Assessment of Parathyroid Function in Clinical Practice: Which Parathyroid Hormone Assay Is Better?

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Serum albumin, body weight and inflammatory parameters in chronic hemodialysis patients: A three-year longitudinal study

Backgrounds and Aims: The present study aimed at making prospective longitudinal measurements of nutritional and inflammatory parameters to determine whether nutritional and inflammatory status decline or increase over time in a cohort of prevalent hemodialysis patients, and to evaluate which factors influence eventual changes. Patients: 64 hemodialysis patients were followed at 0, 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, and 36 months. At each follow-up visit, dry body weight, serum albumin, serum total cholesterol, total white blood cells, total lymphocyte count, serum glucose, C-reactive protein, ferritin, fibrinogen, hemoglobin, and weekly erythropoietin dose were assessed. Main Outcome Measures: Changes in nutritional and inflammatory parameters over time. Results: 43 patients completed the study at 36 months. Mean serum albumin levels (g/dl) improved significantly between baseline (3.76 ± 0.24) and 36 months (3.93 ± 0.27) (F = 4.005; p = 0.0009). Dialytic age was significantly associated with changes of serum albumin (F = 2.797; p = 0.028). The mean dry weight slightly remained stable over time (F = 1.473; p = 1.0) as well as the level of total cholesterol (p = 0.77) and lymphocyte count (F = 1.539; p = 0.186). Over time, the levels of C-reactive protein tended to decrease, although the differences were not statistically significant (F = 1.332; p = 0.19). Over time, the serum level of fibrinogen (F = 0.422; p = 0.17) and ferritin (F = 0.314; p = 0.52) remained stable. The number of white blood cells significantly decreased over time (F = 4.691; p = 0.0079) and dialytic age (F = 3.214; p = 0.015) was the variable significantly associated with such decline. The hemoglobin levels (F = 1.423; p = 0.14) and the weekly erythropoietin dose did not change significantly during the study (F = 1.019; p = 0.61), nor did the serum glucose levels (F = 1.231; p = 0.10). Conclusion: These results support the hypothesis that end-stage renal disease and HD are not necessarily associated with deterioration of the nutritional status over time. Copyright © 2007 S. Karger AG

Parathyroid Ultrasonography in Renal Secondary Hyperparathyroidism: An Overlooked and Useful Procedure

In secondary hyperparathyroidism (SHPT), ultrasonography (US) can accurately define the size and structure of parathyroid glands as well as differentiate diffuse and nodular hyperplasia. US may be also useful to predict the response of SHPT to vitamin D analogs and cinacalcet and to assess for regression of parathyroid glands hyperplasia by measurement of parathyroid gland volume. There is increasing evidence that US can potentially identify patients who will benefit from prompt surgical intervention. Therefore, US should be part of the diagnostic armamentarium in the treatment of SHPT in the daily clinical practice

Haemodialysis treatment in uremic patients: investigation of the correlation between depression, reward system and chronic fatigue

Haemodialysis is considered a life-saving treatment, allowing a good level of survival for uremic patients waiting for organ transplant. Uraemia, if not addressed in an adequate manner, can lead to death. However, treatment greatly influences the patient\u2019s life. Eighty percent of patients has chronic fatigue, affecting the quality of life (QoL). Fatigue is a multidimensional symptom. The \u201cphysical\u201d dimension is linked to obvious bodily limitations, but recovery mechanisms save all of their effectiveness, allowing to get the strength back as a result of an adequate rest period. The \u201cmotivational\u201d dimension, however, is more complex and refers to a central fatigue, often associated with pain, disturbed sleep, affective and cognitive disorders. In spite of studies carried out in groups of patients with chronic disease, suggest that psychological interventions to decrease the fatigue is necessary, these interventions are not available for haemodialysis patients. The aim of this study is to evaluate the level of fatigue, assuming a comorbidity with a past of anxiety and depression, and how the motivation mechanisms are affected with a significant impact on QoL. Evaluative scales have been administered to a sample of haemodialysis patients (N=94) older than 18 years, with no neurocognitive disease. Fatigue Severity Scale (FSS) has been applied to measure the impact of fatigue on motivation and social functionality. BIS/BAS Scale has been administered to investigate the mechanisms of reward: Behavioural Activation System (BAS) and Behavioural Inhibition System (BIS) result in behavioural inhibition/activation to rewards/punishments. Finally, the State-Trait Anxiety Inventory (STAI-Y) and the Back Depression Inventory (BDI-II) have been used to evaluate the potential presence of anxiety and depression disorders. For a qualitative analysis, a semi-structured interview has been performed. The results show a linear correlation between the fatigue and depression level: a. Fatigue is directly proportional to symptoms such as sadness, frustration, irritability, difficulty concentrating and loss of interest. b. The inclination to act, led by the BAS system, is inversely proportional to depression. Therefore, its indirect correlation with chronic fatigue is conceivable. c. The BIS system, on the other hand, is directly related to the sense of fatigue, especially in men. This study shows that the sense of fatigue is not exclusively linked to pathophysiologic factors of uraemia and haemodialysis but to a central fatigue on a psychological level. A psychosocial intervention would be useful to improve the QoL of the haemodialysis patients, lessening the \u201cfatigue\u201d symptom

Fatigue is associated with high prevalence and severity of physical and emotional symptoms in patients on chronic hemodialysis

Purpose: The symptom burden of fatigued hemodialysis patients is poorly known. We aimed to investigate possible differences in the prevalence and severity of symptoms between fatigued and not fatigued patients on chronic hemodialysis. Methods: All prevalent patients on chronic hemodialysis referring to the Hemodialysis Service between January 2016 and June 2017 were considered eligible. The Dialysis Symptom Index (DSI) questionnaire was performed during the dialysis treatment. Patients underwent assessment of fatigue using the Italian version of the vitality scale of the SF-36 (SF-36VS). Results: We studied 137 patients: 107 (78.1%) were fatigued and 30 (31.9%) were non-fatigued. The median [95% CI] number of symptoms was 15 [14–16] for patients who reported fatigue and 9 [8–19] for the non-fatigued (P < 0.0001). In fatigued patients, with respect to non-fatigued ones, the prevalence of dry skin, itching, muscle soreness, bone or joint pain, restless legs, shortness of breath, feeling sad, feeling anxious, difficulty concentrating, and difficulty becoming sex aroused was significantly higher. Restless legs, feeling sad, difficulty concentrating, and difficulty becoming sex aroused were symptoms independently associated with fatigue. The severity of dry skin, trouble staying asleep, and bone/joint pain was higher in fatigued patients. Conclusion: Fatigued hemodialysis patients report suffering from physical and emotional symptoms more frequently than non-fatigued patients. This finding suggests the need to accurately and routinely define the symptom burden of chronic hemodialysis patients and may help to investigate eventually common underlying pathogenic mechanisms of symptoms in these patients

Parathyroid-gland ultrasonography in clinical and therapeutic evaluation of renal secondary hyperparathyroidism

This study evaluated the relationship between ultrasonographic (US) parameters of parathyroid glands (PTGs) in haemodialysis patients (HDP) and degree of secondary hyperparathyroidism (SHPT), therapeutic responsiveness and type of PTG hyperplasia (diffuse or nodular)

Correlazione tra depressione, sistema di reward e fatica cronica in pazienti con insufficienza renale sottoposti a trattamento di emodialisi

Il trattamento di emodialisi consente ai pazienti con insufficienza renale un buon livello di sopravvivenza in attesa di un possibile trapianto d’organo. Tuttavia, la terapia condiziona enormemente la vita del paziente. Circa l’80% dei pazienti cronici soffre di stanchezza grave, la quale influenza fortemente il livello della qualità di vita (QoL). La fatica è un sintomo multidimensionale costituito da due dimensioni: "fisica" e "motivazionale". La prima è associata ad evidenti limitazioni fisiche ma i meccanismi di recupero conservano tutta la loro efficacia permettendo all’organismo di riacquistare le forze per mezzo di un adeguato periodo di riposo. La seconda è invece più complessa ed è riferita ad una stanchezza di tipo centrale, spesso associata a disturbi del sonno, dolore e alterazioni affettive e cognitive. Precedenti studi in altri gruppi di pazienti affetti da patologie croniche suggeriscono il ricorso a interventi psicologici per ridurre la fatica ma, tali interventi, non sono disponibili per pazienti in emodialisi. Questo studio valuta la presenza e il livello di fatica ipotizzandone una comorbidità con pregressi vissuti di ansia e depressione e come i meccanismi di motivazione vengano influenzati dalla stanchezza e provochino un impatto rilevante sulla QoL. Sono state somministrate scale valutative ad un campione di circa 50 pazienti dializzati con età superiore a 18 anni e senza patologie neurocognitive. La Fatigue Severity Scale (FSS) è stata adoperata per misurare l'impatto della fatica sulla motivazione e funzionalità sociale del paziente. Per l’indagine dei meccanismi di reward abbiamo somministrato la BIS/BAS Scale, che permette di indagare i meccanismi di disposizione motivazionale, il Behavioral Activation System (BAS) e Behavioral Inhibition System (BIS) che, in termini comportamentali, si possono tradurre in tendenza motivazionale all’avvicinamento o all’allontanamento da ricompense e punizioni. Infine, per valutare la possibile presenza di disturbi ansiosi e depressivi, sono state adoperate rispettivamente la State-Trait Anxiety Inventory (STAI-Y) e la Back Depression Inventory (BDI-II). I risultati mostrano una relazione di linearità tra il senso di fatica e i livelli di depressione: a. La stanchezza è direttamente proporzionale a sintomi quali tristezza, frustrazione, irritabilità, difficoltà a concentrarsi e perdita di interesse b. La riduzione della motivazione all’azione, guidata dal sistema di reward BAS, è inversamente proporzionale ai sintomi depressivi. Pertanto sembrerebbe ipotizzabile una loro correlazione indiretta con la sensazione di fatica cronica. Questo studio mostra come la sensazione di fatica non sia riconducibile esclusivamente a fattori fisiopatologici dell'insufficienza renale e del trattamento dialitico ma ad una stanchezza di tipo centrale, legata al piano psicologico. Un intervento psicosociale risulterebbe utile a migliorare la qualità di vita dell'emodializzato attenuando il sintomo “fatica”

Histology Amd Immunochemistry Of Parathyroid Glands In Hemodialysis Patients Refractory To Conventional Or Cincalcet Therapy.

BACKGROUND: Cinacalcet is a new effective treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients (HP), but the alterations of parathyroid gland (PTG) hyperplasia determined by cinacalcet and vitamin D have not been extensively investigated in humans. METHODS: We performed histological analyses of 94 PTGs removed from 25 HP who underwent parathyroidectomy (PTx) because of SHPT refractory to therapy with vitamin D alone (group A=13 HP and 46 PTGs) or associated with cinacalcet (group B=12 HP and 48 PTGs). The number, weight, the macroscopic cystic/hemorrhagic changes, and type of hyperplasia of PTG (nodular=NH, diffuse=DH) were assessed. In randomly selected HP of group A (4 HP and 14 PTGs) and group B (4 HP and 15 PTGs), the labeling index of cells positive to Ki-67 and TUNEL and the semiquantitative score of immunohistochemistry staining of vitamin D receptor, calcium-sensing receptor, and vascular endothelial growth factor-α (VEGF-α) were measured in the entire PTGs and in the areas with DH or NH. RESULTS: The number and weight of single and total PTG of each HP were similar in the two groups as well as the number of PTG with macroscopic cystic/hemorrhagic areas. TUNEL, Ki-67, and VEGF-α scores were higher in NH than in DH areas. CONCLUSION: This observational study of a highly selected population of HP, submitted to PTx because SHPT refractory to therapy, shows that the macroscopic, microscopic, and immunochemistry characteristics of PTG in HP who received or did not receive cinacalcet before PTx did not differ significantly

Histology and immunohistochemistry of the parathyroid glands in renal secondary hyperparathyroidism refractory to vitamin D or cinacalcet therapy.

Histology and immunohistochemistry of the parathyroid glands in renal secondary hyperparathyroidism refractory to vitamin D or cinacalcet therapy