A Long-term Study On Changes of Serum Middle Molecules Concentration according to the Frequency of On-line Hemodiafiltration :A Comparison between 1/week and 3/week On-line Hemodiafiltration / 대한신장학회지

PURPOSE:The purpose of this study was to assess the effect of long-term and differing frequency of on-line hemodiafiltration (OL-HDF) on changes in degree of hemoglobin, albumin level, serum small and middle molecules concentration in stable patients with undergoing high-flux hemodialysis (HF-HD). METHODS:Twenty five patients with more than 3 months of HF-HD were divided into two groups and followed for more than 36 months. Group 1 was treated once with OL-HDF and twice with HF-HD per week. Group 2 was treated three times with OL-HDF per week. Analysis was performed to compare hemoglobin, biochemical parameters, serum beta-microglobulin, leptin, alpha-microglobulin levels in both groups. RESULTS:There were significant improvements in hemoglobin and albumin level in group 2 compared to group 1. After receiving OL-HDF for a mean of 24 months, patients on both groups had the significantly reduced predialysis level of beta-microglobulin compared to baseline level. However, there is no significant difference in beta-microglobulin level between both groups. The predialysis level of leptin and alpha-microglobulin with relatively large molecular weight was not significantly reduced during observational period and was not significantly different between both groups. CONCLUSION:There were improvements in hemoglobin and albumin level according to the frequency of OL-HDF. The predialysis level of beta-microglobulin was significantly reduced after receiving even once with OL-HDF per week for long-term. Therefore, our study can suggest that there is no correlation between the frequency of OL-HDF and the predialysis level of beta-microglobulin.

Assessment of Fluid Shifts of Body Compartments using Both Bioimpedance Analysis and Blood Volume Monitoring

Fluid shifts are commonplace in chronic hemodialysis patients during the intra- and interdialytic periods. In this study, we evaluated fluid shifts of body compartments using both bioimpedance spectroscopy and blood volume monitoring from the start to the end of hemodialysis. 24 stable hemodialysis patients were included on the study. Relative change of blood volume was progressively reduced from the start to the end of hemodialysis (1 hr, -7.22+/-3.23%; 2 hr, -9.78+/-4.69%; 3 hr, -12.88+/-5.65%; 4 hr, -15.41+/-6.54%, respectively). Mean % reduction of intracellular fluid was not significantly different to that of extracellular fluid at the end of hemodialysis (delta ICF, -6.58+/-5.34% vs. delta ECF, -7.07+/-5.12%). Mean % fluid reduction of arms, legs and trunk was -11.98+/-6.76%, -6.43+/-4.37% and -7.47+/-4.56%, respectively at the end of hemodialysis. There were 3 characteristic patterns in blood-volume change. Similar amounts of fluid were removed from the extracellular and intracellular compartments during hemodialysis, with the arms showing the greatest loss in terms of body segments. The pattern of blood volume change measured by blood volume monitoring may be useful for more accurate determination of dry-weight and for correcting volume status in hemodialysis patients.

A Case of Hemolytic Uremic Syndrome associated with EB Virus Infection / 대한신장학회잡지

Hemolytic uremic syndrome (HUS) is characterized clinically by classic triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The illness is uncommon and various agents have been associated with HUS, such as infectious, genetic, environmental and phamacological factor. We experienced a case of hemolytic uremic syndrome in a eighty-year old man with a evidence for recent Epstein-barr virus infection. He developed hemolytic anemia, thrombocytopenia, hypertension and azotemia. His renal dysfunction was recovered by hemodialysis, plasmapheresis, warfarin and dypiridamole. We present this case with a review of the literature.

Heat Shock Protein Expression in Adenosine Triphosphate Depleted Renal Epithelial Cells

BACKGROUND: In this study, the putative interactions between apoptosis and heat shock proteins disturbed as a result of ATP depletion were investigated as a hypoxia model. METHODS: The direct cellular damages were assessed by the release of LDH from the cytoplasm of the human tubular epithelial cells (HK-2 cells) following ATP depletion. The Bcl-2/Bax mRNA expression ratio, used as an index to assess to what extent apoptosis contributed to tubular cell damage, and the expressions of HSP 90, 72 and 27 in relation to the Bcl-2/Bax ratio in the ischemic model, as parameters of their functional contributions to tubule cell damage, were also studied. Heat preconditioning (HS) was performed at 43 degrees in a temperature-regulated water bath for 1 h. RESULTS: The release of LDH due to ATP depletion was not significantly increased in HK-2 cells compared to the control, but was slightly increased in heat preconditioned cells compared to non heat preconditioned cells, but the difference was not statistically significant (6.33 +/- 0.57 U/L vs. 8.67 +/- 2.52 U/L, p> 0.05). The Bcl-2/ Bax mRNA expression ratio increased progressively from the control to the heat preconditioned and ATP depleted cells (control; 100%, ATP depletion; 154 +/- 6%, heat preconditioning; 212 +/- 6%, heat preconditioning and ATP depletion; 421 +/- 8%). No contribution of heat preconditioning and ATP depletion was observed on the expressions of HSP90 and HSP27. However, HSP72 expression was prominent by ATP depletion, especially after heat preconditioning. CONCLUSION: There may be a possibility that the preservation of cytolytic damage and an increase in the Bcl-2/Bax mRNA expression ratio is related to the increase of HSP72 in ATP depletion as a hypoxia model.