Search

The aim of the study is to analyze the voice changes occurring during a hemodialysis session objectively and to investigate the statistical correlation between voice changes and ultrafiltration, blood pressure, dry weight and the other variables of the patients.A total of 169 patients were included in the study. Electronic voice recordings of the patients were performed with the aim of making objective voice analysis before and after dialysis. Fundamental frequency measurements occurring at the level of the larynx (Fo) and harmonic-to-noise ratio (HNR) were measured from these voice recordings.When the voice recordings obtained from 169 hemodialysis patients before and after dialysis were investigated, it was observed that a significant increase occurred in the Fo (from 164.52±43.36 Hz to 193.19±47.08 Hz, p0.01). When the change in HNR was investigated, a significant reduction was determined in the post-dialysis measurements (4.6±3.23 dB) compared to the pre-dialysis measurements (16.10±4.06 dB, p0.01). Mean 2.49±0.83 L of ultrafiltration was performed and a significant reduction was observed in post-session body weights of the patients (p0.01). There was a highly statistical significance between the measurements of post-dialysis Fo and post-dialysis body weights. A highly significant correlation was determined between the amount of ultrafiltration performed and a significant increase observed in Fo before and after dialysis. Also a significant correlation was determined between the reduction in the mean post-session blood pressures and the reduction in the HNRs.Objective voice analysis is suggesting that it can be a simple and applicable method that can be used to determine the dry weight.

Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular complications in hemodialysis (HD) patients. Hypervolemia has been accepted as an independent risk factor for progressive LVH in HD patients. Additionally, high FGF23 levels have been a significant predictor of cardiovascular mortality and morbidity in chronic kidney disease and HD patients. The aim of our study is to investigate the correlation among LVH, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program.A total of 97 chronic hemodialysis patients (64.43 ± 11.28 years old, M/F:47/50) were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples. Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using the Devereux Formula. We collected the following data: LVMI, FGF-23 levels, interdialytic fluid gain, blood pressure changes, and the other biochemical and clinical parameters.Mean LVMI of the patients was 184.41 ± 48.62 g/m(2). LVMI of the patients with daily urine output250 mL was found significantly lower. Statistically significant positive correlation was found between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements (p0.01). Mean interdialytic volume excess was correlated with LVMI measurements of the patients (r = 0.459; p0.01). Increased FGF-23 levels (159.79 ± 134.99 ng/L) predicted increased LVMI measurements of the patients (r = 0.322; p0.01). In addition, FGF-23 levels were also increased as the interdialytic fluid volume increased (r = 0.326; p0.05). A positive correlation was also found between FGF-23 levels and interventricular septum thickness (r = 0.238; p0.05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI on multivariate regression analysis.Our study showed that interdialytic volume overload increased both LVMI and FGF-23 values. We can consider that interdialytic volume control exerts positive effects on increased FGF-23 levels which predict the negative cardiovascular outcomes.

Patients with subclinical hypothyroidism (sHT) have an increased risk of developing atherosclerosis, probably related to dyslipidemia. We compared the effects of levothyroxine (L-T4) versus simvastatin treatment on carotid intima-media thickness (IMT) and lipid profiles in patients with sHT.Forty female patients with newly-diagnosed sHT and 20 age- and-sex matched euthyroid female controls were enrolled. Patients were randomized to receive L-T4 (n = 20) or simvastatin (n = 20) for 8 months. Carotid IMT and the serum concentration of cholesterol were measured at baseline and at the end of the treatment.Compared with controls, sHT patients had higher IMT values (0.66 +/- 0.16 mm versus 0.54 +/- 0.10 mm, P0.001). A significant reduction in serum levels of total and low-density lipoprotein (LDL)-cholesterol, triglycerides and mean IMT was observed in patients randomized to the simvastatin group compared to their baseline values. No correlation was demonstrated between the changes in total or LDL-cholesterol concentration and IMT in the simvastatin group. L-T4 replacement resulted in a significant reduction in IMT but serum lipid levels did not change significantly.Our results demonstrate that simvastatin significantly reduces IMT in addition to the significant improvement in serum lipids in female patients with sHT. This reduction of IMT was independent of the decrease in serum cholesterol during simvastatin treatment. Although L-T4 substitution therapy also decreases IMT, it does not appear to significantly improve lipid levels.

Patients with subclinical hypothyroidism (SCH) have impaired endothelial function probably related to dyslipidemia. The present study compares the effects of simvastatin versus levothyroxine (LT-4) treatment on lipid profile and endothelial function in patients with SCH. Fifty-nine patients with newly diagnosed SCH were enrolled. Patients were randomized into 3 groups to receive no treatment (n = 19), LT-4 (n = 20), or simvastatin (n = 20). We measured endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) at baseline and after 8 months. Serum total cholesterol, triglycerides and LDL-cholesterol were significantly lower following simvastatin. EDV increased significantly in simvastatin treatment group (7.5% +/- 3.3% vs 14.0% +/- 4.5% (P < 0.01). The improvement of EDV correlated with the percent decrease of LDL-cholesterol (rho = 0.68, P < 0.01). Although LT-4 therapy caused a trend towards an increase in EDV compared to baseline, statistical significance was not achieved. EIV remained unchanged in all three groups. Simvastatin but not LT-4 treatment significantly improves EDV of the brachial artery and dyslipidemia in patients with SCH. Improvement in brachial artery endothelial function may be related in part to a hypolipidemic effect of simvastatin treatment.