Influence of Apolipoprotein E Polymorphism into Alteration of Atherosclerotic Cardiovascular Disease in CAPD Patients / 대한신장학회잡지

Specific apolipoprotein (apo) E genotype has been suggested as a risk factor for atherosclerosis in the general population. Lipid metabolism is known to be modulated by apo E genotype. In this study, we measured apo E genotype, lipoprotein (a)[Lp (a)], apo A phenotype and other lipoproteins in 50 CAPD patients, and evaluated the association of lipid parameters with atherosclerotic cardiovascular disease. Dipyridamole thallium scan with SPECT and ankle- arm blood pressure index (AABI) were performed in all the subjects. The patients who had positive finding in at least one of the two test were considered to have atherosclerotic cardiovascular disease [CVD (+)]. Fifteen patients had evidence of cardiovascular disease. Serum Lp (a) concentration (median; interquartile range) of CVD (+) patients (n=15, 62.0 mg/dl; 29.5-82.3) was not different from that of CVD (-) patients (n=35, 65.1mg/dl; 34.3-89.9). The frequency distribution of apo (a) phenotype of CVD (+) patients did not differ from that of CVD (-) patients. In addition, there were no differences of other lipoproteins levels and lipid profiles between two group. However, significant difference in the frequency distribution of apo E genotype (E2; 6.7 vs 20%, E3; 40 vs 68.6%, E4; 53.3 vs between CVD (+) and CVD (-) patients. After stratifying the subjects according to the apo E genotype, we observed no difference of lipid profiles, apolipoproteins and Lp (a) concentration in E2, E3, E4. Multivariate regression analysis of risk factors for CVD revealed age and the presence of apo E4 phenotype as independent risk factors of atherosclerotic cardiovascular disease. In conclusion, Apo E4 genotype could be an independent risk factor of atherosclerotic cardiovascular disease in CAPD patients.

Usefulness of Intravenous Iron Supplement During Recombinant Human Erythropoietin(rHuEPO) Therapy in Hemodialysis(HD) Patients / 대한신장학회잡지

Compared with iron dextran, iron chondroitin sulfate(ICS) is much cheaper and has better bioavailability. To evaluate the efficacy and safety of ICS in maintenance HD patients, i.v. ICS was given to 37 HD patients [20 M, 17 F, median age 51 years, median duration of HD 21 months] whose ferritin(Fer)or=100microgram/L and TFS>or=20% [Group II, 8 M, 7 F]. The patients had taken oral iron [227+/-73mg/day(mean+/-SD)] before this study. All patients received 120mg i.v. ICS weekly for 1 month. Then, ICS dosage was adjusted to 40-120mg/week depending on Hb, Fer and TFS in the following 3 months. Hb, Fer, TFS, rHuEPO dose and side effects were monitored monthly. The results were as follows : 1) I.v. iron therapy produced a significant rise in Hb(8.3+/-0.9g/dL to 9.7+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(95+/-50U/kg/wk to 69+/-28U/kg/wk; P<0.05), a significant increase in serum ferritin levels(162+/-149microgram/L to 472+/-255microgram/L; P<0.01) and TFS(24+/-13% to 41+/-18%; P<0.05). 2) In group 1, i.v. iron therapy produced a significant rise in Hb(8.5+/-1.1g/dL to 9.9+/-0.9g/dL; P< 0.01), a significant reduction in rHuEPO dose(87+/-45U/kg/wk to 69+/-27U/kg/wk; P<0.05), increased serum ferritin levels(90+/-48microgram/L to 379+/-186microgram/L; P<0.01) and TFS(18+/-9% to 36+/-16%; P<0.05). 3) In group 2, i.v. iron therapy produced a significant rise in Hb(8.1+/-0.6g/dL to 9.3+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(108+/-55U/kg/ wk to 69+/-31U/kg/wk; P<0.05) and increased serum ferritin levels(274+/-185microgram/L to 602+/-287microgram/L; P< 0.01) with a tendency of increase in TFS(35+/-13% to 41+/-18%; P=0.06). 4) No significant side effect was observed. 5) An annual cost reduction of 221 US dollars per patient was expected. In conclusion, ICS is an effective and safe intravenous iron preparation in HD patients.