Relative contribution of anemia, hypertension and hyperparathyroidism to left ventricular abnormalities in end stage renal disease

To study the relative contribution of hypertension, anaemia, hyper parathyroidism and the urernic state per Se. to left ventricular [LV] morphological and functional abnormalities in end stage renal disease [ESRD], 60 patients with ESRD were studied by the end of their first year on hemodialysis. They were classified into 3 groups; a group with uncontrolled hypertension and uncorrected anemia. n=20, a group with controlled hypertension but uncorrected anemia. n=20. and a group with corrected anemia and controlled hypertension n=20. Twenty healthy control subjects were also included. Echocardiographic and doppler studies of the LV were recorded in each subject. Echocardiogrophic parameters of LV hypertrophy [septal thickness, posterior wall thickness and LV mass index] were significantly increased in ESRD patients with uncorrected anemia compared to normal controls. The presents of uncontrolled hypertension was associated with a further significant increase in LV hypertrophy parameters. In ESRD patients with controlled hypertension and corrected anaemia. no evidence of LV hypertrophy was found. LV diastolic dysfunction [decreased E/A] was found in all ESRD patient groups compared to normal controls. No correlation was found between serum parathyroid hormone level and any studied parameter. LV systolic function [ejection fraction and fractional shortening] was similar to controls in all ESRD patient groups. In conclusion. LV diastolic dysfunction is related to the uremic state per se. while LV hypetrophy is related to hypertension and anemia

Prothrombin fragment 1 - 2 as a marker of throm bosis risk in hemodialysis patients

Plasma levels of prothrombin fragment 12 [PF 1.2] were measured in 15 young patients on hemodialysis. PF 1.2 was significantly higher in the hemodialysis population compared to age and sex matched controls denoting increased intravascular thrombin generation in this patient group. The observed increase in PF 1.2 implies early activation of the coagulation system in end stage renal disease before the development of clinically significant vascular disease