Cardiac complications of secondary hyperparathyroidism in chronic hemodialysis patients

Aim: To evaluate the eff ects of intact parathormone (iPTH) on left ventricular function using transthoracicechocardiography on chronic hemodialysis (HD) patients with secondary hyperparathyroidism. In HD patients,mortality is high and is frequently due to cardiac complications. Secondary hyperparathyroidism, high levels ofphosphate (PO4), and high calcium phosphate product (Ca × PO4) are related to cardiac complications.Materials and methods: We examined 20 patients with normal iPTH levels (Group 1) and 20 patients with high iPTHlevels (Group 2). Intact parathormone levels were measured in serum with a Coat-A-Count kit (Diagnostic ProductsCorporation, Los Angeles, CA, USA) using an immunoradiometric assay. Th e normal level of iPTH was 0.8-5.2 pmol/L.In patients with end-stage renal disease, iPTH levels should be 1.5 to 3 times higher than the normal range in order tomaintain the bone mass; thus, patients with iPTH levels 4 or more times higher than the normal range (PTH ? 20.8pmol/L) were defi ned as Group 2 while patients who had normal iPTH levels were defi ned as Group 1.Results: In both groups, Doppler parameters indicated diastolic dysfunction. However, mitral annular E velocity waslower in Group 2 than in Group 1 (6.1 ± 1.1 cm/s and 7.5 ± 1.6 cm/s, respectively; P = 0.034). It is well known thatleft ventricular hypertrophy (LVH) increases mortality rates. Left ventricle mass index and relative wall thickness areparameters refl ecting LVH, and both were higher in Group 2 (294.4 ± 103.0 g/m² and 53.5 ± 11.7%) when comparedwith Group 1 (179.2 ± 104.2 g/m² and 41.8 ± 8.9%). Th ese diff erences were found to be statistically signifi cant (P <0.001).Conclusion: Th is study demonstrates that high levels of iPTH contribute to diastolic dysfunction and LVH inhemodialysis patients

The efficacy of cinacalcet in the treatment of hyperparathyroidism in Turkish hemodialysis patient population

WOS: 000393291900012OBJECTIVE: Cinacalcet reduces parathyroid hormone levels by increasing the sensitivity of the parathyroid gland to calcium. in this study, we firstly aimed to evaluate the efficacy of cinacalcet in Turkish hemodialysis patients. MATERIAL and METHODS: 4483 hemodialysis patients were screened and 469 patients who had used cinacalcet were included in the study. the patients were divided into 4 groups according to drug usage durations (Group 1: 3 months, Group 2: 6 months, Group 3: 9 months and Group 4: 12 months). the patients' Parathormone, Ca, P and CaxP levels at the 3rd, 6th, 9th and 12th months were compared to the start of treatment and previous months. RESULTS: the levels of Parathormone, Ca, P and CaxP significantly decreased compared to their initial levels in all groups (from 1412 pg/ml to 1222 pg/mL for Parathormone, p< 0,001) in the 3rd month. However, this reduction was not continued in the subsequent months (Parathormone: 1381 pg/ml for the 12th month). CONCLUSION: Cinacalcet may not provide adequate benefit in control of hyperparathyroidism in Turkish hemodialysis patient population

Serum neuron specific enolase and S-100B levels in hemodialysis and peritoneal dialysis patients

Objective: Neuron-specific enolase (NSE) and S-100B are brain-derived proteins, and their levels increase in brain injury. The aim of the study was to determine serum S-100B and NSE levels in patients with end-stage renal disease undergoing hemodialysis (HD) and peritoneal dialysis (PD) and to demonsrate how these levels were affected by the type of dialysis applied. Methods: The study group consisted of age- and gender-matched 20 patients undergoing HD, 26 patients undergoing continuous ambulatory PD (CAPD) and 21 healthy controls. Blood samples were obtained before and after dialysis in the HD patient group, and fasting blood samples were obtained in the CAPD and control groups. The routine biochemical parameters were measured within two hours from all serum samples. The remaining serum samples were stored at -80 °C until the day of analysis of the S-100B and NSE assays. Serum S-100B and NSE levels were measured by chemiluminescence immunoassay method. Routine biochemistry tests were measured by colorimetric method using a biochemistry analyzer. Results: Serum S-100B (0.11±0.06 ng/mL in HD, 0.13±0.09 ng/mL in CAPD and 0.05±0.03 ng/mL in controls) and NSE (12.7±5.99 ng/mL in HD, 9.26±5.52 ng/mL in CAPD and 6.82±2.36 ng/mL in controls) levels were higher in HD and CAPD groups compared to controls. S-100B and NSE levels were higher after HD compared to before HD (p<0.001). There was a weak but significant correlation between S-100B and NSE levels (r=0.290; p=0.006). Conclusion: In this study, serum S-100B and NSE levels were found to be high in patients undergoing HD and PD. Serum S-100B and NSE concentrations were higher in HD and CAPD patients. Increased S-100B and NSE levels may be associated with cerebrovascular events in patients with chronic renal failure. They may also be important markers for the determination of cerebrovascular events

Role Of Local Renin Angiotensin System Activation On Blood Pressure And Residual Renal Function In Peritoneal Dialysis Patients

Objective: Several studies have shown that local renin-angiotensin system (RAS) activity in the kidneys may play a role in the pathogenesis of hypertension and kidney damage in patients with chronic kidney disease. In this study, we aimed to investigate the effect of local RAS activity on hypertension and residual renal function (RRF) in patients undergoing peritoneal dialysis (PD). Materials and Methods: Fifty patients with residual urine undergoing PD were included in the study. They were divided into the hypertensive (n=30) and non-hypertensive (n=20) groups. The urine angiotensinogen-to-creatinine ratio, which is an indicator of local RAS activity, was compared between the two groups. Factors affecting this ratio were also investigated. Results: There was no significant difference in the mean urine angiotensinogen-to-creatinine ratios between the two groups. A correlation analysis revealed that the urine angiotensinogen-to-creatinine ratio had a significant negative correlation with RRF determined by 24-hour creatinine excretion (r=-0.391, p=0.005). There was a positive correlation between the urine angiotensinogen-to-creatinine ratio with proteinuria (r=0.289, p=0.04) and negative correlation with serum albumin (r=-0.280, p=0.049). However, we could not find any association between the urine angiotensinogen-to-creatinine ratio and blood pressure values. Conclusion: Local RAS activation in the kidney reflected by urinary angiotensinogen is associated with RRF and proteinuria in patients undergoing PD; however, high blood pressure was not correlated with urinary angiotensinogen levels.Wo

Effects of Renin-Angiotensin-Aldosterone System Blockade on Chlorhexidine Gluconate-Induced Sclerosing Encapsulated Peritonitis in Rats

Sclerosing encapsulated peritonitis (SEP) is a rare complication of long term peritoneal dialysis. Renin-angiotensin-aldosterone system (RAAS) may play a role in the development of peritoneal fibrosis in CAPD patients. We aimed to evaluate the effect of aliskiren, valsartan, and aliskiren + valsartan therapy on SEP. The study included 30 Wistar albino rats which were divided into five groups: I (Control) SF solution i.p.; II (CG group) chlorhexidine gluconate i.p.; III aliskiren oral plus CG i.p.; IV valsartan oral plus CG i.p.; and V aliskiren oral, valsartan oral and CG i.p. On the twenty-first day, all of the rats were sacrificed. All of the groups were analyzed in terms of peritoneal thickness, degree of inflammation, vasculopathy, neovascularization and fibrosis. Also, the parietal peritoneal tissue samples were evaluated for matrix metalloproteinase 2 (MMP-2) using the ELISA method. Peritoneal thickness and fibrosis scores were lower in the valsartan group compared to the CG group (P 0.05). Tissue MMP-2 levels were significantly higher in the CG group compared other groups (P < 0.05). There were no statistically significant differences between the aliskiren, valsartan and aliskiren + valsartan groups according to the tissue MMP-2 levels. Due to the antifibrotic properties of valsartan, it is thought to be a possible choice to prevent SEP development. We found no positive impact of aliskiren or aliskiren + valsartan combination compared to valsartan alone

Influence of Bone Morphogenic Protein 7 (BMP7) on the Progression of Chronic Kidney Disease

Background-Aims: Chronic kidney disease (CKD) is an important health problem worldwide. TGF (transforming growth factor)-beta and particularly bone morphogenetic protein 7 (BMP7) are held responsible for renal fibrosis. In our study we aimed to evaluate the association between CKD progression and BMP7 levels.Materials and Methods: Our study included 80 patients who are diagnosed with CKD and being followed between January 2008 and December 2010. Progression of CKD was defined as 50% decrease in glomerular filtration rate (GFR), doubling of serum creatinine and initiation of renal replacement therapy. Serum BMP7 levels have been measured initially and at the end of two years follow-up.Results: At the end of the follow-up CKD progression was detected in 18 out of 80 patients (%22.5). Decrease in glomerular filtration rate was found to be correlated with an increase in PTH, phosphorus and a decrease in serum albumin levels. In patients with progressive disease serum BMP7 levels were significantly higher than the ones with stable disease, which were 458±62.3 pg/mL and 360±82.4 pg/mL, respectively.Conclusion: Our results show that the patients with progressive disease have higher BMP7 levels which is a different finding from the previous trials. We speculate that this paradoxal increase may be a compensatory action against the increase in other profibrotic cytokines