Effect of Endotoxemia on Cardiac Disease in high and low flux Hemodialysis patients

Background: endotoxemia can be the missing link between ESRD and cardiac disease, the first cause of death in hemodialysis patients

Patients and methods: patients were recruited from Ain Shams University Hospitals, hemodialysis units. 120 patients on prevalent HD were enrolled in the study: 31 cardiac patients on high flux HD [group A], 29 cardiac patients on low flux HD [group B], 32 non-cardiac high flux HD [group C], and 28 non cardiac low flux HD [group D] . For all patients we measured: Hb, URR, serum albumin, HsCRP, predialysis and postdialysisa endotoxin, endotoxin delta change, echocardiography, and ECG

Results: we found that cardiac high flux and low flux groups had higher endotoxemia levels than non cardiac high flux and low flux groups

Conclusion: High flux hemodialysis patients had higher accumulated endotoxin than low flux hemodialysis patients, within either cardiac or non - cardiac groups

Non-fasting non-high density lipoprotein cholesterol [Non-HDL-C] as a predictor of atherosclerosis in patients with end stage renal disease on regular hemodialysis

Fifty patients with chronic renal failure on regular hemodialysis 31 males and 19 females, aged from 18 to 62 years were included in the study. They were selected from those attending the Nephrology and Dialysis Unit in Damanhour Medical Institute. Ten age and sex matched subjects with normal renal function served as control group. Full history taking, clinical examination, resting ECG and serum cholesterol, HDL [non-fasting], fasting LDL, non-fasting non-HDL from special equation, Non- HDL = total cholesterol - HDL and Duplex scanning of both carotid and femoral arteries. Non fasting non-HDL was more than 130 mg/dl in more than 65% of patients group versus 30% in control group, serum level of non-fasting cholesterol and non-fasting non-HDL were significantly elevated in hemodialysis patients as compared with control group, while serum level of non-fasting HDL and fasting LDL were significantly decreased in hemodialysis patients as compared with control group. Intima-Media thickness [IMT] of both carotids and both femoral arteries was elevated in hemodialysis patients as compared with control group. There was a significant positive correlation between non-fasting non-HDL and IMT of both carotids and both femoral arteries and a significant positive correlation between fasting LDL and IMT of both carotids and femoral arteries. There was a significant positive correlation between duration of dialysis and IMT of both carotids and left femoral arteries. A positive correlation exists between ECG ischemic changes and IMT of both carotids and left femoral arteries and between carotid plaques and IMT of both carotids and left femoral arteries