Bone mineral density in chronic hemodialysis patients and its correlation to biochemical markers

Renal osteodystrophy may result in considerabli morbidity for patients with end-stage renal disease. Secondary hyperparathyroidism, adynamic bone disease and osteomalacia, the main bony problems in chronic renal failure, may all be responsible for a reduction in bone mineral density [BMD]. The aim of this study is to investigate the biochemical parameters and bone mineral density in patients undergoing regular hemodialysis and to assess their possible correlation to different variables, Patients and Methods: thirty nine patients with end-stage renal disease maintained on regular hemodialysis for variable intervals were participated in the study. Osteocalcin, type1-C terminal collagen propeptide [CICP], Osteoprotegrin [OPG], receptor activator of nuclear factor kB ligand [RANKL], parathyroid hormone [PTh], serum total calcium, inorganic phosphorus and alkaline phosphatase were estimated to all patients. Bone mineral density[BMD] was measured by dual energy X ray absorptiometry [DEXA] in lumbar spine and femoral neck with estimation of BMD t-score. Body mass index [BMI] was calculated. Assessment of correlation between clinical, laboratory data and BMD was done. There was a positive correlation between age, BMD and CICP, between BMI and RANKL and also between BMD hip and spine. BMD in both sites correlated inversely, with PTH [P< 0.01], there was a significant correlation between duration of dialysis and PTH [P< 0.001], calcium level and hip t-score were the most important variable for prediction of reduced BMD. Osteopenia was frequent in patients on hemodialysis and those with hyperparathyroidism and longer duration of hemodialysis were more susceptible to reduced BMD developing osteoporosis

Cigarette smoking as an acute threat for the cardiovascular system

Cigarette smoking is one of the major risk factors for cardiovascular disease as well as hyperlipidemia. Lecithin: Cholesterol acyl transferase [LCAT] activity represented a key factor in the esterification of serum cholesterol and reverse cholesterol transport. Leptin, the protein product of the ob gene, seems to regulate body fat stores. The present study was carried out to evaluate changes in the circulating levels of leptin, LCAT activity, insulin, glucose, cotinine and lipid profile [total cholesterol TC, triglycerides TG, HDLC, LDL-C], free fatty acids [FFA5] and apolipoprotiens [Apo Al and Apo B] in healthy smokers [n=48] and non smokers [n=32] group. The results showed remarkable increase in the levels of LDL-C, FFAs, cotinine, leptin [p<.000], TC[P<0.01] and glucose [p<0.05] in healthy smokers than non smokers group. However, the activity of LCAT and levels of HDL-C and Apo Al, were significantly reduced [p<.000] in smokers subjects than non smokers group. Present results showed, the significant increase in levels of leptin, FFAs, LDL-C and the significant decrease in HDL-C and LCAT activity during cigarette smoking which may implicate high risk for further vascular complications

Health related quality of life among Egyptian patients on hemodialysis

The present research was carried out to evaluate the physical [PCS] and mental [MCS] component summary scales in hemodialysis patients as compared to healthy subjects at a baseline and two years later. 130 patients on hemodialysis [mean age 40.6 +/- 8.1 years] were enrolled in the study between February 2003 to February 2005. The short-form with 36 [SF-36] questionnaire was given every 6 months to hemodialysis patients. Results were compared to the general population and changes in QoL over time were determined. Mean PCS was 34 +/- 15.46 and mean MCS was 38.80 +/- 15.17 compared to the general population there were significant decline in PCS and MCS at baseline and two years later. There was no significant correlation between causes of End-Stage Renal Disease [ESRD] and Quality of Life [QoL], except for diabetes mellitus as regard MCS. High levels of serum albumin and hemoglobin was associated with highly significant quality of life. Serum albumin was a good predictor for quality of life in this study. Adequacy of dialysis treatment in hemodialysis patients was determined by serum albumin, hematocrit, KT/V and Urea Reduction Ratio [URR]. Present results showed the negative impact that ESRD and hemodialysis treatment have on self-assessed physical and mental health and it is important to treat all factors that induce hypoalbuminemia as well as anaemia