Search

The effects of acute changes during hemodialysis (HD) on the myocardium are not yet known. The invention of three-dimensional speckle tracking echocardiography (3DSTE) has offered clinicians a new method to assess the movements of ventricular segments simultaneously in three spatial directions. The aim of this study was to evaluate the effect of first weekly standard HD process on the left ventricle (LV) and right ventricle (RV) global and regional myocardial function in patients with normal left ventricle ejection fraction using 3DSTE-derived indices. Patients (n=38) receiving maintenance HD in our clinic who have no known cardiovascular disease are examined just before and after a HD session using 3DSTE. Demographic and comorbidity data, renal replacement treatment characteristics, and laboratory test results are recorded. 3DSTE analysis is performed to calculate the LV global longitudinal, circumferential area and radial peak systolic strain, as well as RV septum and free-wall longitudinal strain and fractional area change. Patients are aged 52.8 ± 13.6 years and 52.6% of them are male. Mean dialysis duration is 56 months. The LV strain values of the patients changed markedly before and after HD (GLS: -14.2 ± 5.2, -11.1 ± 4.6 [P < .001], GCS: -14.8 ± 4.2, -12.4 ± 5.28 [P < .009]; GRS: 41.5 ± 16, 33.3 ± 16.5 [P = .003]; AREA -24.7 ± 7.2, -20.1 ± 7.6 [P = .001], respectively). We could not demonstrate any improvement in RV strain values before or after HD. LV strain values are positively correlated with blood pressure variability during the dialysis sessions. LV function is preserved better after HD in patients on beta or calcium channel blocker therapy compared to those who do not use these agents (P < .001, P < .01, respectively). HD treatment results in deterioration in all LV strain directions but not in RV. Strain assessment may improve vascular risk stratification of patients on chronic HD., (© 2020 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background/aims: The objective of this study is to evaluate the relation between sclerostin, arterial stiffness, and cardiovascular events (CVE) in hemodialysis patients (HD)., Methods: Sclerostin level and carotid-femoral pulse wave velocity (PWV) in 97 HD patients and sclerostin level in 40 controls were measured., Results: Sclerostin level was significantly higher in patients than in controls. Sclerostin associated positively with age, male gender, cardiovascular disease, statin use, BMI, and PWV while negatively with alkaline phosphatase, parathormone (PTH), Kt/V, cinacalcet and vitamin D use in univariable correlation analyses. Sclerostin associated positively with male gender and statin use but negatively with PTH in multivariate regression analyses. During observation, 30 fatal or nonfatal CVEs were observed. While univariate correlation analysis showed a positive association between PWV and sclerostin, there was no relation between the two in multivariate regression analysis., Conclusion: Further studies are needed to understand the role of sclerostin in predicting PWV changes in HD patients., (© 2018 S. Karger AG, Basel.)

Objective: Myocardial performance index (MPI, Tei index) has been described as a noninvasive measurement of left ventricle (LV) function. Our aim was to investigate the influence of preload on the LV MPI obtained by pulsed-wave tissue Doppler imaging (PWTDI) and determined by flow Doppler waveforms in patients with end-stage chronic renal failure (CRF). The second aim of this study was to investigate the relationship between the Tei indices obtained by both methods., Methods: Eighty-four patients on regular hemodialysis (HD) treatment were included (mean age of 45.3 ± 14.5 years). Standard echocardiographic measurements, the Tei indices obtained by conventional flow Doppler and PWTDI methods, mitral inflow velocities, and mitral lateral annulus tissue Doppler velocities were measured immediately before and after hemodialysis., Results: After HD, weight loss in patients was significantly revealed (predialysis 63.6 ± 13.3 kg; postdialysis 60.9 ± 13.0 kg; P < 0.001). Left ventricle and left atrium diameters were significantly decreased after HD. Transmitral E and A velocities decreased after HD. Although Tei index measuring by conventional flow Doppler method significantly increased, Tei index measuring by PWTDI did not change after HD., Conclusions: The conventional flow Doppler-derived LV Tei index is influenced by hemodialysis. However, PWTDI-derived LV Tei index is not influenced by hemodialysis. The loading status of a patient should be taken into account during the application of the Tei index to the evaluation of myocardial performance., (© 2015, Wiley Periodicals, Inc.)

Background: Arterial stiffness and left ventricular hypertrophy (LVH) are major independent risk factors for cardiovascular disease in healthy and renal population. In this study, we aimed to investigate comparative long-term effects of renal transplantation (RTx) and of hemodialysis (HD) on both arterial stiffness and LVH., Methods: Twenty-eight RTx patients, 23 HD patients, and 20 healthy subjects were included in this prospective study. In addition to demographical and laboratory parameters, arterial stiffness [pulse wave velocity (PWV)] and left ventricular mass index (LVMi) were assessed before and one-yr after RTx, and at the baseline and one-yr later in HD patients., Results: There were no differences in the parameters between HD and RTx patients at baseline. PWV was significantly higher than that of healthy controls. After one yr, PWV had significantly decreased in RTx patients, but was unchanged in HD patients. Changes in PWV were significant when both groups were compared (p < 0.0001). Although LVMi significantly decreased after RTx (p = 0.02), changes were not significant between the groups., Conclusions: Renal transplantation markedly improved arterial stiffness, while it remained elevated in HD patients at the one-yr follow-up. There was no difference between maintenance HD and RTx groups with respect to impact on LVMi in the one-yr follow-up.

Background: The long-term behavior of left ventricular hypertrophy (LVH) was evaluated and potential predictors of change in left ventricular mass index (LVMI) in hemodialysis (HD) patients were determined., Methods: One hundred eight patients on regular HD treatment were included. In addition to hematologic and biochemical evaluations, annual echocardiography and 24-hour ambulatory blood pressure monitoring were performed in all patients. During the median follow-up of 50 months (range, 12 to 63 months), a median of 4 echocardiographic examinations were performed in each patient. The presence of LVH was defined on the basis of an LVMI greater than 131 g/m2 for men and greater than 100 g/m2 for women., Results: Eighty-two patients (75.9%) had LVH at baseline. LVH status was stable in 64 patients, whereas it changed on at least 1 occasion in the remaining patients (40.7%). LVH disappeared during the first year in 8 patients and beyond the first year of dialysis therapy in an additional 9 patients. An 8.0 +/- 39.6-g/m2 decrease in LVMI was detected between the first and final evaluations. Independent predictors of change in LVMI were C-reactive protein level (P < 0.001), baseline hemoglobin level (P = 0.025), and baseline postdialysis systolic blood pressure (P = 0.003). Twenty-four-hour systolic blood pressure was the only independent predictor of both LVMI (P < 0.001) and LVH (P = 0.001) at baseline. Nighttime systolic blood pressure and C-reactive protein level were found to be independent predictors of final LVMI (P < 0.001 for both). Independent predictors of LVH at the end of the study were 24-hour systolic blood pressure (P = 0.022) and C-reactive protein level (P = 0.003), whereas hemoglobin level had marginal significance (P = 0.051)., Conclusion: Progressive LVH is not inevitable in HD patients. Aggressive treatment against the predictors may result in regression of LVMI and may improve patient outcome.

Dialysis improves most symptoms of end-stage renal disease (ESRD), yet many patients continue to experience sexual dysfunction (SD) during the dialysis treatment. The aim of this preliminary study was to evaluate the frequency and the course of SD during a 6-month dialysis treatment. Additionally, relationships between the level of depression, cognitive impairment and biochemical parameters of SD were also assessed. The subjects were 43 ESRD (25 male and 18 female) on dialysis treatment for at least 12 months. SD was assessed using the Arizona Sexual Experiences Scale (ASEX); the level of depression and cognitive impairment were assessed using the Hamilton Depression Rating Scale (HDRS) and Mini Mental Status Exam (MMSE). Several biochemical parameters were also assessed. All assessments were carried out at baseline and repeated at 6-month follow-up. Of 43 patients, 20 (47%) and 18 (42%) complained of SD at baseline and at 6-month assessments, respectively. Of 25 males, nine (36%) and seven (28%) patients described SD at baseline and 6-month assessments, respectively; erectile dysfunction was the most frequent complaint. Of 18 females, 11 (61%) and 11 (61%) patients reported SD at baseline and 6-month assessments, respectively; difficulties with arousal and reaching orgasm were the most frequent complaints. Both total and item-by-item comparisons of baseline and 6 months ASEX scores did not reveal any significant changes during 6-month period, indicating that patient's sexual functions do not improve with dialysis treatment. For female patients, HDRS scores were significantly higher in patients with SD at baseline (t = 2.15, P = 0.05) and at 6-month follow-up (t = 2.44, P = 0.03) assessments; after excluding the effects of age and duration of dialysis for females using regression analysis, HDRS still significantly (t = 4.02, P = 0.003) associated with the SD. This preliminary prospective study suggests that SD is frequent in dialysis patients, does not remit with dialysis treatment, associated with depression in female patients, and much clinical attention is indicated.

There are various changes in the thyroid gland and its function in chronic renal failure (CRF). These changes include lower levels of circulating thyroid hormone, altered peripheral hormone metabolism, decreased binding to carrier proteins, possible reduction in tissue hormone content, and increased iodine storage in the thyroid gland. The decrease of excretion of urinary iodine in CRF increases serum inorganic iodine level and iodine content of the thyroid, which consequently enlarges the gland. This study is designed to investigate the prevalence of goiter and thyroid dysfunction in patients with end-stage renal disease (ESRD) on hemodialysis (HD) in an iodine-deficient community. Eighty-seven (40 females and 47 males) HD patients and 169 (79 females and 90 males) healthy individuals as controls are included. Sex ratios for the patient and control groups are 0.85 and 0.88, respectively. Mean ages for the patient and control groups are 42.94 +/- 11.88 and 40.20 +/- 10.72 years, respectively. Examination of the thyroid gland using ultrasonography along with simultaneous measurement of blood levels of free-T4 (FT4), free-T3 (FT3), and thyrotropin (TSH) are made for every individual. The presence of goiter demonstrable by ultrasonography is found in 32.2% of the uremic patients and in 23.5% of the controls and its prevalence increases with age (P = 0.01). In 32 (36.8%) of the patients and 29 (17.1%) of the controls at least one thyroid nodule is found in ultrasonography. Between patients with or without a nodular goiter the authors could not observe any difference for duration of dialysis and serum levels of TSH, FT4, FT3, calcium, and albumin. In ESRD patients the prevalence of nodular goiter is higher for females (47.5% vs. 27.7%, P = 0.045) and increases with age (P = 0.04). Though incidence of hyperthyroidism is found to be similar for the two groups (1.14% in ESRD patients vs. 1.10% in controls), hypothyroidism is observed in 3.4% of ESRD patients but only 0.6% of controls. This high incidence of hypothyroidism and nodular goiter in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests and ultrasonography, should be considered in evaluation of every ESRD patient.

Background: Relevance of serum CRP for morbidity and mortality in pre-dialysis patients has not been assessed extensively. The aim of this study was to determine the incidence of elevated serum CRP in pre-dialysis patients and to identify the factors that associate with serum CRP. We were also evaluated the effects of serum CRP on cardiovascular disease, anemia, and nutritional markers., Methods: One hundred and eight pre-dialysis patients with a mean creatinine clearance (CrCl) of 30.1 ml/min were included in the study. Data collected from each patient included demographics, co-morbidity, medications, blood pressures, blood biochemistry including serum CRP, renal function, and echocardiography., Results: Serum CRP was elevated (>5 mg/l) in 43 patients (39.8%). There was a negative correlation between serum CRP and CrCl (r = -0.370, p < 0.001). CrCl was the unique independent factor affecting serum CRP. Serum CRP was an independent factor affecting left ventricular mass index, fractional shortening, serum albumin and hematocrit in multivariate analyses., Conclusions: Prevalence of elevated serum CRP in pre-dialysis patients is high. Reduced renal clearance of CRP and/or cytokines may contribute to the inflammatory status. Elevated serum CRP is an important cause of morbidity in pre-dialysis patients., (Copyright 2005 S. Karger AG, Basel.)

The major goal of this study is to assess the frequency of psychiatric disorders in end-stage renal disease (ESRD) patients, who were on hemodialysis (HD) treatment in Turkey. Additionally, it aims to determine whether depression, anxiety, and functional and occupational levels of patients who did not receive any psychiatric treatments change at the end of 6 months. We conducted Structured Clinical Interview for the DSM-IV, Clinical Version on 50 HD patients, and 16 (32%) fulfilled the criteria for a psychiatric disorder. Depressive disorder, not otherwise specified, was observed in 12 (24%) patients. Adjustment disorder with depressed mood and dysthymic disorder were observed in 8% of our population. Fourteen patients were followed up for 6 months. All patients were assessed with Hamilton Depression (HDRS), Anxiety Rating Scale (HARS), and Global Assessment of Functioning (GAF) at baseline and at 6 months. The comparisons of baseline and 6 months HDRS, HARS, and GAF scale scores did not reveal any statistically significant differences in 14 depressed patients. The level of depression, anxiety, and functional and occupational impairment did not remit spontaneously in our untreated depressed HD patients. We believe that further studies regarding categorization, prognosis, and treatment of these patients are needed to better understand what to do when we encounter depressive ESRD patients.

Background: Vitamin C has been reported to be an effective adjuvant agent in the treatment of anemia in iron-overloaded hemodialysis patients. We aim to evaluate its effect on erythropoietin (EPO) response in a prospective, randomized, double-blind, crossover study., Methods: Sixty-three patients were randomly divided into two groups. Group 1 was treated with intravenous vitamin C, 500 mg, three times a week, and group 2, with placebo for 6 months. During the second 6-month period, group 1 was treated with placebo, and group 2, with the same dose of vitamin C. Thirty patients in group 1 and 28 patients in group 2 completed the study. Hemoglobin levels, weekly EPO dose, and ratio of EPO to hemoglobin as an index of EPO need were determined at both baseline and the end of the two periods, together with other parameters known to be associated with EPO response., Results: Twenty patients in group 1 (66.7%) and 18 patients in group 2 (64.3%) were responsive to vitamin C. In both groups, vitamin C resulted in a significant increase in hemoglobin levels (P < 0.0001 for both) and a significant decrease in EPO-hemoglobin ratio (P < 0.0001, P = 0.019). Transferrin saturation also increased with vitamin C treatment in both groups (P = 0.009, P = 0.005). All these parameters remained stable with placebo in both groups. Other parameters did not change throughout the study., Conclusion: Vitamin C can be used as an effective adjuvant therapy to EPO in hemodialysis patients. Further studies are needed to determine possible predictors of hematologic response to vitamin C.

Objective: Today questionnaires developed to assess important outcome measures such as health-related quality of life are widely used. In this study we evaluated the construct validity of the Nottingham Health Profile (NHP) and the reliability of its Turkish version in hemodialysis patients., Methods: In a sample of patients on renal dialysis (n = 94) the quality of life is measured by the NHP. The validity of this questionnaire is evaluated by using the Kidney Disease Questionnaire (KDQ) in the same patient group. The NHP is administered twice to each patient, at dialysis intervals two weeks apart., Results: NHP scores at both administrations are similar in both assessments. Pearson's correlation coefficients range from 0.61 to 0.84. Cronbach's alpha coefficients for the NHP sections range between 0.64 and 0.79. The alpha coefficients for three of the NHP scales (energy, sleep and social isolation) are well below 0.7. In the KDQ the mean values obtained for the five dimensions are: 4.2 +/- 1.5 for physical symptoms, 4.8 +/- 1.7 for fatigue, 4.9 +/- 1.9 for depression, 4.2 +/- 1.2 for relationship with others, and 4.8 +/- 1.5 for frustration. In general the correlation between the dimensions of the NHP and KDQ is good and the correlation coefficients varies from 0.18 to 0.73. Clinical validity is assessed by examining the correlation between the results obtained for the two questionnaires (components of the NHP and KDQ) and hemoglobin level, number of the co-morbid conditions and educational level., Conclusions: The NHP is shown to have construct validity when used in patients with end-stage renal disease (ESRD) in Turkey. The application of the NHP in patients with ESRD is easy, fast and the questions are not difficult to understand. The multiple-degree scoring in the KDQ causes a complexity in answering. The correlation between the dimensions of the NHP and KDQ is good. Our results show better correlations between disease specific questionnaires and clinical parameters.

Background: Both in vitro and in vivo studies have shown that calcitriol, the active form of vitamin D, is involved in hematopoiesis. We hypothesized that the vitamin D receptor (VDR) genotype, which may differentiate response to endogenous or exogenous active vitamin D, has a role in the management of anemia in hemodialysis (HD) patients., Methods: The VDR BsmI gene polymorphism was determined in 91 HD patients and 85 healthy controls. In addition to well-known factors responsible for both anemia and inadequate response to erythropoietin (EPO), we examined the contribution of the VDR genotype to hematocrit (Hct), hemoglobin (Hb) level, total weekly dose of EPO, and EPO-Hb ratio as an index of patient EPO need., Results: Genotype distributions for the VDR gene were under the Hardy-Weinberg equilibrium and similar in patients and controls (genotypes BB, Bb, and bb: 22.0%, 38.5%, and 39.5% in patients versus 24.7%, 48.2%, and 27.1% in controls). There were statistically significant differences in Hct, Hb level, EPO dose, and EPO-Hb ratio in patients with the three BsmI genotypes, whereas the other parameters were the same. Comparison of patients with an Hb level less than versus greater than 11 g/dL showed that the former patients had lower albumin levels (P = 0.001), higher C-reactive protein levels (P = 0.014), and a greater frequency of BB genotype (P < 0.001). Similarly, comparison of patients with an EPO-Hb ratio in the highest quartile versus those in the lowest quartile showed that the former patients had lower albumin and transferrin levels (P = 0.013 for both) and greater frequencies of BB genotype (P = 0.016). In logistic regression analysis, both BB genotype and low serum albumin level were found to be the only independent predictors for an Hb level less than 11 g/dL (P < 0.001 and P = 0.046, respectively). Both parameters also predicted being in the highest quartile of EPO-Hb ratio (P = 0.004 for both)., Conclusion: The VDR BsmI gene polymorphism may predict both Hb level and EPO need in HD patients. However, because the underlying mechanisms have not been clarified in the present study, further research on this issue is needed., (Copyright 2002 by the National Kidney Foundation, Inc.)

The prevalence of Cryptosporidium infection in patients who are on chronic hemodialysis due to end-stage renal failure is investigated and compared with the incidence in the healthy population. Stool specimens of 74 adult hemodialysis patients treated on an outpatient basis and 50 healthy individuals are examined for Cryptosporidium oocysts by using the modified acid-fast method. While 20.27% (15/74) of patients in the dialysis group had Cryptosporidium oocysts in their stools, none (0/50) of the controls had such an infection (p < 0.001). Ten of 15 patients who had Cryptosporidium oocysts in their stool specimens were asymptomatic and the remaining 5 had diarrhea. Four of these 5 diarrheic patients had Cryptosporidium oocysts in their stools and 1 had both Cryptosporidium oocysts and Giardia trophozoites. Since hemodialysis patients with chronic renal failure are candidates for renal transplantation, general preventive measures against infection must be taken and these patients must be screened for their carrier state before transplantation., (Copyright 2002 S. Karger AG, Basel)

We sought to determine the prevalence, recognition, and consequences of mental impairment among chronic hemodialysis patients. We administered the Mini Mental Status Exam (MMSE), a brief validated method for assessing cognitive mental status that is commonly used by clinicians, to 84 patients from our dialysis units. To determine the clinical implications of mental impairment, we obtained Kt/V, albumin, protein catabolic rate, blood pressure, and hematocrit values. We found that 21% of subjects had mild mental impairment (MMSE 18 to 23) and that 11% had moderate-severe mental impairment (MMSE 0 to 17). We found no relationship between MMSE score and years on dialysis, Kt/V value, hematocrit value, or erythropoietin use. On univariate analysis, MMSE score was associated with albumin, protein catabolic rate, inter-dialytic weight gain, number of co-morbid conditions, number of hospitalizations. Outcomes on univariate analysis were further analyzed by multivariate analysis. There was an independent relationship between decrement in MMSE score and lower protein catabolic rate and increased hospitalization number and number of co-morbid conditions. Based on our findings, we recommend that clinicians routinely screen hemodialysis patients for mental impairment and target impaired patients for interventions to improve mental status and associated adverse outcomes.