Intensification of anemia by secondary hyperparathyroidism in hemodialysis patients

The excessive amounts of parathyroid hormone in secondary hyperparathyroidism (SHPTH) is suggested to interfere with normal erythropoiesis. In SHPTH, during chronic renal failure, due to the impairment of erythropoietin synthesis, this effect is more pronounced. In the present study the role of secondary hyperparathyroidism in the severity of anemia was evaluated in hemodialysis patients (n=36; 16 females and 20 males) with the end-stage renal failure. CBC, Hgb, Hct, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), serum iron, total iron binding capacity, transferin saturation, ferritin as well as dialysis adequacy were measured. Partial correlation test was performed for analysis of the data making adjustments for age, duration of hemodialysis and ferritin levels. The mean±SD for iPTH, Hgb and Hct were 439.4 ± 433 pg/ml, 9 ± 1.9 and 28.8 ± 6.3 respectively. The mean duration of hemodialysis for the patients was 25.1 ± 24 months. A reverse correlation was found between iPTH and Hct and Hgb as well as between alkaline phosphatase and Hgb and Hct (0<0.05). It was shown that severity of hyperparathyroidism correlated with severe of anemia. It is concluded that secondary hyperparathyroidism per se can intensify anemia in hemodialysis patients. A more efficient control of hyperphosphatemia and parathormone hypersecretion is thus needed to achieve a better management of anemia in hemodialysis patients

Association of Ca×PO4 product with levels of serum C-reactive protein in regular hemodialysis patients.

INTRODUCTION Numerous studies have attempted to identify risk factors for mortality and morbidity in maintenance hemodialysis patients. In this study we sought to examine the association of the levels of serum C-reactive protein (CRP) with value of Ca×PO4 product, in stable hemodialysis patients. PATIENTS AND METHODS Based on the severity of secondary hyperparathyroidism, patients being treated with oral active vitamin D3, calcium carbonate/Renagel tablets at various doses. Fasting serum 25-hydroxy vitamin D and intact serum parathormone and also serum blood urea nitrogen, CRP, calcium, phosphorus, alkaline phosphatase was measured. RESULTS A total of 41 patients, enrolled to the study. The mean patients' age were 46(17.6) years. The value of serum CRP of patients was 8.6 (6.6) mg/l (median 6 mg/l). The value of Ca×PO4 product was 50.5(15.5) mg2/dl2 (median: 50 mg(2)/dl(2)). In this study, a significant inverse association between Ca×PO4 product and the age of the patients was seen. A significant positive correlation of logarithm of serum CRP with Ca×PO4 product was found. CONCLUSION The result of this study, revealed the need to further attention to hyperphosphatemia in hemodialysis patients

Impact of serum homocysteine on platelet count in stable hemodialysis patients

Objective: The objective of this study was to elucidate whether and how the level of homocysteine as a cause of hemostatic abnormalities affects platelet count in hemodialysis patients with uremia. Methods: A cross-sectional study was conducted on patients with end-stage renal disease (ESRD) who were undergoing maintenance hemodialysis treatment with acetate basis dialysate and polysulfone membranes. Serum total homocysteine (HCY), hemoglobin, platelet (PLT), and white blood cell (WBC) counts were measured. Levels of serum calcium (Ca), phosphorus (P), and magnesium (Mg) were also measured. There were 39 study patients (15 female, 24 male) with a mean age of 46 ± 18 years. Results: The duration of dialysis treatment was 31 ± 35 months (median, 18 months).The value of serum homocysteine for all the patients was 5 ± 2.5 μmol/L (median, 4.5 μmol/L).The mean PLT count was 155 ± 77 × 103 u/L (median, 158 × 103 u/L). Conclusion: This study showed a significant positive correlation of PLT count with serum homocysteine (r=0.35, P=0.044). In hemodialysis patients high homocystiene levels make the platelets more likely to clump and cause clots and contribute to the possibility of thrombotic events among these patients

Serum C-reactive protein (CRP) in association with various nutritional parameters in maintenance hemodialysis patients.

Malnutrition and inflammation are common in hemodialysis (HD) patients, and are usually closely associated. Serum C-reactive protein (CRP) concentrations have been found to be significantly elevated in hemodialysis patients and reflects chronic inflammation, and as an acute-phase reactant, is a sensitive and independent marker of malnutrition. To investigate the association of serum CRP level with some nutritional variables in diabetic and non diabetic end-stage renal failure patients undergoing regular hemodialysis, we designed a study on 36 maintenance hemodialysis patients (f = 15, m = 21), consisting of 25 non-diabetic HD patients and 11 diabetic HD patients. In this study a near significant difference of CRP between diabetic and non-diabetics of all patients with more values of CRP in diabetics and a significant difference of CRP between diabetic and non-diabetics of female HD patients with more values in diabetics were seen. A significant difference of CRP between males and females of non-diabetic population with more values of CRP in males was found too. An inverse correlation of serum CRP with serum cholesterol and triglyceride levels and a near significant positive correlations of CRP with serum ALP and with serum intact parathormone (iPTH) were found too. An inverse correlation of serum CRP with dialysis efficacy was also seen. No significant association between serum CRP and serum albumin was seen. Compatible with some studies and in contrast to some other studies, the association of serum albumin with serum CRP levels in this study was insignificant. The positive correlation of high serum iPTH with inflammation implies further need to control hyperphosphatemia and secondary hyperparathyroidism in HD patients, also inverse correlation of serum CRP with cholesterol and triglyceride further support the malnutrition-inflammation complex syndrome (MICS) which frequently seen in hemodialysis patients (Tab. 3, Fig. 3, Ref. 42)

A positive correlation of serum homocysteine with leptin in maintenance hemodialysis patients

Introduction: Serum leptin is cleared principally by the kidneys and serum leptin concentrations are increased in patients with chronic renal failure and those undergoing a maintenance dialysis. Mild-to-moderate elevations in plasma total homocysteine (Hcy) levels are also observed in the great majority of patients with end-stage renal disease who are undergoing a dialysis. A paradoxically inverse association between higher serum leptin and improved markers of the nutritional status was shown. Based on the above mentioned data regarding the associations of homocysteine and leptin with the nutritional status, we tested the hypothesis that the concentration of serum homocysteine and leptin in hemodialysis patients may have an association. Material and methods: In a cross-sectional analysis on 36 (F=15, M=21) stable hemodialysis (HD) patients, consisting of 25 non-diabetic HD patients and 11 diabetics, serum homocysteine and serum leptin were measured. Results: In this study a significant positive correlation of serum leptin with homocysteine and a significant positive correlation of homocysteine with the body mass index (BMI) and also a significant positive correlation of leptin with BMI were found. Conclusions: The positive correlations of serum homocysteine with leptin and also with BMI show its good correlation with the nutritional status of regular hemodialysis patients. Copyright © 2006 Termedia & Banach

Strong inverse correlation between Helicobacter pylori infection and body mass index in male haemodialysis patients

Introduction and Aim of study: In dialysis patients chronic infections induce overproduction of pro-inflammatory substances. Inflammation has been associated with cachexia and anorexia. Infection with H. pylori is also associated with anorexia, inflammation, and malnutrition in dialysis patients. This study aimed to evaluate the association of body mass index (BMI) of haemodialysis (HD) patients with Helicobacter pylori IgG antibodies to find the effects of H. pylori infection on the development of malnutrition. Material and methods: Patients with end-stage renal disease undergoing maintenance haemodialysis treatment who had had various upper gastrointestinal complaints consisting of epigastric pain, epigastric burning, postprandial fullness, early satiety, bloating and belching were studied. Serum Helicobacter pylori specific IgG antibody titers, serum Leptin, serum post and predialysis blood urea nitrogen, albumin, C-reactive protein were measured. Body mass index was calculated. Results: In this study no significant difference of serum H. pylori specific IgG antibody titer, serum Alb, serum leptin and BMI between males and females and also between diabetics and non diabetic HD patients were found. In all patients and in female non diabetic and diabetic groups no significant correlation of H. pylori IgG antibody titer with BMI was seen, while in male population a significant inverse correlation of H. pylori IgG antibody titer with BMI (r=0.54; P=0.009) (adjusted for age and urea reduction rate) was found. Conclusions: It is possible that inflammation and activity in antrum with H. pylori infection may be higher in men with end-stage renal disease on haemodialysis treatment, although this susceptibility needs more investigation with larger groups of patients. Copyright © 2006 Cornetis

Serum leptin concentration and left ventricular hypertrophy and function in maintenance hemodialysis patients.

AIM The aim of the study was to investigate the potential relationship between left ventricular hypertrophy (LVH) and left ventricular ejection fraction with serum leptin in end-stage renal failure patients undergoing regular hemodialysis (HD) treatment. METHODS A cross-sectional study was carried out on 41 patients (15 women, 26 men) with end-stage renal disease (ESRD), undergoing maintenance HD treatment with acetate basis dialysate and polysulfone membranes. Serum leptin, pre- and post-dialysis creatinine, predialysis BUN, calcium (Ca), phosphorus (P), serum albumin (Alb) and serum ferritin were monitorized; the patients were categorized into no LVH, mild , moderate and severe LVH, according to the performed echocardiographies. RESULTS The mean patient's age was 46+/-17.6 years. The mean length of the time patients had received HD was 29.5+/-34 months (median: 18 months). The mean serum leptin was 9.5+/-13.8 ng/mL (median value 4.7 ng/mL). In this study no significant association between stages of LVH with serum leptin was seen. In this study a significant positive correlation between LV ejection fraction with logarithm of serum leptin (r=0.32, P=0.048) (adjusted for age, duration and doses of dialysis, BMI, diabetes mellitus, serum ferritin, Ca, P and serum Alb was observed). CONCLUSIONS Leptin might not be an aggravator for LV hypertrophy. This behavior of leptin in maintenance HD patients which is in contrast to general population, especially in obese patients with normal renal function could be explained through its reverse epidemiology role in HD patients. Our results emphasize the importance of leptin in HD and clinical impact of these findings merit further investigation

Helicobacter pylori infection and its relationship to plasma magnesium in hemodialysis patients

Dyspeptic symptoms are quite common in chronic hemodialysis patients, and Helicobacter pylori (cagA(+)) is thought to play an important role in the pathogenesis of the active gastritis and other upper gastrointestinal mucosal lesions in these patients. The aim of this study was to evaluate a probable association between plasma magnesium (Mg2+) and Helicobacter pylori infection in maintenance patients. Helicobacter pylori specific IgG antibody levels and plasma magnesium were measured in patients. Totally 44 patients consisted from 34 non diabetic hemodialysed patients and 10 diabetic hemodialysis patients. In this study, a significant positive correlation between anti-Helicobacter IgG antibody and plasma magnesium was found in all patients (r=0.29, p=0.050) (adjusted for dialysis sessions). The results of this study suggest the association of serum magnesium with the infection of Helicobacter pylori. Mg2+ acquisition by CorA is essential for Helicobacter pylori in vitro. We concluded that high serum magnesium level and probably its higher concentration in gastric mucosa might facilitate the colonization of Helicobacter pylori in the stomach of hemodialysis patients, although more studies are needed to prove the clinical relevance of this finding (Tab. 1, Fig. 1, Ref. 23)