Hyperhomocysteinemia and the risk of cardiovascular disease in hemodialysis patients and renal transplant receipients

The aim of this work was to study serum total homocysteine [tHcy] in dialysis dependent end stage renal disease [ESRD] patients as well as in renal transplant recipients [RTR] in relation to the established cardiovascular disease [CVD] risk factors. The study included 20 ESRD patients on hemodialysis [HD, group I], 20 RTR [group II] as well as 15 healthy age and sex matched controls. In HD patients, the mean fasting tHcy was significantly higher than that of the controls and hyperhomocysteinemia occurred in 90% of the patients. In RTR, mean tHcy level was significantly lower than in HD patients, yet still significantly higher than the controls and hyperhomocysteinemia occurred in 60% of the patients. None of the studied CVD risk factors [blood lipids, smoking, and hypertension] was significantly correlated to tHcy. In RTR, tHcy was not correlated to blood cyclosporine trough level. It was concluded that hyperhomocysteinemia was a common characteristic of HD patients and a frequent finding in RTR. The results indicated that hyperhomocysteinemia was associated with the occurrence of cardiovascular disease in both patient groups as an independent risk factor

High performance liquid chromatographic assay of urinary sucrose as a marker of gastric mucosal damage

In this study, a total of 164 patients underwent upper gastroduodenal endoscopy and sucrose permeability test to evaluate the diagnostic sensitivity and specificity of increased urinary sucrose excretion in the prediction of endoscopic finding. It was found that the urinary sucrose excretion, reflecting the sucrose permeability, was highly significantly increased in patients with severe gastritis and gastric ulcer; while, there was no significant difference in sucrose permeability between controls and patients with esophagitis, mild gastritis, duodenitis or duodenal ulcer. Compared with endoscopy, sucrose permeability test provided a new, simple, cheap and noninvasive diagnostic tool that was readily accepted by the patients for effectively screening large populations at a risk of gastric mucosal damage and for a follow up

Inferior vena cava echography and plasma cGMP level as markers of hydration state of hemodialysis patients

Adequate estimation of the dry weight of hemodialysis [HD] patients represents a central issue for renal replacement therapy. This work aimed to evaluate inferior vena cava [IVC] echography as well as cGMP plasma levels as reliable, non invasive markers of the hydration state of HD patients. Twenty five uremic patients [group A] as well as fifteen healthy volunteers [group B] were included in the study. Blood pressure, body weight, plasma cGMP level and IVC echography were recorded before and after HD both expiratory and inspiratory IVC diameters decreased significantly as compared to predialysis values [p < 0.05 and p < 0.05 respectively]. A significant positive correlation was observed between the expiratory IVC diameter and the body weight in patients of group A before [r = 0.57, p < 0.05] and after [r = 0.62, p < 0.05] HD. There was a positive correlation between the decrease in body weight and decrease in mean BP [MBP] [p < 0.05]. There was no significant, increase in WC collapse index [CI] after HD [p>0.05]. Also, there was no correlation between the CI and body weight of RD patients before and after HI] [p>0.05 and p> 0.05 respectively]. Predialysis cGMP levels were highly significantly greater [p <0.001] in group A patients compared to group B patients. HD resulted in a decrease in plasma cGMP levels, and this decrease is of a high statistical significance [p < 0.001]. However, postdialysis plasma cGMP level was highly significantly greater in Group A than in group B [p < 0.001]. There was a significant positive correlation between HD induced percent decrease in plasma cGMP level and reductions recorded in body weight [p < 0.05]. There was no significant correlation between plasma cGMP and MBP changes both pre and post dialysis [p > 0.05 and p > 0.05 respectively]. A significant correlation was found between IVC diameter and cGMP before HD [r = 0.69, p < 0.001]. No such correlation was found between CI and cGMp values [p > 0.05]. Furthermore, a significant correlation was observed between IVC diameter before and after HD and the change in cGMP during HD [r = 0.66, p < 0.01]. We conclude that cGMP is a sensitive marker for overhydration and fluid overload in HD patients, however, it cannot be considered as a marker for the dry weight of such patients since it does not return to normal found in healthy subjects after fluid removal. Furthermore, IVC diameter as estimated by echography appears to be a valuable accurate non invasive tool to assess the hydration state of HD patients