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

Study of erythropoeitin on IGM serum levels in HCV positive patients on regular HD

Both uremia and HD process cause immunosuppression in HD patients. There was significant increase of total serum IgG and IgM levels found in patients with chronic HCV compared with healthy controls. There is evidence pointing to direct effect of rHuEPO upon B cells. High doses of recombinant human erythropoietin [rHu EPO] enhanced in vitro Ig production and proliferation of various plasma cell lines, as well as human plasma cells generated in vitro. Study was conducted at hemodialysis Unit of Shubra Municipal hospital between August 2010 to February 2011. 30 HCV positive patients on regular hemodialysis were included in study, using bicarbonate dialysate and polysulfone membrane dialyser, for 4 hours 3 times weekly. Patients were divided into 2 groups: first group: 15 patients on EPO therapy. 4000 IU/week and second group not taking EPO for all patients full clinical examination was done, CBC, BUN, serum creatinine, ALT, AST, serum albumin and serum IgM by ELISA [quantitative assay], were done. There was no significant difference between 2 groups as regards age, sex distribution, WBC count, ALT, AST, serum creatinine, BUN and IgM serum level. First group had borderline significant higher Hgb and Hct than second group [p = 0.056]. Females didn't have higher serum IgM level than males [p = 0.403]. All correlations of IgM serum level to other parameters of study were irrelevant. Uremia seems to protect ESRD patients on regular HD from complications of HCV and also EPO effect on Ig serum levels