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Objective: Because omega-3 polyunsaturated fatty acids (PUFAs) may have anti-inflammatory properties, we tested the hypothesis that intradialytic, intravenous omega-3 PUFA treatment, combined with dietary supplementation, can modify the inflammatory response to dialysis, and influence the nutritional status of hemodialysis (HD) patients., Methods: Twenty HD patients with serum albumin at <39g/L received 100mL of 10% omega-3 PUFA emulsion during 11 consecutive HD sessions. Body mass index (BMI), serum albumin, transferrin, and lipids were measured before and after treatment. Serum interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) levels were determined before and after the HD session at baseline and after 4 weeks of treatment., Results: No adverse events were evident during the study. There were no significant changes in BMI, serum albumin, transferin, total and low-density lipoprotein cholesterol, and triglycerides. Predialysis hsCRP and IL-6 did not change. There was a significant increase in hsCRP (P=.01) and a tendency of IL-6 concentration to increase during the HD session before treatment (P=.067). In contrast, neither hsCRP (P=.21) nor IL-6 (P=.26) changed during the final HD session. Neither urea reduction ratio nor Kt/V changed significantly during the study, but the normalized protein catabolic ratio increased after treatment (P=.003)., Conclusions: Short-term parenteral administration of omega-3 PUFA is safe and well-tolerated by HD patients. The intervention does not significantly influence markers of inflammation or change the nutritional status of chronic HD patients, but it may attenuate the inflammatory response to HD sessions.

The effect of high-flux hemodialysis membranes on patient survival has not been unequivocally determined. In this prospective, randomized clinical trial, we enrolled 738 incident hemodialysis patients, stratified them by serum albumin < or = 4 and >4 g/dl, and assigned them to either low-flux or high-flux membranes. We followed patients for 3 to 7.5 yr. Kaplan-Meier survival analysis showed no significant difference between high-flux and low-flux membranes, and a Cox proportional hazards model concurred. Patients with serum albumin < or = 4 g/dl had significantly higher survival rates in the high-flux group compared with the low-flux group (P = 0.032). In addition, a secondary analysis revealed that high-flux membranes may significantly improve survival of patients with diabetes. Among those with serum albumin < or = 4 g/dl, slightly different effects among patients with and without diabetes suggested a potential interaction between diabetes status and low serum albumin in the reduction of risk conferred by high-flux membranes. In summary, we did not detect a significant survival benefit with either high-flux or low-flux membranes in the population overall, but the use of high-flux membranes conferred a significant survival benefit among patients with serum albumin < or = 4 g/dl. The apparent survival benefit among patients who have diabetes and are treated with high-flux membranes requires confirmation given the post hoc nature of our analysis.

In this paper we present the current reviews on the causes, symptoms, prevalence and clinical importance of hypotonia in chronic renal failure patients undergoing dialysis therapy. The results of clinical studies indicate that persistent hypotonia in dialysis patients is associated with increased mortality.

Thiopurine S-methyltransferase (TPMT) is a cytosolic enzyme, catalyzing S-methylation of thiopurine drugs. TPMT exhibits autosomal codominant polymorphism. Patients carrying a variant genotype have low TPMT activity, and produce elevated levels of 6-thioguanine nucleotides (6-TGN) in their red blood cells (RBC). 6-TGN accumulation may result in azathioprine (AZA)-induced bone marrow myelosuppression in the course of treatment with the drug in a standard dosage regimen in patients following renal transplantation. In the current study, TPMT activity (phenotype) and genotype were determined in dialyzed patients, qualified for renal transplantation. TPMT activity was measured in RBC after dialysis by HPLC method. Patients were genotyped for TPMT *2, *3A and *3C variant alleles using PCR-RFLP and allele-specific PCR methods. TPMT activity ranged between 12.2 and 45.5 nmol 6-mMP/g Hb/h (median value 30.6). A significant correlation between TPMTphenotype and genotype was noted: the heterozygous patients (11.5%) demonstrated significantly lower mean TPMT activity as compared to the wild homozygotes (17 +/- 3.6 vs. 32.4 +/- 4.8 nmol 6-mMP/g Hb/h, p < 0.0003). No overlap in TPMT activity values between the group of heterozygous (range 12.2-20.6) and wild-type homozygous patients (range 22.7-45.5) was noted. TPMT activity, established after hemodialysis and TPMT genotyping results seem to be convergent in dialyzed patients, so both methods can be used for the identification of patients with lower TPMT activity. Such tests could be helpful in AZA dose individualization, and thus in reducing the risk of myelosuppression during AZA therapy following renal transplantation.

Heart rate variability (HRV) is a non-invasive method used for the assessement of autonomic modulation of heart rate. Decreased HRV is an indicator of increased cardiovascular risk. The aim of this study was to evaluate the relationship between the heart rate variability and left ventricular hypertrophy and native parathormone (iPTH) serum concentration in patients with chronic renal failure (crf) treated by hemodialysis. 24-hours ECG recording with time domain HRV evaluation, resting, transthoracic echocardiography (ECHO), were measured in 59 crf patients and in 30 healthy volunteers. Creatinine, urea, total protein, albumin, electrolytes, hemoglobin, hematocrite and iPTH serum concentration as well as body mass index (BMI) were assessed in all patients. All crf patients had decreased lower values of HRV. The correlations between SDNN, pNN50, rMSSD and parameters of LVH and with PTH serum level indicated the disturbances of the autonomic function in chronic renal patients. Left ventricular hypertrophy (LVH) in all crf patients was observed. The correlations between iPTH serum level and parameters of LVH suggest the role of PTH in the development of uremic cardiomyopathy.

Objective: Prospective evaluation of the effect of 6-month-long intradialytic amino acids (AA) supplementation on selected nutritional variables in malnourished hemodialysis (HD) patients., Design: Multicenter, prospective, (nonrandomized, noncontrolled) observational study., Setting: Thirty-one HD units affiliated with academic centers and tertiary-care hospitals., Patients: Adult patients treated by HD for at least 6 months. Inclusion criteria were: serum albumin concentration < or =39 g/L and at least 4% loss of body weight during the last 6 months in otherwise stable HD patients. From a cohort of 133 patients who were enrolled, 97 (54 men and 43 women) were eligible for the analysis., Intervention: Intradialytic AA supplementation with 500 mL 10% solution per HD session for a period of 6 months., Main Outcome Measures: Serum albumin concentration, modified Subjective Global Assessment (SGA) score, body mass index (BMI), mid-arm circumference (MAC), and total lymphocyte count. Measurements were recorded at baseline and after 3 and 6 months of AA supplementation., Results: Serum albumin concentration increased significantly from the mean 32.5 +/- 4.6g/L at baseline to 36.4 +/- 4.8 g/L at 3 months (P <.001) and 37.1 +/- 4.8 g/L at final observation (P <.001 versus baseline). Significant correlation was observed between frequency of AA supplementation and serum albumin increase (r = 0.41; P <.0001). Rate of improvement negatively correlated significantly with baseline concentration of serum albumin (r = - 0.42; P <.0001). SGA score significantly improved from median of 16 points at baseline to 12 points at 3 months (P <.01) and 11 points at 6 months (P <.01 versus baseline), and this improvement also correlated with the frequency of AA supplementation. Small yet significant increase of MAC was observed at 6 months (from baseline 24.1 +/- 4.3 to 24.8 +/- 4.8 cm; P <.01), whereas BMI remained unchanged., Conclusion: Intradialytic AA supplementation improves selected nutritional parameters of HD patients with malnutrition. The improvement depends on the intensity of supplementation.

Unlabelled: Elevated serum concentration of cardiac troponin I (cTnl) is a highly sensitive and specific marker of myocardial damage. Patients with chronic renal failure (crf) treated by hemodialysis often have increased serum cTnl level without evidence of acute myocardial ischemia. In chronic HD patients, elevated serum concentration of endothelin-1 (ET-1) and angiotensin II have been reported which may be associated with ischemic heart disease. The aim of the present study was to investigate possible association between cTnl serum level, ET-I, angiotensin II, other cardiac markers and the structural changes of myocardium assessed by echocardiographic (ECHO) method. Fifty nine patients with crf treated by HD were studied. ECHO and ECG examinations were performed in all patients and serum levels of cTnl, endothelin-1 (ET-1), angiotensin II were evaluated. In all patients left ventricular mass (LVM) was increased, and in 78% of patients was found concentric hypertrophy of the heart while in 22% excentric hypertrophy was found. In 54 patients there was no ECG changes and ST segment depression in V4-V6 leads, less than 1 mm was found in 5 patients. Arterial hypertension was found in 44 patients (75%), systolic and diastolic pressure was significantly higher (p<0.05) than in a control group. Increased serum level of cTnl was found in 12.0% of HD patients, increased serum level of endothelin-1 and angiotensin II were found in all patients. LVM in HD patients with elevated cTnl levels was significantly higher than in patients with normal cTnl concentration. There was a positive correlation between LVM and cTnl levels, and between angiotensin II serum concentration and cTnl levels and between ET-1 serum level and RWT., In Conclusion: our findings suggest that elevated cTnl serum level reflect left ventricular hypertrophy and/or myocardial ischemia in HD patients, and indicate that ET-1 and angiotensin II might be associated with these conditions.

A case of 45-year-old patient with chronic renal failure treated by hemodialysis associated with skin changes typical for porphyria cutanea tarda is reported. The diagnosis was based on clinical manifestations and on histopathologic examination of the skin segment. The skin was low sensitive for UVA rays, serum levels of aluminium and lead were significantly elevated. We did not find porphyrins in the urine (24-hour collection 100 ml) as well as in the dialysis fluid.

Left ventricular hypertrophy (LVH) is common and important predictor of risk of death in end-stage renal failure. In the present study we have analysed echocardiographically the left ventricular hypertrophy and some possible risk factors continuing to its development in patients with chronic renal failure (crf) treated by hemodialysis (HD). From a cohort of 85 patients with crf we selected for analysis 59 clinically stable patients. Echocardiography (ECHO), body mass index (BMI), serum creatinine, urea, total protein, albumin, hemoglobin, hematocrit, electrolytes and parathyroid hormone (PTH) concentrations were evaluated in all patients at the next hours after HD session. LVH was common in HD patients: concentric LVH was detected by ECHO in 46 patients and in 13 patients eccentric LVH was observed. Mean serum concentrations of urea, creatinine, PTH and phosphate differed from normal values while hemoglobin, total protein, albumin, sodium kalium, calcium serum concentration were in the normal range. Positive correlation was found between PTH serum concentration and LVM r = 0.704 (p < 0.001), between PTH serum concentration and IVS r = 0.267 (p < 0.04), between PTH serum concentration and PW t = 0.238 (p < 0.04), and negative correlation between BMI and LVMI r = -0.451 (p < 0.05). The correlations between serum PTH concentration and LVH and between BMI and LVH confirmed that both hyperparathyroidism and malnutrition are important factors influencing the development of LVH in HD patients.

Low serum concentration of the carnitine is one of the causes of muscle weakness and cardiomyopathy in patients with chronic renal failure treated by hemodialysis. The carnitine facilitate transport of the free fatty acid into the straitened muscle cells where the product of oxidation is energy-ATP. In the present paper we presented the investigation of the influence of L-carnitine substitution on cardiac performance. The results indicate the positive influence of this treatment on metabolic and haemodynamic cardiac parameters. The subjective patients opinion of L-carnitine treatment was also positive.