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1.
Organ Transplantation ; (6): 232-2022.
Article in Chinese | WPRIM | ID: wpr-920854

ABSTRACT

Objective To investigate the clinical manifestations, treatment and prognosis of primary hyperoxaluria type 1 (PH1). Methods Relevant literature review was conducted from Chongqing VIP, CNKI, Wanfang Data, PubMed, Web of Science, Embase and Cochrane databases. Clinical data of 57 patients with PH1 were collected, and the clinical manifestations, diagnosis and treatment and prognosis were analyzed. Results A total of 35 eligible studies were searched, including 57 patients with PH1, 39 male and 18 female, aged 0.2-57.0 years old, and the age of onset was from date of birth to 42 years old. The specificity of clinical symptoms of 57 patients with PH1 was relatively low, including 41 cases of renal stones, 21 cases of renal calcification and/or calcium deposition, 12 cases of oxalic acid deposition outside the urinary system, 12 cases of lumbago, backache and abdominal pain, and 8 cases of ureteral stones. Besides, alternative symptoms, such as decreased urine output, metabolic acidosis, disorder of water and electrolyte, anemia and gross hematuria were also reported. Thirty-three patients were diagnosed with end-stage renal disease (ESRD) upon admission. Twenty-six patients received transplantation. Among them, 17 cases underwent kidney transplantation (2 cases repeatedly received combined liver-kidney transplantation due to recurrence of stones and resumption of dialysis, and 1 case repeatedly received liver transplantation due to resumption of dialysis), 7 cases received combined liver-kidney transplantation, 2 cases underwent liver transplantation, and 3 cases received sequential liver-kidney transplantation, respectively. Thirty-one patients did not undergo transplantation. Significant differences were observed in the survival rate between patients treated with and without transplantation (85% vs. 58%, P < 0.05). Conclusions Clinical manifestations of PH1 are diverse and lack of specificity. A majority of PH1 patients are diagnosed with ESRD upon admission. Clinical prognosis of patients undergoing transplantation is better than that of those counterparts without transplantation. Prior liver transplantation or combined liver-kidney transplantation is recommended.

2.
J. inborn errors metab. screen ; 10: e20210033, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1360545

ABSTRACT

Abstract Fabry disease is a metabolic alteration linked to an enzymatic deficiency of Alpha-Galactosidase A, this disorder compromises the sphingolipid metabolism, leading to an accumulation of lysosomal globotriaosylceramide and is inherited in an X-linked recessive way. The diagnostic of this disease, in general, requires the confirmation of below-normal levels of Alpha-Galactosidase A obtained from dried blood spot (DBS) samples, followed by an assessment of the enzyme in leukocytes. We aimed to report the Alpha-Galactosidase A values obtained in Colombian males with end-stage renal disease (ESRD) screened using dried blood spot samples during ten years. This screening was performed with samples sent to the analysis center from 6156 patients between 2006- 2016. All patients with low levels in enzyme activity (compared to the control population) were sent to confirmation through enzyme analysis in isolated leukocytes. 26 males (0.42%) with low levels of Alpha-Galactosidase A were identified (Range 0.0 - 1.14 nmol/ml/hour, cut-off: 1.15), 22 patients were subsequently measured in isolated leukocytes having a confirmation of Fabry disease in 5 patients (0.08% of total male population) (Range: 0.3 -4.7 nmol/mg prot/h). These results are similar to those reported in studies with comparable characteristics being this the first reporting frequency of Fabry disease among Colombian males with end-stage renal disease.

3.
Organ Transplantation ; (6): 244-2021.
Article in Chinese | WPRIM | ID: wpr-873738

ABSTRACT

Autosomal dominant polycystic kidney disease (ADPKD) is a common monogenic hereditary kidney disease, which can progress into end-stage renal disease (ESRD). Patients with ADPKD constantly suffer from recurrent intracapsular infection. The drug resistance caused by antibiotic treatment is becoming increasingly prominent. The pattern of renal transplantation should be selected according to the infection of polycystic kidney disease. In this article, the origin of renal cyst, classification and source of cystic fluid, type and drug resistance of bacteria in the cystic fluid, and intracapsular infection of patients with renal transplantation- associated ADPKD were reviewed, aiming to provide reference for the diagnosis and treatment of intracapsular infection of patients with ADPKD.

4.
Article in Chinese | WPRIM | ID: wpr-843153

ABSTRACT

Objective: To explore the patterns of cerebral structural abnormalities and cognitive function alterations in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis, and the underlying correlative factors. Methods: Thirty-seven ESRD patients undergoing maintenance hemodialysis without prior stroke in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected. All patients underwent brain magnetic resonance imaging (MRI) and assessment of cognitive function by using Mini-Mental State Examination (MMSE). Patients were divided into lacunar infarction group (n=33) and non-lacunar infarction group (n=4), or white matter hyperintensities (WMH) group (n=14) and non-WMH group (n=23). The difference of demographic characteristics, past history, blood parameter and dialysis adequacy between patients and their controls were analyzed by t test, Mann-Whitney U test, χ2 test and Fisher exact test. Spearman correlation analysis were performed to explore the relationship between clinical features, cerebral structural abnormalities and cognitive function. Results: Nineteen male and eighteen female patients participated in the study. The mean age was (59.4±12.3) years. The incidences of lacunar infarction and WMH were 89.2% and 37.8%, respectively. 24.3% of the participants were diagnosed as cognitive impairment. Patients with lacunar infarction were elder, who had lower level of hemoglobin, hematocrit, serum albumin and serum total protein, while parathyroid hormone (PTH), erythrocyte sedimentation rate, tumor necrosis factor-α and interleukin-6 were elevated. Patients with WMH were also significantly elder, lower in transferrin saturation and higher in PTH. The differences between the two groups were statistically significant (all P<0.05). Spearman correlation analysis showed MMSE score had a negative correlation with age (r=-0.471, P=0.003) and had positive correlations with education status (r=0.355, P=0.031) and hypertension (r=0.358, P=0.030). The study did not find the relationship among lacunar infarction, WMH and MMSE score; however, recall function was found negatively correlated with lacunar infarction (r=-0.357, P=0.030). Conclusion: ESRD patients undergoing maintenance hemodialysis have a high prevalence of cerebrovascular disease and cognitive impairment. Older age, anemia, inflammation status, chronic kidney disease-mineral and bone disorder may be the influencing factors of the cerebral structural abnormalities and cognition decline.

5.
Yonsei Medical Journal ; : 291-297, 2019.
Article in English | WPRIM | ID: wpr-742532

ABSTRACT

PURPOSE: Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose of this study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factors in patients with preserved ejection fraction following KT. MATERIALS AND METHODS: We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preand post-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measured using the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′). RESULTS: Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e′ after KT (11.9±4.4 to 10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e′ (odds ratio, −0.056; 95% confidence interval, −0.014 to −0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients), the amount of intraoperative fluid administration was related to E/e′ changes (odds ratio, 0.003; 95% confidence interval, 0.000 to 0.005; p=0.029). CONCLUSION: KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LV diastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients with preexisting diastolic dysfunction.


Subject(s)
Cause of Death , Filtration , Humans , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Renal Insufficiency, Chronic , Retrospective Studies , Risk Factors
6.
Article in Chinese | WPRIM | ID: wpr-695660

ABSTRACT

Objective·To explore the changes of pyruvate dehydrogenase (PDH) activity and pyruvate dehydrogenase kinase 4 (PDK4) expression in the end-stage renal disease (ESRD) patients' skeletal muscles. Methods·Skeletal muscle samples were collected from non-chronic kidney disease (non-CKD) patients and ESRD patients. PDH activity was detected by ELISA assay. Real-time qPCR was performed to examine gene transcription levels of PDK1-PDK4 and PDH subunits.Western blotting analysis was used to detect protein expression levels of PDK1 and PDK4. Results·There were no demographic differences between two groups of patients. Plasma creatinine and urea nitrogen were significantly elevated in ESRD group (both P<0.05), while estimated glomerular filtration rate, hemoglobin and plasma albumin in ESRD group were significantly lower than those in non-CKD group (all P<0.05).Skeletal muscle PDH activity in ESRD group was markedly lower than that in non-CKD group(P=0.014).There were no differences in PDK1-PDK4 and PDH subunits mRNA transcription levels between ESRD and non-CKD group.PDK4 protein expression was significantly higher than that in non-CKD group (P=0.000). Conclusion·The decreased PDH activity in ESRD patients' skeletal muscle may be related to up-regulation of PDK4.

7.
Article in Chinese | WPRIM | ID: wpr-843755

ABSTRACT

Objective: To explore the changes of pyruvate dehydrogenase (PDH) activity and pyruvate dehydrogenase kinase 4 (PDK4) expression in the end-stage renal disease (ESRD) patients' skeletal muscles. Methods: Skeletal muscle samples were collected from non-chronic kidney disease (non-CKD) patients and ESRD patients. PDH activity was detected by ELISA assay. Real-time qPCR was performed to examine gene transcription levels of PDK1-PDK4 and PDH subunits. Western blotting analysis was used to detect protein expression levels of PDK1 and PDK4. Results: There were no demographic differences between two groups of patients. Plasma creatinine and urea nitrogen were significantly elevated in ESRD group (both P<0.05), while estimated glomerular filtration rate, hemoglobin and plasma albumin in ESRD group were significantly lower than those in non-CKD group (all P<0.05). Skeletal muscle PDH activity in ESRD group was markedly lower than that in non-CKD group (P=0.014). There were no differences in PDK1-PDK4 and PDH subunits mRNA transcription levels between ESRD and non-CKD group. PDK4 protein expression was significantly higher than that in non-CKD group (P=0.000). Conclusion: The decreased PDH activity in ESRD patients' skeletal muscle may be related to up-regulation of PDK4.

8.
Childhood Kidney Diseases ; : 165-168, 2017.
Article in English | WPRIM | ID: wpr-220621

ABSTRACT

Focal segmental glomerulosclerosis (FSGS) in children, which is a kind of nephrotic syndrome showing steroid resistance, usually progresses to a substantial number of end stage renal disease (ESRD). Although the pathogenesis of primary FSGS is unclear, several recent studies have reported that FSGS is associated with circulating immune factors such as soluble urokinase-type plasminogen activator receptor (suPAR) or anti-CD40 autoantibody. We report a successfully treated case of a 19-year-old female patient who experienced a recurrence of primary FSGS. After the diagnosis of FSGS, the patient progressed to ESRD and received a kidney transplantation (KT). Three days later, recurrence was suspected through proteinuria and hypoalbuminemia. She has been performed plasmapheresis and high dose methylprednisolone pulse therapy and shown remission status without increasing proteinuria for four years after KT. In conclusion, strong immunosuppressive therapy may be helpful for a good prognosis of recurrent FSGS, suppressing several immunologic circulating factors related disease pathogenesis.


Subject(s)
Child , Diagnosis , Female , Glomerulosclerosis, Focal Segmental , Humans , Hypoalbuminemia , Immunologic Factors , Kidney Failure, Chronic , Kidney Transplantation , Methylprednisolone , Nephrotic Syndrome , Plasmapheresis , Prognosis , Proteinuria , Recurrence , Urokinase-Type Plasminogen Activator , Young Adult
9.
Article | IMSEAR | ID: sea-186828

ABSTRACT

Background: Diabetes mellitus is one of the most common endocrine disorders affecting about 6% of the world’s population. Diabetes mellitus is the leading cause of end stage renal disease (ESRD), a major cause of non-traumatic amputations, responsible for preventable blindness and a leading cause of cardiovascular mortality. Objective: The objective of the study was to assess the glycemic control by estimation of glycated hemoglobin (HbA1c), and lipid profile in patients of Diabetes mellitus without complications and in Diabetes mellitus with complications like neuropathy, retinopathy and nephropathy and compare with controls. Material and methods: The present study comprised of 100 clinically diagnosed and confirmed cases of type 2 Diabetes mellitus attending and admitted in RNT Medical College and Hospital, Udaipur, Rajasthan, India. Glycosylated hemoglobin (HbA1c), Total Cholesterol, Triglycerides, HDL-Cholesterol, LDLCholesterol and VLDL-Cholesterol were calculated in all groups using Friedewald’s formula. Result: Our study showed that HbA1c levels were significantly higher (p<0.01) in all groups of patients as compared to controls. The increase in Serum Cholesterol, Triglyceride, LDL-Cholesterol, VLDL-Cholesterol and decrease in HDL-Cholesterol levels were statistically significant (p<0.01) in Diabetic retinopathy and Diabetic nephropathy group as compared to controls, whereas in Diabetic neuropathy group and in Diabetes mellitus without complication, the increase in Serum Cholesterol, Triglyceride, LDL-Cholesterol, VLDL-Cholesterol and decrease in HDL-Cholesterol levels was not statistically significant as compared to controls. Conclusion: Our study revealed that poor glycemic control and dyslipidemia are associated with Diabetic complications like neuropathy, retinopathy and nephropathy. Estimation of glycosylated hemoglobin and lipid profile helps in predicting the development of microvascular complications.

10.
Chinese Journal of Immunology ; (12): 79-82,89, 2016.
Article in Chinese | WPRIM | ID: wpr-603947

ABSTRACT

Objective:To explore the associations of MYH9 gene polymorphisms with ESRD in Han population in the fragment between exon 23 and 24.Methods:A hospital-based case control study was carried out including 180 patients and 118 controls in this study.Single nucleotide polymorphisms of MYH9 gene were determined using PCR sequencing,and the haplotypes were calculated using phase software(version 2.0),and transcription factor binding sites were predicted using AliBaba2.Univariate analysis was conducted for exploring the associations between polymorphisms and ESRD.Results: Five newly discovered and three previously reported SNP loci [Rs4821480(MYH9-92),Rs2032487(MYH9-273) and Rs4821481(MYH9-787)]were homozygote genotyped by bidirectional se-quencing.Among newly discovered polymorphisms,two were found at the 489 locus(G→A)and the 616 locus(A→C) in the 901 bp fragment which located in the intron 23 of MYH9 gene.A G489A transversion was very likely a risk mutation contribute to the occurrence of ESRD(P=0.013).No association was observed between ESRD and three previous reported sites [Rs4821480(MYH9-92),Rs2032487(MYH9-273)and Rs4821481(MYH9-787)].The most common haplotype was TCTCGGAT,which was less frequent in the cases than that in the controls.Moreover, TCTCGGCT and TCTCAGAT haplotypes were more in the cases than that in the controls.The number of transcription binding sites increased from 82 ( wild ) to 85 ( mutation ) in the 23th intron of MYH9 gene.Conclusion:Polymorphisms of MYH9 at intron 23 may influence the prevalence of ESRD in Chinese Han population and TCTCGGAT haplotype may be one protective haplotype.TCTCGGCT and TCTCAGAT may be risk haplotypes attributed to ESRD.The polymorphism of MYH9 at the 23th intron may company with the amount alteration of transcription factor binding sites.

11.
Article in Korean | WPRIM | ID: wpr-180488

ABSTRACT

BACKGROUND: The purpose of this study was to examine the cost-effectiveness of renal transplantation and hemodialysis among end-stage renal disease patients. METHODS: Empirical data on treatment costs were collected from five hospitals in Korea. We used European Renal Association-European Dialysis and Transplant Association registry data for transition probability. Quality adjusted life year (QALY) values were derived from the literature. A Markov model was used for predicting the cost utility of transplantation and hemodialysis over a 10-year period. RESULTS: Renal transplantation was less costly and resulted in a better outcome than hemodialysis. The cost per QALY gained was 19,450 thousand won in transplantation patients, whereas it was 36,514 thousand won per QALY gained in hemodialysis patients. CONCLUSIONS: Although the cost of the first year after transplantation was expensive, transplantation was more effective over 2 years and was less costly than hemodialysis. The results suggest that transplantation is more cost-effective than hemodialysis in Korea.


Subject(s)
Dialysis , Health Care Costs , Humans , Kidney Failure, Chronic , Kidney Transplantation , Korea , Quality-Adjusted Life Years , Renal Dialysis , Transplants
12.
Article in Korean | WPRIM | ID: wpr-49932

ABSTRACT

For patients with type 1 diabetes complicated by end stage renal disease (ESRD), kidney transplantation prolongs life and frees the recipient from the substantial morbidities of dialysis. Transplantation of whole pancreas has emerged as an effective treatment modality for patients with diabetes mellitus, especially those with established end-stage renal disease. However, it is not clear that transplantation of the pancreas itself prolongs the life of the recipient. Living donor kidney transplant (LDKT) and simultaneous pancreas-kidney transplant (SPKT) provide distinct benefits over deceased donor kidney transplant (DDKT) alone. But, previous studies have not demonstrated that the SPKT approach prolongs life compared with LDKT. Patients who receive an LDKT can later opt for a pancreas after kidney transplant (PAKT) or an islet after kidney transplant (IAKT). Therefore, when a transplant doctor is counseling a patient with type 1 diabetes and ESRD and has a live donor, the decision about whether to proceed with an LDKT or to remain on the waiting list for an SPKT requires careful consideration. The aim of this review was to summarize the current status and outcomes of SPKT, LDKT, IAKT, and PAKT and their effects on survival of patients with type 1 diabetes and ESRD.


Subject(s)
Counseling , Diabetes Mellitus , Diabetes Mellitus, Type 1 , Dialysis , Humans , Kidney , Kidney Failure, Chronic , Kidney Transplantation , Living Donors , Pancreas , Pancreas Transplantation , Tissue Donors , Transplants , Waiting Lists
13.
Korean Journal of Medicine ; : 461-471, 2009.
Article in Korean | WPRIM | ID: wpr-80328

ABSTRACT

BACKGROUND/AIMS: Dyslipidemia is one of the major causes of cardiovascular disease in end-stage renal disease (ESRD) patients. Most of them are dyslipidemic despite the use of lipid-lowering agents. Ezetimibe is a novel chemical entity that inhibits the intestinal absorption of dietary and biliary cholesterol. This study evaluated the effects of ezetimibe on the lipid profile, inflammation markers, endothelial injury, and thrombogenesis in ESRD patients. METHODS: Sixty-five patients with serum low-density lipoprotein (LDL)-cholesterol levels > or =100 mg/d were recruited: 33 patients were on hemodialysis and 32 patients were on peritoneal dialysis. They were assigned randomly to the ezetimibe (10 mg) monotherapy group and the ezetimibe (10 mg) plus simvastatin (10 mg) combination therapy group. Both drugs were administered for 8 weeks. RESULTS: There were no significant differences in the baseline demographic and laboratory characteristics between the two groups. In the monotherapy group, the total and LDL-cholesterol levels were reduced by 14.7 and 21.9%, respectively. There were no changes in the high-density lipoprotein (HDL)-cholesterol or triglyceride levels. Fibrinogen increased significantly (p=0.04). In the combination therapy group, the total and LDL-cholesterol levels were reduced by 29.8 and 42.4%, respectively. There was an additional 15.1% reduction in total cholesterol and an additional 20.5% reduction in LDL cholesterol compared with monotherapy. Several patients complained of minor adverse effects and only one patient in the ezetimibe monotherapy group discontinued medication, because of diarrhea. CONCLUSIONS: In ESRD patients, ezetimibe used as combination therapy with a statin is more effective than ezetimibe monotherapy in ESRD patients.


Subject(s)
Azetidines , Cardiovascular Diseases , Cholesterol , Cholesterol, LDL , Dyslipidemias , Fibrinogen , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Inflammation , Intestinal Absorption , Kidney Failure, Chronic , Lipoproteins , Peritoneal Dialysis , Renal Dialysis , Simvastatin , Ezetimibe
14.
Article in Korean | WPRIM | ID: wpr-203487

ABSTRACT

Situs inversus is a rare congenital anomaly that occurs in adults at the rate of 1:5,000-1:10,000. In the total form, the thoracic organs, as well as the abdominal organs, are completely reversed in a "mirror image" of their normal arrangements. Ureteral duplication is the most common ureteral anomaly founded incidentally. However, there is a higher incidence of duplication in cases of urinary tract infection, and it may be associated with upper urinary tract stasis, obstruction, or reflux. But ureteral duplication has no relation to situs inversus. Vesicoureteral reflux (VUR) is the most common disorder usually detected during radiologic evaluation of children with urinary tract infection. Complications such as renal scarring, reflux nephropathy, chronic renal failure and hypertension are well known in patients with VUR. Reflux nephropathy is responsible for about 10% of all cases of treated ESRD and is the most common case of ESRD in children. Thus, if VUR exists, early diagnosis and intensive treatment is necessary. Herein, we present a case of reflux nephropathy related ESRD in a 41-year-old woman with total situs inversus and duplicated ureter.


Subject(s)
Adult , Child , Cicatrix , Early Diagnosis , Female , Humans , Hypertension , Incidence , Kidney Failure, Chronic , Situs Inversus , Ureter , Urinary Tract , Urinary Tract Infections , Vesico-Ureteral Reflux
15.
Article in Korean | WPRIM | ID: wpr-725120

ABSTRACT

Depression is common in patients with end-stage renal disease(ESRD) and has a negative effect on the quality of life, functional ability, and mortality of the patients, with a prevalence rate as high as 20-25%. Especially, the increasing tendency of mortality in ESRD patients is associated with recent or current depression, and the suicide rate is also increased by depression in patients with ESRD. Therefore, accurate detection and appropriate treatment of depression is very important in ESRD patients. Also, a deferential diagnosis is needed concerning uremic symptoms and depression in ESRD patients. However, there has been little data so far particularly in terms of randomized clinical trials. This review focused on the recent knowledge of depression in ESRD, and could encourage clinical study and trials in this field.


Subject(s)
Depression , Humans , Kidney Failure, Chronic , Prevalence , Quality of Life , Suicide
16.
Rev. Assoc. Med. Bras. (1992) ; 53(6): 492-496, 2007. tab
Article in English | LILACS | ID: lil-470424

ABSTRACT

OBJECTIVES: Subjective sleep complaints have been reported in up to 80 percent of patients with end stage renal disease (ESRD). In these patients, sleep disturbances manifesting as insomnia, sleep apnea syndrome, restless leg syndrome (RLS), periodic limb movement disorder and excessive daytime sleepiness (EDS) have been frequently reported. Moreover, studies about the role of dialysis shift on sleep abnormalities, morbidity and mortality are still scarce. The aim of this study was to investigate the influence of dialysis shift on the quality of sleep and sleep abnormalities in patients with ESRD. MÉTHODS: We studied one hundred consecutive patients from a dialysis center. Quality of sleep was assessed by the Pittsburgh Sleep Quality Index and subjective EDS by the Epworth Sleepiness Scale. Restless leg syndrome was diagnosed using the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Clinical and laboratory parameters were obtained by interview and chart review. Adequacy of dialysis was evaluated by the Kt/V index. RESULTS: Poor quality sleep (PSQI>6) was found in 75 percent of cases and was associated with RLS (p=0.004) and with snoring (p=0.016). EDS (ESS>10) was present in 28 percent of cases. Patients with EDS (1.33±0.29) had lower values of the Kt/v index (P=0.01) than those without EDS (1.52±0.32). RLS was present in 48 percent of cases. Irrespective of dialysis shift, poor quality sleep, EDS and RLS were not different among patients. CONCLUSION: Poor quality sleep, EDS and RLS were common and not related to dialysis shift.


OBJETIVOS: Alterações do sono têm sido relatadas em até 80 por cento dos pacientes com Insuficiência renal crônica dialítica (IRCD). Insônia, síndrome da apnéia do sono, síndrome das pernas inquietas (SPI), movimentos periódicos de extremidades e sonolência excessiva diurna (SED) têm sido descritos. A influência que o turno da diálise exerce sobre as alterações do sono e sobre a morbidade e mortalidade ainda é desconhecida. O objetivo deste estudo foi avaliar a influência do turno da diálise sobre as anormalidades do sono em pacientes com IRCD. MÉTODOS: Estudamos 100 pacientes consecutivos provenientes de um centro de diálise. A qualidade do sono foi avaliada através do Índice de Qualidade do Sono de Pittsburgh (IQSP) e a SED através da Escala de sonolência de Epworth (ESE). A SPI foi avaliada utilizando os quatro critérios mínimos definidos internacionalmente pela International Restless Legs Syndrome Study Group. Os parâmetros clínicos e laboratoriais foram obtidos através de entrevistas e revisão de prontuários. A qualidade da diálise foi avaliada pelo índice Kt/V. RESULTADOS: Má qualidade do sono (IQSP>6), encontrada em 75 por cento dos casos, associou-se à SPI (P= 0.004) e à presença de ronco (P= 0.016). Pacientes com SED (ESE>10) (1.33±0.29) apresentaram valores do índice Kt/v menores (P=0.01) do que aqueles sem SED (1.52±0.32). Observou-se a presença de SPI em 48 por cento dos pacientes. Má qualidade do sono, SED e SPI não diferiram entre os pacientes agrupados quanto ao turno de diálise. CONCLUSÃO: Má qualidade do sono, SED e SPI são freqüentes e não se relacionam com o turno da diálise.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Circadian Rhythm , Kidney Failure, Chronic/therapy , Renal Dialysis , Sleep Wake Disorders/diagnosis , Sleep/physiology , Epidemiologic Methods , Kidney Failure, Chronic/complications , Quality of Life , Renal Dialysis/adverse effects , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/etiology , Sex Factors , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/etiology , Sleep Wake Disorders/etiology , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/etiology , Snoring/physiopathology , Time Factors
17.
Article in Korean | WPRIM | ID: wpr-218837

ABSTRACT

BACKGROUND: Type 2 diabetes develops because of defects in both insulin secretion and action. The half-life of insulin in uremia is prolonged because the metabolic clearance rate of insulin in diabetic end stage renal disease (ESRD) patients is reduced with consequence that the dose of insulin and/or oral hypoglycemic agent (OHA) administered in normal renal function make them increase the risk of hypoglycemia. Therefore, we should usually reduce the dose of insulin and/or OHA, or stop administration of insulin and/or OHA if type 2 diabetic patients are progressed to ESRD. But in some patients, that is not true. The aim of this study was to test the hypothesis that insulin resistance plays an important role in (re)evaluation of optimal insulin and/or OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD. METHODS: Insulin resistance was examined in 23 type 2 diabetic ESRD patients with tight control of glycemia using the K index of the insulin tolerance test (Kitt). We divided 23 patients into three groups. Group 1 (n=10) was defined as patients who were administered neither insulin nor OHA after ESRD. Group 2 (n=9) was defined as patients who were changed from insulin to OHA as drug for glycemic control after ESRD. Group 3 (n=4) was defined as patients in whom insulin or OHA was continuously administered after ESRD without a change of them for glycemic control. We compared the degree of insulin resistance among these three groups. RESULTS: Insulin resistance determined by Kitt was significantly different between group 1 (Kitt, 2.1422/0.94-4.01%/min), group 2 (Kitt, 1.3811/0.79- 3.90%/min) and group 3 (Kitt, 0.8550/0.44-1.81%/min) by using Kruskal-Wallis test (p=0.048). Kitt in group 3 was significantly lower than in group 1 by using Mann-Whitney test (p=0.016). CONCLUSION: Although metabolic clearance of insulin is reduced by renal failure, demand of insulin/ OHA for optimal glycemic control is not reduced in higher insulin-resistant type 2 diabetic ESRD patients on hemodialysis. Insulin resistance plays an important role in determination of optimal insulin/ OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD.


Subject(s)
Half-Life , Humans , Hypoglycemia , Insulin Resistance , Insulin , Kidney Failure, Chronic , Metabolic Clearance Rate , Renal Dialysis , Renal Insufficiency , Uremia
18.
Article in Korean | WPRIM | ID: wpr-203778

ABSTRACT

BACKGROUND: Non-traditional risk factors of cardiovascular disease such as endothelial dysfunction, inflammation and malnutrition may be significant contributors to the excessive cardiovascular mortality in end stage renal disease (ESRD) patients. This study was undertaken to evaluate endothelial function in diabetic ESRD patients on hemodialysis and correlation between endothelial dysfunction and clinical, biochemical parameters. METHODS: Twenty eight stable diabetic ESRD patients (M: F=1.3: 1, average age: 60.1+/-1.0 yr) on hemodialysis were included. flow-mediated dilation (FMD) of brachial artery was measured using Doppler ultrasonography with 10 MHz transducer. Subjective global assessment (SGA) was used to assess the nutritional status of patients. RESULTS: The FMD (%) (% change of brachial artery diameter between before and after cuff inflation) was 5.1+/-1.0%. Serum albumin and C-reactive protein (CRP) were independent factors influencing SGA. When the patients were divided into groups according to history of ischemic heart disease (IHD), systolic pressure was significantly higher and FMD (%) was significantly lower in the group of patients with IHD compared with the group of patients without IHD. The FMD (%) showed significant positive correlation with SGA, serum albumin, and significant negative correlation with CRP. On multiple regression analysis, however, only CRP was an independent factor affecting FMD (%). CONCLUSION: These findings suggest that CRP influenced the nutritional status of diabetic ESRD patients on hemodialysis, and endothelial dysfunction, estimated by FMD, was significantly correlated with CRP. Therefore, CRP can be a modifiable risk factor for endothelial dysfunction in diabetic ESRD patients on hemodialysis.


Subject(s)
Blood Pressure , Brachial Artery , C-Reactive Protein , Cardiovascular Diseases , Humans , Inflammation , Kidney Failure, Chronic , Malnutrition , Mortality , Myocardial Ischemia , Nutritional Status , Renal Dialysis , Risk Factors , Serum Albumin , Transducers , Ultrasonography, Doppler
19.
Article in Korean | WPRIM | ID: wpr-67229

ABSTRACT

BACKGROUND: Abnormalities of the left ventricular (LV) diastolic dysfunction are common in patients with end-stage renal disease (ESRD). Recently, Doppler tissue imaging (DTI) has been introduced as a method to evaluate diastolic function or myocardial relaxation by measuring mitral annulus velocity during diastole. This study was undertaken to assess resting diastolic function and diastolic functional reserve during exercise in ESRD patients starting dialysis treatment. METHODS: Mitral inflow velocities by Doppler echocardiography and septal mitral annular velocities by DTI were measured at rest and during supine bicycle exercise in 22 new ESRD patients and 23 age- and sex-matched subjects with normal renal function as a control. RESULTS: LV end-diastolic and end-systolic dimensions, septal thickness, and left atrial volume index were significantly higher in patients with ESRD compared with those of controls (p<0.01). LV ejection fraction was significantly lower in ESRD group (p<0.05). There were no significant differences in mitral inflow velocities (E, E/A, DT) between the two groups except A velocity, which was significantly higher in ESRD group (p<0.01). However, early diastolic mitral annular velocity (E') at rest (5.3+/-1.3 cm/sec vs. 6.5+/-1.5 cm/sec, p=0.013) and augmentation of E' with exercise (deltaE') were significantly lower in ESRD group compared with controls (at 25W exercise, 1.3+/-1.6 cm/sec vs. 4.0+/-3.0 cm/sec, p=0.002; at 50W exercise, 3.3+/-2.3 cm/sec vs. 6.5+/-5.3 cm/sec, p=0.030). CONCLUSION: Unlike conventional mitral inflow parameters, longitudinal resting diastolic function and diastolic functional reserve during exercise assessed by DTI were significantly reduced in ESRD patients starting dialysis treatment.


Subject(s)
Dialysis , Diastole , Echocardiography, Doppler , Humans , Kidney Failure, Chronic , Relaxation
20.
Article in Korean | WPRIM | ID: wpr-208176

ABSTRACT

BACKGROUND: The present study was aimed to know the cause of impaired bactericidal activity, especially the metabolism of oxygen free radicals in neutrophils from patients with end-stage renal disease (ESRD). METHODS: We measured the amount of superox ide anion, the activity of three antioxidant enzymes, myeloperoxidase, copper ion level, zinc ion level and the amount of malondialdehyde in neutrophils from patients with ESRD before and after hemodialysis. Reverse transcription-polymerase chain reaction (RT-PCR) for superoxide dismutase (SOD) was also done. RESULTS: The malondialdehyde level, the amount of superoxide anion, catalase, and myeloperoxidase levels in the neutrophils from the patients with ESRD were higher than those from healthy controls. SOD activity, hydrogen peroxide level and zinc level were lower in ESRD patients. On the RT-PCR, the relative index, which is defined the ratio of the band densities for SOD to glyceraldehyde 3-phosphate dehydrogenase, was decreased in neutrophils from patients with ESRD. Glutathione peroxidase activity in the neutrophils from ESRD patients did not show any significant change. CONCLUSION: These results indicate that there are some alterations in metabolism of oxygen free radicals including lower levels of hydrogen peroxide which exerting a direct germicidal ability, due to decreased gene expression and mineral levels. And these alterations might be one of the major mechanisms of impaired microbicidal activity in patients with ESRD.


Subject(s)
Catalase , Copper , Free Radicals , Gene Expression , Glutathione Peroxidase , Glyceraldehyde 3-Phosphate , Humans , Hydrogen Peroxide , Kidney Failure, Chronic , Malondialdehyde , Metabolism , Neutrophils , Oxidoreductases , Oxygen , Peroxidase , Reactive Oxygen Species , Renal Dialysis , Superoxide Dismutase , Superoxides , Zinc
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