evaluation of increase in hemodialysis frequency on C-reactive protein levels and nutritional status

Malnutrition and inflammation are the most important causes of cardiovascular disease in hemodialysis patients. This study was conducted to evaluate the effect of increase in hemodialysis frequency on C-reactive protein [CRP] level and nutritional markers in contrast to previous routine method. 18 hemodialysis patients with a mean age of 53 +/- 16 years were randomly selected in this before-and-after clinical trial. The patients under a standard hemodialysis of 3 times/4 h per week were converted to 4 times/4 h for a period of 6 weeks. The CRP, albumin, triglyceride, total cholesterol, LDL, HDL serum levels, anthropometric indices and 24-h diet recall intake was assessed before and after of the period. The data were analyzed using paired t-test, and P-value less than 0.05 was considered significant. All patients completed the study. Mean weight, body mass index and serum albumin increased while serum CRP level decreased significantly after the intervention [P<0.03]. Triglyceride, total cholesterol, LDL, HDL, as well as energy, protein and fat intake had no significant change before and after the study. Increase in dialysis frequency decreased systemic inflammation and improved the nutritional state of hemodialysis patients. Therefore, it may decrease the risk of cardiovascular events in these patients

Effect of hydroxymethylglutaryl-CoA reductase inhibitors on low-density lipoprotein cholesterol, interleukin-6, and high-sensitivity C-reactive protein in end-stage renal disease

This study was conducted to determine the effect of statins on the serum levels of interleukin-6 [IL-6], low-density lipoprotein cholesterol [LDLC], and high-sensitivity C-reactive protein [HSCPR]. This randomized clinical trial was carried out on 95 hemodialysis patients divided into three groups of atorvastatin, 10 mg; simvastatin, 20 mg; and lovastatin, 40 mg, daily, administered for 2 months. Levels of serum HSCRP, IL-6, and LDLC were all measured before and after the study period. At baseline, 59% of the hemodialysis patients presented with elevated HSCRP, 46.3% them had increased IL-6, and 26.3% had an increased LDLC level. The three drugs were capable to lower the level of HSCRP, among which atorvastatin had the highest effect size [41.8% reduction, P = .001]. Lovastatin stood in the next [37.6% reduction, P = .02], while HSCRP reduction was not significant in the simvastatin group [25% reduction, P = .14]. Neither of the drugs significantly reduced IL-6 levels. Effects of atorvastatin and simvastatin on the LDLC levels were significant, while lovastatin had a marginal effect. Use of statins resulted in CRP reduction in patients on hemodialysis. Atorvastatin was much more effective than lovastatin, while CRP reduction was not significant by simvastatin. However, simvastatin had the greatest impact on LDLC. None of these drugs could reduce IL-6 levels within 2 months

Comparison of oral folic acid and folinic acid on blood homocysteine level of patients on hemodialysis

Hyperhomocysteinemia is common in patients with chronic kidney disease. There is a direct relationship between cardiovascular mortality and increase of blood homocysteine. Folic acid is used as common treatment in such patients. Folinic acid, a shortened form of folic acid, is not affected by inhibitors of dihydrofolate reductase enzyme such as methoterxate. This study was performed to evaluate the effect of oral folinic acid on the blood homocysteine level of hemodialysis patients, in comparison with folic acid. This clinical trial was performed on 60 hemodialysis patients. The participants were divided into 2 groups to receive either 15 mg of oral folic acid or 15 mg of oral folinic acid, daily. Blood homocysteine levels were measured before dialysis and after the study period. Folic acid and folinic acid decreased the blood homocysteine levels by 33.0% and 28.7%, respectively [P < .001]. However, only 3 patients [6.5%] enjoyed a normalized homocysteine level. Our study showed that both folic and folinic acid decreased the blood homocysteine level and no meaningful difference was observed between them; therefore, we suggest they can be used interchangeably

Prognostic value of B-type natriuretic peptide for assessment of left ventricular function in patients with chronic kidney disease

Since the level of B-type natriuretic peptide [BNP] increases in heart failure, elevated plasma BNP concentration is used as a predictor in the diagnosis and management of heart failure. Due to the diminished renal clearance of BNP, its level is above normal in kidney failure. This study evaluated the BNP prognostic value for assessing ventricular function in patients with chronic kidney disease. All the participants were diagnosed with chronic kidney disease. Echocardiography was employed to assess ejection fraction. Body mass index, serum creatinine, and BNP were measured for all the patients. Prognostic value of BNP was assessed for ventricular function measured by ejection fraction. Forty-four patients, including 34 men and 10 women, participated in the study. Level of BNP had a significant correlation with body mass index, ejection fraction, age, and gender. The sensitivity and specificity of BNP levels of 150 pg/mL and 705 pg/mL were 93.3% and 28.6% and 50.0% and 85.7%, respectively, for the diagnosis of ventricular dysfunction in the patients with chronic kidney disease. These findings suggest that a level of BNP of 705 pg/mL is a rather acceptable predictive factor for heart failure in patients with chronic kidney disease. The participants' height and weight, which were associated with BNP as body mass index, contributed to this level