System In Hemodialysis Patients Research Articles

Early Result of Arteriovenous Graft with Deep Forearm Veins as an Outflow in Hemodialysis Patients

The purpose of this study was to evaluate the result of arteriovenous (A-V) grafting with the deep forearm veins as an outflow system in hemodialysis patients. Between June 1999 and July 2001, 27 A-V grafts consisting of ePTFE and deep forearm veins were constructed in 26 patients. All patients followed up for assessment of all relevant values, and the median follow-up period was 17.3 months. Seven grafts (26%) failed during the follow-up. The patency rates were 93% and 80% at 3 months and 12 months, respectively. No difference in patency rate was found between males and females, or between diabetics and nondiabetics. Graft-related complications, excluding graft thrombosis, occurred in five patients. These included operative wound dehiscence in two cases, a graft infection, a seroma, and a mild hypoperfusion in the hand. We conclude that the early patency rate of A-V graft using the forearm deep veins as an outflow system is very good and that this technique may be a recommended surgical modality for vascular access in patients with exhausted superficial veins.

Serum Levels of Soluble CD26 and CD30 in Patients on Hemodialysis

Background/Aims: Various abnormalities of the immune system have been demonstrated in patients on hemodialysis (HD). We hypothesize that the imbalance between type 1 helper T (Th1) cells and type 2 helper T (Th2) cells in patients on HD contributes to these abnormalities. Furthermore, we investigate the relationship between the Th1/Th2 imbalance and HD duration. Methods: We measured the serum levels of soluble CD26 (sCD26) and soluble CD30 (sCD30) in 47 patients on HD and in 13 patients with chronic renal failure not on HD and analyzed the effect of HD duration on the serum levels of sCD26 and sCD30. Results: The serum level of sCD26 in the HD group was significantly lower than that in the control group. On the other hand, the serum levels of sCD30 in the HD group and in the CRF group were significantly higher than in the control group. In the short-term HD group (<1 year), the serum levels of sCD26 were lower and the sCD30 levels higher than those in middle-term HD group (1–10 years). Conclusions: In the HD group, the Th1/Th2 balance may shift towards Th2 dominance. It is possible that this imbalance contributes to the abnormality of the immune system in HD patients.

Muscle sympathetic nerve does not decrease early after renal transplantation

Uremia is proposed to cause tonic activation of the sympathetic nervous system in hemodialysis patients (HD) which may contribute to the high cardiovascular morbidity and mortality in this population. The effect of renal transplantation (RTX) with correction of uremia has not yet been investigated. Therefore, we compared muscle sympathetic nerve activity (MSNA) in HD wait-listed for RTX, in renal allograft recipients 3 months after transplantation treated with cyclosporine (RTX-CSA) or tacrolimus (RTX-FK) and in healthy volunteers (CTR) matched for age, sex, body mass index and time since onset of end-stage renal disease (RTX and HD). Exclusion criteria were diabetes mellitus and clinical evidence of atherosclerotic disease. We measured supine blood pressure (MAP, automatic sphygmomanometer), heart rate (HR, ECG), calf blood flow (plethysmography) and MSNA (microneurography) in the fasting state at least 12 hours after intake of any medication (HD and NTX) and calculated calf vascular resistance (CVR). (See Table) Data are mean ± SEM. p < 0.05 vs. CTR, p < 0.05 vs. HD(ANOVA, Fisher's PLSD). Data are mean ± SEM. p < 0.05 vs. CTR, p < 0.05 vs. HD(ANOVA, Fisher's PLSD). The results show increased muscle sympathetic nerve activity in both hemodialysis patients and renal allograft recipients as compared to healthy volunteers. Despite correction of uremia MSNA does not normalize in cyclosporine treated renal transplant patients early after transplantation.

Indices of activity of the nitric oxide system in hemodialysis patients

Arginine deficiency and/or increased levels of circulating nitric oxide (NO) synthesis (NOS) inhibitors can cause reduced NOS, which may contribute to hypertension in patients with end-stage renal disease (ESRD). To test these hypotheses, NO oxidation products (NO(2) + NO(3) = NO(x)) and cyclic guanosine monophosphate (cGMP), the vasodilatory second messenger of NO, were measured in the blood, urine, and dialysate effluent of hemodialysis (HD) patients and compared with the blood and urine of healthy subjects. The subjects ate a controlled low-nitrate diet (approximately 330 micromol/d) for 48 hours before and during blood, dialysis effluent, and 24-hour urine collection. NO(x) output was significantly reduced in HD patients versus controls (552 +/- 51 v 824 +/- 96 micromol/24 h; P < 0.001), whereas cGMP output was not low versus controls. Plasma arginine level was normal and plasma levels of citrulline and the endogenous NOS inhibitor, asymmetric dimethylarginine (ADMA), were markedly elevated in patients with ESRD versus controls. Systolic blood pressure was greater in HD patients compared with controls despite concurrent antihypertensive therapy in most patients with ESRD. These studies suggest NO production is low in patients with ESRD undergoing HD, possibly because of the increased ratio of plasma ADMA to arginine.

Peripheral hemodynamics, blood viscosity, and the renin-angiotensin system in hemodialysis patients under therapy with recombinant human erythropoietin.

Treatment of renal anemia with rhEPO (120 U/kg body weight/hemodialysis) in transfusion-dependent patients on maintenance hemodialysis led to an increase in blood pressure, regional peripheral resistance and whole blood viscosity. Our results are in agreement with earlier findings that partial correction of renal anemia results in hemodynamic changes characterized by a fall in cardiac output together with an increase in blood pressure due to increased vascular resistance. The increase in whole blood viscosity correlated with the increase in regional peripheral resistance but not with the increase in mean arterial blood pressure. Thus, other regulating factors of vascular resistance must be involved. Correction of renal anemia does not influence the reninangiotensin system. However, peripheral responsiveness of vascular smooth muscles may have changed due to improved tissue oxygenation and thus leading to an increase in vasoconstriction.

The significance of the HBeAg/anti-HBe system in hemodialysis patients. A multicenter study.

The HBeAg/anti-HBe system was studied as a marker of infectivity and chronic progressive liver disease in 460 hemodialysis patients. The importance of HBeAg as an index of infectivity was confirmed in that it was present simultaneously with specific DNA polymerase (31 patients) and by the presence of widely diffuse core particles in the hepatocyte nuclei (revealed by biopsy in six patients). In contrast, HBeAg showed no useful correlation with progressive liver disease, the absence of which was confirmed in all cases by biochemical and histological studies.

Nephrology: An Annotated Bibliography of Recent Literature

Nephrology: An Annotated Bibliography of Recent Literature

Abnormalities of the musculoskeletal system in hemodialysis patients

Osteoarticular disorders significantly limit the quality of long-term survival with chronic renal failure. β2M amyloidosis is a complication of chronic renal failure that has been recognized mostly in patients receiving long-term haemodialysis. Patients with β2M amyloidosis typically present with the triad of shoulder periarthritis, carpal tunnel syndrome, and flexor tenosynovitis of the hands. Other musculoskeletal manifestations of β2M amyloidosis include destructive spondyloarthropathy, cervico-occipital pseudotumours, bone cysts, and pathological fractures. At present, only renal transplantation may slow or halt the progession of β2M amyloidosis. Crystal-induced arthropathy, most commonly caused by basic calcium phosphate crystals, is an important cause of acute joint inflammation in the patient with renal failure. The incidence of bone and joint infection is increased in patients undergoing dialysis. Haemodialysis and peritoneal dialysis are also associated with an erosive or destructive arthropathy of finger joints, which is not explained by local amyloid deposition.