Hemodialyzed Research Articles

Adrenergic activity in normotensive (N) and hypotensive (H) haemodialysed (HD) patients

Adrenergic activity in normotensive (N) and hypotensive (H) haemodialysed (HD) patients

Serum paraoxonase activity is decreased in uremic patients

Paraoxonase is a high-density lipoprotein (HDL)-associated enzyme capable of hydrolysing lipid peroxides. We measured the activity of serum paraoxonase together with serum concentrations of a variety of lipid constituents — total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL), cholesterol, triglycerides, apolipoproteins A-I and B — in 60 hemodialyzed (HD) patients. We found that the paraoxonase activity was significantly reduced in HD patients compared with 64 healthy controls (mean median and interquartile values: 93, 63, 87 IU/l in HD patients and 151, 120 and 135 IU/l in controls). In patients, the trimodal frequency of distribution of paraoxonase activity showed a shift toward lower levels. The effect of NaCl on enzyme activation was more pronounced in the patient group, as compared with controls, suggesting a higher frequency of the B allozyme (more responsive to NaCl) in this population. We suggest that altered HDL subfraction, present in HD patients, may be the main cause of the widespread depression of paraoxonase. Furthermore, the higher frequency of allozyme B among HD patients might increase the risk of coronary artery disease. In conclusion, paraoxonase activity may be an adjunctive index of altered lipoprotein metabolism with important repercussions on atherosclerosis.

Chronic HCV infection in HD (hemodialysed) candidates to KT (kidney transplant). Influence of HCV genotypes on response to IFN (interferon): [formula omitted]. Liver Transplant and Kidney Transplant Units, Hospital of Beltvitge, Barcelona (SPAIN)

Chronic HCV infection in HD (hemodialysed) candidates to KT (kidney transplant). Influence of HCV genotypes on response to IFN (interferon): [formula omitted]. Liver Transplant and Kidney Transplant Units, Hospital of Beltvitge, Barcelona (SPAIN)

The impact of long-term hemodialysis on pituitary-adrenocortical function.

The activity of the hypothalamic-pituitary-adrenal axis in hemodialyzed (HD) patients has been investigated, with conflicting results. Different results are reported concerning both basal ACTH and cortisol concentration and the responses to different stimulating agents, in chronic hemodialyzed patients. The present study was performed in order to asses whether the length of the hemodialytic treatment may affect the pituitary and adrenocortical response to stimulation with ovine CRH (oCRH) and with exogenous ACTH in a group of patients on chronic HD for more than 10 years. Ten uremic patients (aged 38-71, 6 males and 4 females) on chronic hemodialysis for at least 10 years and 7 healthy subjects matched for age and sex were studied. The patients were tested on the day preceding dialysis session. Each subject received on different non-consecutive days oCRH (100 micrograms i.v. in bolus) and ACTH (Synacthen 0.25 mg i.v. in bolus), and blood samples were obtained at appropriate intervals. Basal ACTH and cortisol levels of HD patients were in the upper limit of normal range (ACTH 39.21 +/- 11.11 pg/mL in HD patients vs. 26.88 +/- 14.12 pg/mL in controls; cortisol 19.96 +/- 5.07 in HD patients vs. 12.66 +/- 4.44 in controls); however, the means were not significantly different compared with controls. Following oCRH administration a net increase of ACTH and cortisol was observed in every patient tested (ACTH peak 83.81 +/- 28.49 in HD vs. 78.73 +/- 22.87 pg/mL in controls; cortisol peak 30.73 +/- 19.31 in HD vs. 20.05 +/- 3.19 micrograms/dL in controls).(ABSTRACT TRUNCATED AT 250 WORDS)

Calcitriol effect on natural killer cells from hemodialyzed and normal subjects

Patients with chronic renal failure have a decreased secretion of calcitriol (CTR). They also show an impaired cellular immune response including a defective natural killer (NK) cell-mediated activity. The aim of this study was to analyze, in vivo and in vitro, the effect of CTR on NK cell cytotoxicity in healthy control subjects and in hemodialyzed (HD) patients. Our results show that HD patients had baseline-depressed NK cell activity when compared with controls (P < 0.001), which increased significantly after 1 month of oral CTR treatment (0.5 microgram/day) (P < 0.001). Calcitriol treatment also induced a significant increase in CTR serum levels (P < 0.001) and a significant decrease (P < 0.001) in total parathyroid hormone (PTH). In vitro CTR treatment (10(-7) M) of peripheral blood mononuclear cells (PBMC) increased NK cell-mediated cytotoxicity after 24 hours of incubation with a maximum at 48 hours (P < 0.001). In vitro CTR treatment at doses of 10(-11) and 10(-9) M did not significantly increase NK cytotoxic activity. The enhanced NK activity after CTR treatment was not the consequence of increased numbers of CD56 positive cells, nor to lymphocyte activation, as tested by the expression of the interleukin 2 receptor p55 alpha chain (CD25) on their surface. In vitro treatment of PBMC from HD patients with CTR (10(-7) M, during 48 hours) also induced a strong increase in NK cell cytotoxicity (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibitory effect of cysteine and methionine on free radicals induced by mercury in red blood cells of patients undergoing haemodialysis

The inhibitory effects of cysteine and methionine on mercury-induced free radicals were studied in the red blood cells (RBC) of haemodialysed (HD) patients, using polyacrylonitrile membranes. RBC were taken from a control group of 10 healthy subjects and a group of 30 HD patients. The following were determined before and after HD: malonyldialdehyde (MDA), total glutathione (GST), reduced (GSH) and oxidized (GSSG) glutathione, and percentage haemolysis (before HD). RBC were incubated for 6 hr with mercury (Hg 2+; 10 −5 m), mercury and cysteine (0.001 m) and mercury and methionine (0.005 m). The percentage of mercury induced haemolysis differed between the control group and HD patients. The addition of cysteine and methionine to RBC has a markedly inhibitory effect on the mercury-induced haemolysis (a reduction from about 80 to 5% for cysteine and to 15% for methionine). MDA was increased in HD patients and increased further after HD. GST, GSH and GSSG were lower than normal in HD patients, both before and after HD. There was very little change in MDA concentration when the RBC were incubated with mercury for 6 hr.

Effect of aging on compressive strength of lumbar trabecular bone in hemodialyzed and non-hemodialyzed patients

In order to clarify the effect of aging and bone mineral content on the compressive strength of lumbar trabecular bone, the third lumbar vertebral body (L3) was analyzed by mechanical and chemical tests in hemodialyzed (HD) and non-hemodialyzed (non-HD) patients. L3 was removed from 40 non-HD patients and 10 HD patients at autopsy. Cylindrical trabecular bone samples from L3 were analyzed by compression test, relaxation test and Brinel's test. Bone mineral content was based on Ca, P and Mg measured after incineration of the samples. In non-HD patients, a significant age-related decrease was observed in both Brinel's hardness (HBS) (r = -0.470) and Young's modulus (Qo) (r = -0.527), and there was a significant increase in age and viscoelasticity (B) (r = 0.439). HBS and Qo in about 50 percent of HD patients were larger than those in non-HD patients. C-PTH in HD patients showed a significant positive correlation with HBS and with Qo. Bone Ca content of the 50-69-year-old non-HD patients was 81 percent of that in the patients in their 40s and the content in the patients aged over 70 years was 55.5 percent of that in the patients in their 40s. In non-HD patients, the P/Ca and Mg/Ca weight ratios of bone were nearly constant regardless of age or sex. However, bone P/Ca and Mg/Ca weight ratios were relatively large in 80 percent of the HD patients. Bone Ca content exhibited a significant positive correlation with HBS (r = 0.399) and with bone mineral density measured by quantitative computed tomography (QCT) (r = 0.819). In conclusion, it was indicated that bone mineral content and compressive strength of trabecular bone decreased with aging, and that biomechanical competence in HD patients was much more prominent along with elevated C-PTH.

Functional study of hands among patients dialysed for more than 10 years

Sixty-six haemodialysed (HD) in centre patients (24 h/m2/week, acetate bath, cuprophane membrane), with a mean age of 59.2 years, treated for 16.7 +/- 4.5 years, underwent clinical examination of their hands to determine anatomical and functional alterations. For each hand a functional score was calculated from a medicolegal technique based on sensitivity and angulation amplitude (rating from 0 to 100). Dialysis-related arthropathy (DRA), including carpal-tunnel (CT) syndrome, was scored as well as hand muscle amyotrophia. Trigger fingers, abnormal synovial hypertrophy, and one or more non-functional tendons were found in 15, 26, and 33% of the patients respectively. Thirteen percent had pseudoporphyria. Amyotrophy was moderate or severe in 39%. The global functional score (mean of the two unilateral functional scores) decreased with time spent on haemodialysis and was correlated with the DRA score. The unilateral functional score was linked to tendinous lesions, amyotrophy, and presence of pulses, but not to CT surgery or presence of AV fistula. Hands with ulnar insult at the elbow shown by electromyography had significantly lower functional scores. Repercussions of hand functional alteration may have an important social and psychological impact in daily life. The responsibility of amyloidosis is evidenced by tendinous lesions and nervous entrapment. Ulnar palsy is also important because of the vital motor role of that nerve in hand function.

Hormonal and ultrasound characteristics of menstrual function during chronic hemodialysis and after successful renal transplantation

The cycles of 11 renal transplant recipients (RTR), at least 24 months after stabilization of graft function and four hemodialyzed (HD) patients, menstruating regularly, were evaluated by concurrent and systematic determinations throughout the cycle of LH, FSH, estradiol, progesterone, testosterone, prolactin and SHBG and in the case of RTR also by ultrasound follow-up. Biphasic estradiol secretion, midcycle LH and FSH surge, duration of luteal phase, midluteal progesterone values and in the case of RTR, ultrasonic parameters were consistent with: (1) normal ovulatory cycles in five RTR; (2) ovulatory cycles with luteal phase deficiency in five RTR and two HD patients; (3) anovulatory cycles in one RTR and two HD patients. Thus, in HD patients only abnormal cycles of central etiology were found, while in RTR, luteal phase deficiency was a very common syndrome, in equal percentage with normal ovulatory cycles.

Soluble Interleukin-2 Receptors in Chronic Renal Failure

A depression of the general immune response in uremia is well documented, and hemodialyzed (HD) patients present deficient interleukin-2 (IL2) secretion. Since soluble IL2 receptors (SIL2R) could affect the immune response through interaction with circulating immune cells, we studied the potential relationship between SIL2R concentration and lymphocyte subsets in 44 HD patients. HD patients present lymphopenia, higher CD4/CD8 ratio. CD16 counts and SIL2R concentrations than controls. A significant negative correlation was found between SIL2R concentration and lymphocyte count (p less than 0.01), and between SIL2R concentration and T4/T8 ratio (p less than 0.01). An increase of SIL2R concentration due to abnormal T cell preactivation in HD patients with nonreused cuprophan membranes could perhaps contribute to cell immunity impairment through IL2 binding and inhibition of T cell activation.

Tumor Markers in Chronic Renal Failure and Hemodialysis Patients

Serum levels and the incidence of elevated levels of several tumor markers were measured in 30 patients with chronic renal failure (CRF) of different degrees, as well as in 36 hemodialyzed (HD) patients without clinical evidence of neoplasia. The tumor markers evaluated were carcinoembryonic antigen (CEA), CA 125, CA 15.3, CA 19.9, CA 50, alpha-fetoprotein, neuron-specific enolase (NSE), squamous cell carcinoma antigen (SCC), prostatic acid phosphatase and prostatic-specific antigen. Serum levels of CEA were above the cutoff limit in 33% of patients with CRF and 47% of HD patients, CA 50 was higher than normal values in 37 and 44% of patients, respectively. SCC was elevated in 43 and 72% of patients, respectively. Serum levels of CA 125 were elevated in 18% of patients with CRF and NSE in 36% of HD patients. In CRF several tumor markers (CEA, SCC, CA 50 and NSE) show a high false positive rate and may be unreliable for monitoring malignancies in uremic patients, while the other markers evaluated appear to maintain their specificity in this situation.

High in vitro spontaneous histamine release in long-term hemodialyzed patients

Adverse reactions, such as skin flush and pruritus, have been observed among hemodialyzed (HD) patients. A potential relationship between hemodialysis and allergic phenomena prompted us to investigate some allergologic parameters. Total IgE, specific IgE antiethylene oxide and anti-isocyanate toluene diisocyanate, and in vitro spontaneous histamine release (SHR) were measured in 105 long-term stable HD patients. Thirty-two of the patients had occasionally developed skin flush reactions and/or pruritus during dialysis sessions. Blood samples were taken at the start of dialysis, sera were kept frozen until assay, and in vitro SHR was performed on washed leukocytes at 37 °C for 40 minutes. A high (range, 20% to 80%) and reproducible in vitro SHR was observed among 24% of patients. No correlation was found between SHR and the type of dialysis membrane used (copolymer of acrylonitrile-methallyl-sodium sulfonate, cuprophan, and polysulfone). High SHR (i.e., >20%) was observed mainly among patients with detectable antiethylene oxide IgE antibodies ( p < 0.001). High levels of IgE (>300 ng/ml), specific IgE antibodies, and a high in vitro SHR were all observed concontitantly in 26% of the patients with skin flush reactions and/or pruritus, whereas all three of these parameters together were present in only 3% of the symptom-free patients. To our knowledge, this is the first time that a high in vitro SHR has been described among HD patients, and putative correlations with in vivo phenomena are discussed.

Does muscle carnitine (CAR) depletion exist in hemodialyzed (HD) children? : [formula omitted], L. Heukmann, M. Bulla, C. Puchstein, P. Fürst (Inst. Biol. Chem. & Nutr., Univ. Hohenheim; Dept. Ped. Nephrol., Univ. Münster; Marienhospital Herne, Univ. Bochum. FRG)

Does muscle carnitine (CAR) depletion exist in hemodialyzed (HD) children? : [formula omitted], L. Heukmann, M. Bulla, C. Puchstein, P. Fürst (Inst. Biol. Chem. & Nutr., Univ. Hohenheim; Dept. Ped. Nephrol., Univ. Münster; Marienhospital Herne, Univ. Bochum. FRG)

Perdialytic parenteral nutrition (PDPN) with lipids and amino acids (AA) in malnourished hemodialysed (HD) patients : [formula omitted], J. Labastie-Coeyrehourcq, P. Lacombe, J. di Costanzo-Dufetel, J.P. Durbec, C. Coudray-Lucas, O.G. Ekindjian. Clinique Résidence du Parc, Hôpital de la Timone, INSERM U31, Marseilles, CNRS UA 622, Chatenay, France

Perdialytic parenteral nutrition (PDPN) with lipids and amino acids (AA) in malnourished hemodialysed (HD) patients : [formula omitted], J. Labastie-Coeyrehourcq, P. Lacombe, J. di Costanzo-Dufetel, J.P. Durbec, C. Coudray-Lucas, O.G. Ekindjian. Clinique Résidence du Parc, Hôpital de la Timone, INSERM U31, Marseilles, CNRS UA 622, Chatenay, France

Pharmacokinitics and longterm low-dose supplementation on L-carnitine (CAR) in hemodialyzed (HD) children : [formula omitted], M. Bulla, P. Fürst. Inst. Biol. Chem. & Nutr., Univ. Hohenheim. Dept. Ped. Nephrol., Univ. Münster, FRG

Pharmacokinitics and longterm low-dose supplementation on L-carnitine (CAR) in hemodialyzed (HD) children : [formula omitted], M. Bulla, P. Fürst. Inst. Biol. Chem. & Nutr., Univ. Hohenheim. Dept. Ped. Nephrol., Univ. Münster, FRG

Ornithine alpha-ceto glutarate (OKG) in hemodialysed (HD) patients: Metabolism and nutritional effects : [formula omitted], C. Coudray-Lucas, L. Cynober, P. Lacombe, J. Labastie-Coeyrehourcq, J.P. Durbec, J. di Costanzo-Dufetel, J.P. Fernandez. Clinique Résidence du Parc, Hôpital de la Timone, INSERM U31, Marseilles, CNRS UA 622, Chatenay, France

Ornithine alpha-ceto glutarate (OKG) in hemodialysed (HD) patients: Metabolism and nutritional effects : [formula omitted], C. Coudray-Lucas, L. Cynober, P. Lacombe, J. Labastie-Coeyrehourcq, J.P. Durbec, J. di Costanzo-Dufetel, J.P. Fernandez. Clinique Résidence du Parc, Hôpital de la Timone, INSERM U31, Marseilles, CNRS UA 622, Chatenay, France

Hypochlorhydria and hypergastrinemia and their association with gastrointestinal bleeding in undialyzed and hemodialyzed patients.

In 15 undialyzed (UD) patients and 26 hemodialyzed (HD) patients, (1) basal and test meal-stimulated gastrin concentrations, (2) basal and pentagastrin-stimulated gastric acid outputs, and (3) endoscopic examinations were studied. Also studied were the morphological and functional differences of the gastrointestinal tract between UD and HD patients. HD patients had lower gastric acid outputs and higher circulating gastrin levels in the fasting state. After a test meal, the peak increment of serum gastrin in UD and HD patients occurred 30 and 60 min later, respectively, and the response was prolonged in each group. Endoscopic findings showed that the incidence of abnormalities in each group was very similar, that is, the most predominant lesions in each group were hemorrhagic and atrophic gastritis. The data suggested that the response to gastrin of parietal cell and the defensive mechanism of gastrointestinal mucosa in HD patients may be impaired.

The influence of malnutrition on the prognosis of hemodialyzed (HD) patients (PTS) : M.G.Chiappini, [formula omitted], G.Selvaggi, R.Bartoli. Dpt.of Internal Medicine-Dialysis Unit, Ospedale Fatebenefratelli, Isola Tiberina, Rome, Italy

The influence of malnutrition on the prognosis of hemodialyzed (HD) patients (PTS) : M.G.Chiappini, [formula omitted], G.Selvaggi, R.Bartoli. Dpt.of Internal Medicine-Dialysis Unit, Ospedale Fatebenefratelli, Isola Tiberina, Rome, Italy

1618 CELLULAR MALNUTRITION IN UREMIA

Some of the cellular abnormalities of severe protein-calorie malnutrition in children (PCM), e.g., reduced energy-related enzyme activities, energy and protein synthesis levels and intracellular amino acid deficits, are also thought to occur in chronic uremics. Improvement of these abnormal cell bioactivities, characterizing cellular malnutrition, should stabilize and possibly retard progressive cellular deterioration in uremics. We have used the circulating granulocyte as a cell model to study energy-related enzyme activities (pyruvate kinase (PK), phospho-fructokinase (PFK), adenylate kinase (AK), energy charge (Ech=ATP+0.5ADP/(ATP + ADP + AMP)), protein synthesis (3 H-leucine incorp.) and amino acid pools in 52 adult uremics (9 not dialyzed (ND), 40 hemodialyzed (HD) and 13 peritoneally dialyzed (CAPD)) and 61 normal control (C) subjects. Gross clinical estimators of chronic malnutrition (Wt/Ht ratio, skinfolds, arm muscle area, plasma albumin and total lymphocyte count) were within normal limits for the dialyzed uremics. In the ND uremics, all clinical and cell measures were abnormal. In the HD uremics, cell PK, AK, ATP, Ech and PS were significantly (p < .05) better than ND but less than C. A significant reduction in branched-chain amino acids (BCAA=valine, leucine, isoleucine) and methionine (MET) were noted in both ND and HD patients. In the CAPD patients, after 18 ±9 (SD) months of dialysis PK, PS, BCAAs and MET levels were normalized. Ech was 90% of normal and >HD, but ATP and AK were not improved. We conclude that cellular malnutrition occurs in apparently stabilized adult uremics without clinical signs of malnutrition. CAPD seems to improve many cell bioactivities, and therefore, cellular malnutrition in uremics.

IN VITRO CYTOTOXIC PROPERTIES OF PLASMA FROM UREMIC CHILDREN

This study was designed to compare the effects of control and uremic plasma on growth of cultured cells. Cell multiplication was measured by 3H-Thymidine incorporation during one population doubling time of mouse 3T3 fibroblasts. Uremic plasma were taken from severe uremic children (plasma creat. > 45 mM/1) and from hemodialysed (HD) patients: Plasma from HD patients were obtained at the beginning and end of a dialysis session. The 3H-Thymidine incorporation in the presence of uremic plasma was decreased (3520 ± 160 cpm, n = 13) as compared to the control incorporation (8500 ± 520 cpm, n = 14) (p < 0.01). Dose-response experiments showed a regular decrease in the rate of 3H-Thymidine incorporation in the presence of increasing amounts of uremic plasma. The comparison between the pre and post-dialysis incorporation values (3902 ± 664 cpm vs 9430 ± 1540 cpm, n = 8) showed an improvement in the 3H-Thymidine incorporation with postdialysis plasma (paired t test: p < 0.01). To obtain information on the properties of the cytotoxic material, incubations were made with ultrafiltrate (UF) of plasma and UF fractions obtained by G-15 Sephadex filtration. Uremic UF and fractions displayed no cytotoxic properties when added alone in the culture medium. The preincubation of uremic UF and fraction peak 7 (“middle molecules”) with control plasma restored a cytotoxic effect which was not different from that observed with uremic plasma. Conclusion: uremic plasma displays cytotoxic properties related to ultrafiltrable molecules which are no cytotoxic themselves but when mixed with plasma macromolecules.