Subcutaneous C.E.R.A. for the Treatment of Chronic Renal Anemia in Predialysis Patients

Background: We investigated the efficacy, safety and tolerability of once-monthly administration of C.E.R.A. in erythropoiesis stimulating agents (ESAs) naive predialysis patients with CKD for anemia treatment Study Design: Single arm, open label study. Methods: A total of 75 patients (mean (SD) age was 52.8 (16.4) years, 76.0% were female) were included in this study conducted between 12 August 2008 and 30 October 2009 in 9 centers across Turkey. The mean change in Hb concentration (g/dL) between baseline (week 0) and the efficacy evaluation period (EEP) was the primary efficacy parameter evaluated in three consecutive periods including a dose titration period (DTP; with initial 1.2 ?g/kg dose of C.E.R.A., subcutaneously, 28 weeks), EEP (8 weeks) and a long-term safety period (16 weeks). Results: Our analysis revealed an improvement in Hb levels from baseline value of 9.4 (0.4) g/dL to time adjusted average level of 11.4 (0.7) g/dL in EEP in the per protocol (PP) population and from 9.3 (0.5) g/dL to 11.1 (1.0) g/dL in intent-to-treat (ITT) population. Mean (SD) change in Hb levels from baseline to EEP was 2.0 (0.7) g/dl in the PP population (primary endpoint) and 1.7 (1.1) g/dL in the ITT population. The percentage of patients whose Hb concentrations remained within the target range of 10.0-12.0 g/dL throughout the EEP was 43.9% (95% CI: 28.5-60.3%) in the PP population and 38.7% (95% CI: 27.6% to 50.6%) in the ITP population. A total of 206 adverse events (AE) were reported in 77.0% of patients with hypertension (20%) as the most frequent AE. Conclusion: Once-monthly subcutaneous C.E.R.A. administration is effective and safe in the treatment of anemia in pre-dialysis patients with CKD, who are not currently treated with ESAs

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

The coexistence of focal segmental glomerulosclerosis with carcinoid syndrome: A case report

Carcinoid tumor is originated from neuroendocrine tumorfamily and a rarely presents in humans. Membranous andmembrano-proliferative glomerulonephritis were rarelyreported with presence of carcinoid tumors. However,the coexistence of focal segmental glomerulosclerosis(FSGS) with carcinoid syndrome have not been definedpreviously. We herein present a firs case report of FSGSduring follow up of carcinoid syndrome.Key words: Carcinoid sydrome, focal segmental glomerulosclerosis,glomerulonephriti

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