Insulin Resistance and Left Ventricular Mass in Non-Diabetic Hemodialysis Patients

AbstractBackgroundInsulin resistance (IR) is frequently recognized in patients with uremia, and it is thought that IR has a basic role in the pathogenesis of cardiovascular disease.ObjectiveTo evaluate the effect of IR on cardiovascular risk in non-diabetic patients receiving hemodialysis (HD).MethodsWe performed a cross-sectional observational study that comprised 186 non-diabetic patients receiving HD (95 men; mean [SD] age, 46.4 [10.8] years; age range, 35–60 years) who had been receiving HD for 7.3 (3.5) years. Demographic variables and laboratory values were recorded. Insulin resistance was determined using the Homeostatic Model Assessment (HOMA), and the left ventricular mass index (LVMI) was calculated via echocardiography.ResultsAccording to HOMA-IR levels, patients were categorized as having IR (HOMA-IR score ≥2.5; n = 53) or not having IR (HOMA-IR score <2.5; n = 133). Insulin resistance was determined in 28.4% of study patients. Compared with the non-IR group, the IR group had been receiving HD longer; had greater body mass index; and had higher serum creatinine, uric acid, triglyceride, insulin, and C-reactive protein concentrations, leukocyte count, and LVMI (P < 0.05). Patients with increased LVMI had significantly higher body mass index, systolic blood pressure, serum cholesterol and C-reactive protein concentrations, and HOMA score. At multivariate analysis, systolic blood pressure (β = 0.22; P = 0.03) and HOMA score (β = 0.26; P = 0.01) affected LVMI.ConclusionsInsulin resistance and hypertension are independent risk factors for left ventricular hypertrophy in non-diabetic patients with uremia who are receiving HD. Further studies are needed to indicate the benefits of improving IR for cardiovascular mortality in this subgroup of patients with uremia

Straight versus S-shaped sternotomy: a histologic study in the sheep model

INTRODUCTION: Straight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the sternal instability and bone healing. MATERIALS AND METHODS: We enrolled 31 sheep, weighing 18–30 kg. For all animals a midline skin incision was made. In group I (n = 16 animals), straight median sternotomy and in group II (n = 15 animals), S-shaped incision was marked on the periosteum of the sternum by new created device for standard S-shaped sternotomy. Sternum biopsies were performed on second surgery month for all survived animals from the sternum and the surrounding soft tissue. RESULTS: No early superficial wound complications were observed. Overall mortality in the initial approach group was 19.3% (6 sheep). In group I; 3 sheep had died on first surgery day, the reason may be hemorrhage and in group II; 3 sheep developed intractable VF during surgery procedure or immediately afterwards so died. There were statistically significant differences in the scores of bone healing between group 1 and group 2 (4.2 vs.7.3, ANOVA, p < 0.001). DISCUSSION: Our work is based on the use of a standard S-shaped sternotomy procedure on sheep sternum. In our experience with the sternal healing in the sheep model, the process of new bone formation was accelerated with S- shaped cut than straight sternotomy procedure. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13019-014-0173-x) contains supplementary material, which is available to authorized users

Results of our laparoscopic partial nephrectomy without ischemia: the first ten cases

Laparoscopic partial nephrectomy (LPN) without ischemia is a new method that can only be performed in selected cases. We presented results of patients who underwent LPN without ischemia for renal mass in our clinic. The demographic characteristics, perioperative and postoperative surgical results, complications and renal functions were retrospectively reviewed for patients who underwent LPN without ischemia between March 2014 and September 2015. Renal function was assessed using the estimated glomerular filtration rate (GFR) calculated by the Modification of Diet in Renal Disease (MDRD) equation. Complications was assessed according to modified Clavien classification. Ten cases of LPN without ischemia were performed. The mean age was (year) 50.6 ± 8.6, the mean mass size (mm) 37.9 ± 23, the mean RENAL score was 6.4 ± 1.2. The mean operation time (minute) 110.5 ± 41, the mean bleeding amount (ml) 191 ± 198, the mean hemoglobilin (mg/dl) preoperative 13.86 ± 1.28, postoperative 12.2 ± 1.2, the mean creatinine (mg/dl) preoperative 0.95 ± 0.19, postoperative 0.85 ± 0.2, 1.Year 0,91±0,1, GFR (ml/min) preoperative 77.6, postoperative 1.day 79.6, 1.Year 81.2, hospitalization duration (day) 2.9 ± 0.7. Two patients underwent blood transfusion (According to modified Clavien classification grade 2). LPN without ischemia is a new method that can only be performed in selected cases in experienced clinics. [Med-Science 2018; 7(2.000): 402-5

Does neutrophil to lymphocyte ratio demonstrate deterioration in renal function?

Introduction: Chronic kidney disease (CKD) is a major health issue worldwide, which leads to end-stage renal failure and cardiovascular events. Neutrophil to lymphocyte ratio (NLR) is a surrogate marker of inflammation and has been widely studied in malignancies, hypertension, heart diseases, and vascular diseases. In this study, we aimed to investigate if NLR represents renal reserve and function after partial or radical nephrectomy. Methods: We conducted a retrospective study consists of patients who had undergone radical/partial nephrectomy in our hospital and/or who admitted to urology and nephrology clinics as an outpatient. Patients were divided into four groups: Group 1 (n =  46): Healthy controls; Group 2 (n =  50): Patients who had undergone unilateral partial nephrectomy; Group 3 (n =  46): Patients who had gone unilateral nephrectomy; Group 4 (n =  82): Patients who had CKD. Results: The mean NLR of each group was as follows: Group 1: 2.14 ± 0.73; Group 2: 3.52 ± 3.74; Group 3: 3.64 ± 3.52, and Group 4: 3.53 ± 2.30. NLR was lower in Group 1 compared to other groups but statistically significant difference was observed only between Group 1 (control) and Group 4 (CKD), 2.14 ± 0.73 versus 3.53 ± 2.30 (p = .005). In non-parametric correlation analysis NLR was found negatively correlated with GFR and positively correlated CKD stage (p = .028 for both correlations). Conclusions: The NLR may constitute a practical predictor of CKD besides Cr in patients who had undergone partial or radical nephrectomy

Allopurinol reduces cardiovascular risks and improves renal function in pre-dialysis chronic kidney disease patients with hyperuricemia

To determine the effect of hyperuricemia and allopurinol therapy on renal functions in chronic kidney disease (CKD) stage 3-4, we studied 96 patients in stage 3-4 CKD (57% male, age 65.3 ± 12.4 years). The mean estimated glomerular filtration rate (GFR) was 44.62 ± 14.38 iriL/ min/1.73 m 2 . The study patients were divided into non-allopurinol users (n = 47) and those using allopurinol (n = 49) in the last 12 months. Serum uric acid (UA) and C-reactive protein levels decreased after allopurinol therapy (P = 0.00 and P = 0.04, respectively), but no change was observed in the control group during the study period. In the allopurinol group, the mean GFR increased 3.3 ±1.2 mL/min/1.73 m 2 /year, while it decreased 1.3 ± 0.6 mL/min/1.73 m 2 in the control group during the follow-up period (P = 0.04); the patients in the allopurinol group exhibited lower levels of serum potassium, serum low-density lipoprotein (LDL) and renal resistance index (RRI) (P-values were <0.05). The patients with stable renal functions or GFR change <10% (n = 25) at the end of 12 months had significantly lower LDL and RRI values and more allopurinol users than the group with deceasing GFR (74% vs. 48%, P <0.05). In the regression analysis, UA and RRI were found as independent variables (r 2 = 0.68, P <0.01; r 2 = 0.25, P <0.01) that affected loss of renal function. We conclude that our study suggests a role for allopurinol, an effective agent in lowering serum UA levels, as a reliable therapeutic option in controlling renal progression in pre-dialysis CKD patients