disease and cognitive damage. It is essential to understand cognitive impairment in patients with ESRD to develop better ESRD treatment and prevent further cognitive impairment. Cognitive impairment is believed to be related to structural abnormalities in the brain.Purpose: To investigate white matter microstructural abnormalities in patients with ESRD using TBSS analysis of DTI and to explore the possible mechanisms underlying the impaired cognitive function.Materials and Methods: A TBSS analysis of DTI data was to investigate the microstructural changes in their WM over the whole brain. We chose the white matter tracts or regions with significantly reduced FA as the regions of interest (ROIs), Pearson's correlations were performed between clinical indicators (Mini-Mental State Examination (MMSE), digit span task scores, serum creatinine, blood urea nitrogen and hemodialysis duration) and the mean FA value of the ROIs in the ESRD patients.Results: Lower FA and higher MD, AD and RD values were observed in widespread and symmetrical WM in ESRD patients than healthy controls (HCs), Pearson correlation analysis revealed a significantly positive correlation between the Mini-Mental State Examination (MMSE) scores and FA values in the right corona radiata and left anterior thalamic radiation (ATR) and demonstrated a significantly negative correlation between FA values and the serum creatinine and blood urea nitrogen in the ATR (P < 0.01) in addition, digit span task scores positively correlate with the FA value in the left anterior rather than in the corona radiata. No cluster survived when we adopted the False Discovery Rate (FDR) correction to multiple comparisons.Conclusion: Our study indicate widespread impairment of the white matter in ESRD patients. Damage to the thalamic radiation and corona radiata may affect cognitive function in ESRD patients, the reduced integrity of ATR may tend to affect the working memory while the damage to the corona radiata may involve the executive function impaired in ESRD patients. The accumulation of serum creatinine and blood urea nitrogen may contribute to the WM impairment.

The impact of hemodialysis on cognitive dysfunction in patients with end-stage renal disease: a resting-state functional MRI study.

To investigate the effect of hemodialysis (HD) on cognitive dysfunction in patients with end-stage renal disease (ESRD) using resting-state functional MR imaging (rs-fMRI) with regional homogeneity (ReHo) and functional connectivity algorithms. The rs-fMRI data were acquired in 58 ESRD patients (HD patients, n = 32, 22 male and 10 female, mean age 36.5 ± 9.6years; non-HD ESRD patients, n = 26, 16 male and 10 female, mean years of 35.6 ± 8.2) and 32 healthy controls (22 male and 10 female, mean years of 32.7 ± 8.8). A battery of neuropsychological and blood laboratory tests were prescribed. The Kendall's coefficient of concordance (KCC) was used to measure ReHo for each subject. The ReHo maps were compared by using ANOVA tests among HD, non-HD, and healthy control groups. Regions showing ReHo differences between HD and non-HD patients were defined as seeds for further functional connectivity analysis. A multiple regression analysis was performed to evaluate the relationships between ReHo index and neuropsychological tests, serum creatinine and urea levels, disease and dialysis duration. Compared with healthy controls, both HD patients and non-HD patients showed decreased ReHo in the multiple areas of bilateral frontal, parietal and temporal lobes. Compared with the non-HD, HD patients showed decreased ReHo mainly in default mode network (DMN) including bilateral precuneus, posterior cingulate cortex, inferior parietal lobe, right postcentral gyrus, bilateral superior temporal gyri, right supramarginal gyrus and right angular gyrus. Some reduced ReHo brain regions correlated with some neuropsychological tests, serum creatinine and urea levels, and dialysis duration. Brain regions with ReHo reduction showed increased region-to-region functional network in HD patients compared with non-HD patients. Widespreadly decreased ReHo values were found in both HD and non-HD patients. Lower ReHo values mainly in the DMN correlated with cognition impairments were observed in HD patients compared with non-HD patients, while increased functional connectivity was found between these brain regions. HD might have an adverse effect on the cognitive function in ESRD patients.

Quadriceps tendon rupture in maintenance haemodialysis patients: Results of surgical treatment and analysis of risk factors

BackgroundReports of spontaneous quadriceps ruptures in end-stage renal disease (ESRD) patients are scarce, and the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies. The purpose of the present study is to report a series of patients on haemodialysis with spontaneous quadriceps tendon ruptures operated at our institution. The results of the surgical treatment are described and the potential risk factors associated with the rupture are analyzed. MethodsOur study consisted of retrospective analysis of patient's charts. Clinical and laboratory findings of the operated group were compared to the ones of a control group of haemodialysis patients matched by age, gender, and time on haemodialysis, but without tendon rupture. ResultsBetween 1998 and 2010, six ESRD patients with 11 spontaneous ruptures of the quadriceps tendon were treated at our institution. On postoperative evaluation all patients were able to walk without crutches after six months of follow-up, and there were no new ruptures. Positive serology for Hepatitis C was present in two cases (33%) but in none of the controls (p=0.034). Mean serum levels of intact parathormone (iPTH) and alkaline phosphatase were both higher in cases (p=0.013 and p=0.034, respectively). In contrast, mean serum levels of albumin, ferritin and haemoglobin were all lower in cases (p=0.008, p=0.043 and p=0.016, respectively). ConclusionReconstructive surgery is a good way to restore knee function in ESRD patients with quadriceps tendon ruptures. Our cases exhibited higher levels of iPTH and alkaline phosphatase than control patients, reinforcing the role of secondary hyperparathyroidism in tendon weakening. They also had a higher frequency of hepatitis C and lower levels of albumin and haemoglobin compared to controls, possibly implicating chronic inflammation as a potential risk factor for tendon rupture.

Autonomic Function is Associated With Health-Related Quality of Life in Patients With End-Stage Renal Disease: A Case-Control Study

In the present study, we assessed the associations among fatigue, quality of life (QOL), clinical parameters, and body mass index (BMI) with autonomic function in end-stage renal disease (ESRD) patients undergoing hemodialysis as well as fatigue-free healthy subjects. This was a case-control study. This study compared autonomic function in ESRD patients (n = 192) to that of healthy subjects (n = 282) and evaluated its association with fatigue, QOL, and clinical parameters such as glucose, albumin, cholesterol, and BMI. Fatigue was evaluated by a recently established fatigue questionnaire and performance status, and QOL was evaluated with the kidney disease QOL questionnaire. With regards to autonomic function, spontaneous beat-to-beat variations were measured, according to time- (standard deviation of all normal a-wave intervals [CVa-a%]) and frequency domains (low frequency [LF] power, high frequency [HF] power, and LF/HF ratio) with acceleration plethysmography. CVa-a%, LF power, HF power, and LF/HF ratio were significantly lower in ESRD patients than healthy subjects. There were significant inverse correlations between these factors and age in healthy subjects, but not in ESRD patients. Although the fatigue score was not associated with any autonomic parameters, ESRD patients with impaired performance status exhibited a significantly lower LF/HF ratio. Moreover, in ESRD patients, the LF/HF ratio was significantly and positively associated with several components of QOL, including physical functioning and role emotional, independent of other clinical parameters and BMI. Impaired autonomic function is significantly associated with fatigue and impaired QOL in dialysis patients.

Ventricular Torsion: Research Tool or Novel Clinical Indicator?

Ventricular Torsion: Research Tool or Novel Clinical Indicator?

Altered relative concentrations of high-energy phosphates in patients with uraemic cardiomyopathy measured by magnetic resonance spectroscopy

Premature sudden cardiovascular death is the commonest cause of death in end-stage renal disease (ESRD) patients and is associated with uraemic cardiomyopathy [left ventricular hypertrophy (LVH), systolic dysfunction (LVSD) or LV dilation]. High-energy phosphates (HEP), quantified using phosphorus-31 magnetic resonance spectroscopy, are reduced in patients with diabetes, heart failure and uraemia. Phosphocreatine:β adenosine triphosphate (PCr:ATP) ratio is an index of metabolic activity. We compared resting HEPs in ESRD patients and hypertensive patients (with and without LVH) who had normal renal function (LVH-only or normal myocardia). We also assessed associations of HEP levels with abnormalities of uraemic cardiomyopathy. Fifty-three ESRD and 30 hypertensive patients (18 with LVH, 12 with normal myocardia) underwent phosphorus magnetic resonance spectroscopy of their left ventricle. PCr:ATP ratios were calculated from (31)P-MR spectra obtained from long-axis views of the left ventricle. There were no significant differences in age, LV mass, chamber sizes and ejection fraction between patient groups. PCr:ATP was significantly lower in ESRD patients compared to hypertensive patients, irrespective of the presence or absence of LVH (P = 0.01). In the ESRD group, PCr:ATP was significantly lower in patients with LVSD (P = 0.05) and LV dilation (P = 0.01). LVH was not associated with significant difference in PCr:ATP. ESRD patients have lower HEP levels compared to hypertensive patients. Lower PCr:ATP ratio, indicating altered myocardial metabolic function in ESRD patients, is associated with features of uraemic cardiomyopathy.

Effect of Hemodialysis on Cognitive Function in ESRD Patients

Background. Uremia is associated with impairment of different cognitive functions. However the pathogenesis of this cognitive dysfunction is unknown. Objective. In this study, long-latency event related potentials (ERPs) were used to assess changes in cortical function due to hemodialysis treatment. Methods. In this cross-sectional study, we measured event related potentials in 15 end stage renal disease (ESRD) patients maintained on hemodialysis, two hours before and two hours after they underwent hemodialysis and compared their data with a strictly age and sex matched healthy control group. The P3 was elicited by using standard auditory “odd-ball” paradigm and the data obtained was statistically analyzed (Wilcoxon signed ranks, Mann Whitney). Results. Before hemodialysis, the patients' P3 latency (347.73 ± 39.47 ms) was significantly increased as compared with that of healthy control group (308.4 ± 13.73 ms) (p = 0.001). After hemodialysis, P3 latency of the patients showed a significant decrease (347.73 ± 39.47 ms to 325.20 ± 37.15 ms, p = 0.001). P3 latency after dialysis was not significantly different from controls. No significant correlation was noted between various biochemical parameters (hemoglobin, blood urea, creatinine, uric acid and calcium) and P3 latency or amplitude. Conclusions. Removal of uremic toxins by hemodialysis leads to an improvement in cognitive processing.

Effect of Preload Reduction by Hemodialysis on Myocardial Ultrasonic Characterization, Left Atrial Volume, and Doppler Tissue Imaging in Patients with End-stage Renal Disease

The purpose of this study was to investigate the effect of hemodialysis (HD) on myocardial cyclic variation of integrated backscatter (CVIBS), left atrium (LA) volume and tissue Doppler imaging (TDI) in end-stage renal disease (ESRD) patients. We examined 25 patients with ESRD undergoing routine HD and 19 age-matched healthy volunteers. CVIBS, LA volume and left ventricular echocardiographic parameters were measured before and after HD in ESRD patients. CVIBS of both the intervetricular septum and posterior wall were significantly diminished after HD (8.2 +/- 2.5 dB vs. 6.5 +/- 1.8 dB, P < 0.001; 9.2 +/- 2.6 dB vs. 7.6 +/- 2.2dB, p < 0.05 respectively). LA volume decreased significantly after HD (P < 0.05). There was no change in the mitral annulus early diastolic velocity (Em) estimated by TDI. The results of our study demonstrate that HD leads to decrease of CVIBS in ESRD patients and that early mitral annulus velocity (Em) could be preload independent marker of left ventricular diastolic function in ESRD patients.

Abstract 585: Activated Vitamin D Attenuates Left Ventricular Hypertrophy and Dysfunction in DAHL Salt-Sensitive Rats

Introduction: Cardiovascular disease is the leading cause of death among end-stage renal disease (ESRD) patients. Paricalcitrol (PC), an activated vitamin D analog, is associated with improved survival in patients with ESRD. The mechanism of improved mortality, however, is unclear. We hypothesized that administration of PC would attenuate the development of cardiac dysfunction in Dahl salt sensitive (DSS) rats following a high salt (HS) diet, and improve cardiac structure and function in ESRD patients. Methods: Male DSS rats were fed a HS diet (6% NaCl) for 6 weeks beginning at 6 wk of age. PC was administered IP at 200 ng 3x/wk. Animals were evaluated for cardiac function, hemodynamics, mRNA expression of ANF, and plasma BNP levels. Also, a cohort of 77 ESRD patients treated with PC and followed for one year was examined for cardiac function by echocardiogram. Results: Rats on HS + PC compared with HS + vehicle developed significant decrease in heart weight/body weight (HW/BW) ratio (29%, p&lt;0.05) and lung weight/body weight (LW/BW) ratio (27 %, p&lt;0.05). Echocardiogram analysis revealed that PC treatment lead to significant improvement of fractional shortening compared with HS + vehicle treated animals (52.9±1.0 % vs. 45.7±1.6 %, p&lt;0.05). Furthermore, LV pressure measurement showed that PC treatment resulted in significant improvement of LV end diastolic pressure (46%, p&lt;0.05). In addition, significant increase in plasma BNP level was attenuated by PC treatment (67% reduction, p&lt;0.05). PC treatment also significantly attenuated HS diet induced ANF mRNA increase. PC, however, did not have significant change in mean arterial pressure suggesting that beneficial effect seen by PC is not due to lowering of hypertension. In humans, twelve month echo changes in ESRD patients demonstrated that an improvement in E/A ratio and ejection fraction was associated with increasing dose of PC (p&lt;0.05). Conclusion: Administration of PC 3x/week attenuated the development of LVH and LV dysfunction in high salt-induced cardiac hypertrophy and cardiac dysfunction in DSS rats. This finding may also be present in ESRD patients, but these findings remain observational and require confirmation.

CHAPTER 5

CHAPTER 5