The Effects of On-line Hemodiafiltration on Oxidative Stress and beta2-Microglobulin in Comparison with High-Flux Hemodialysis / 대한신장학회잡지

OBJECTIVE: On-line hemodiafiltration (OL-HDF) is a method that combines diffusive and convective solute transport component. OL-HDF provides improved solute clearance for both low-and large molecular-weight uremic toxins by enhancing convective clearance through highly permeable membranes. The aim of this study is to evaluate the effect of OL-HDF on oxidative stress and beta2-microglobulin (beta2-MG) in comparison with high-flux hemodialysis (HF-HD). METHODS: Twenty-one patients on thrice-weekly low-flux hemodialysis (LF-HD) for at least 6 months were studied. Every patient underwent OL-HDF and HF-HD for four weeks, respectively. There were 2 weeks of wash-out period in which patients were treated with LF-HD, between different treatment periods. Predialysis and postdialysis solute (creatinine, BUN, phosphate, beta2-MG) concentrations were measured in the serum. In addition, predialysis solute (MDA, TAC, hsCRP) concentrations were measured. RESULTS: The urea reduction ratio (64.2+/-14.5 vs. 60.1+/-11.2%), Kt/V (1.4+/-0.2 vs. 1.3+/-0.3), beta2-MG reduction ratio (53.8+/-9.7 vs. 44.3+/-8.7%) and beta2- MG clearance (120.7+/-33.4 vs. 92.7+/-17.6 mL/min) were significantly higher in patients treated with on- line HDF compared with those treated with HF-HD. After 4 weeks of treatment, predialysis serum MDA levels were significantly lower in patients treated with OL-HDF compared with those treated with HF-HD (1.04+/-0.26 vs. 1.19+/-0.25 umol/L). After 4 weeks of treatment with 2 different dialysis modes, predialysis serum beta2-MG (3.7+/-1.0 vs. 2.2+/-0.4 mg/ dL), MDA (1.19+/-0.21 vs. 1.04+/-0.26 umol/L), TAC (265.9+/-21.1 vs. 290.2+/-23.9 umol/L) and log hsCRP (0.07+/-0.51 vs. -0.23+/-0.62) levels were significantly improved compared to the baseline in OL-HDF patients. However, for HF-HD patients, only predialysis serum beta2-MG level at 4 weeks was significantly lower than baseline (3.8+/-1.0 vs. 2.5+/-0.4 mg/dL). CONCLUSION: This study shows that OL-HDF has been significant increase in oxidative stress and inflammatory marker removal compared to HF-HD.

Infection, Inflammation, and Cell Adhesion Molecules are Associated the Progression of Carotid Atherosclerosis in Continous Ambulatory Peritoneal Dialysis Patients / 대한신장학회잡지

BACKGROUND: In ESRD patients, the annual mortality rate due to cardiovascular disease (CVD) is 10 to 20 fold higher than that of the general population. Much recent interest have been focused on the association between chronic inflammation and the increased mortality rate due to CVD in ESRD patients. This study was performed to investigate whether the C.pneumoniae infection and inflammation play important roles in the change of the carotid intima- media thickness (IMT) in ESRD patients. METHODS: 52 patients undergoing CAPD were enrolled in the study. We measured IMT by using B-mode ultrasonography. IL-6, antibody titers to C. pneumoniae, cell-adhesion molecules were assessed by ELISA. RESULTS: Significant increase in carotid IMT (0.71+/-0.02 to 0.77+/-0.12 mm, p<0.05), cIM area (19.62+/-4.21 to 21.82+/-4.80 mm2, p<0.05), prevalence of plaque (36.5% to 57.7%, p<0.05) were observed in 52 patients. The patients were divided into two groups according to the change in IMT. Progressor for 32 patients who had more than 0.1 mm increase in IMT and nonprogressor for 20 who had lesser than 0.1 mm increase or no changes in IMT. Log IL-6, IgA antibody titers to C. pneumoniae, ICAM-1 level were significantly higher in progressors compared to nonprogressors (4.20+/-5.14 vs. 1.44+/-0.58 pg/mL, 1.14+/-0.60 vs. 0.77+/-0.32, 297.42+/-88.22 vs. 233.93+/-88.89 ng/mL, p<0.05). Logistic regression analysis showed that elevated log IL-6 and IgA antibody titers to C. pneumoniae were independent factors adversely affecting change of IMT. Stepwise multiple regression analysis showed that log IL-6, ICAM-1, and IgA antibody titers to C. pneumoniae were independent factors affecting carotid IMT. CONCLUSION: Our data suggest that inflammation and seropositivity of IgA to C. pneumoniae can be associated with the progression of atherosclerosis in CAPD patients.

Clinical Outcome and Prognostic Factors of Biopsy-proven Diffuse Proliferative Lupus Nephritis / 대한신장학회잡지

Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematous. It is generally acknowledged that the presence of diffuse proliferative lupus nephritis(DPLN) is highly predictive of a poor prognosis in terms of renal and patient out- come on survival. The objective of this study was to evaluate the clinicopathologic characteristics, renal out- come according to therapeutic regimen, and prognostic factors of biopsy-proven diffuse proliferative lupus nephritis. Among the biopsy-proven lupus nephritis patients who were admitted to Yonsei University Medical Center from January 1986 to June 1997, 36 patents who were diagnosed DPLN by renal biopsy and treated for at least 6 months and regularly followed-up for at least 12 months were included. We retrospec-tively reviewed the medical recorders. Patients were treated with steroid regimen with or without cyclo-phosphamide. According to the therapeutic response, patients were divided into two groups : a therapeutic response group(n=24), and a therapeutic non-response group