RESUMO
Trace element is defined as one that makes up less than 0.01% of body's mass. Those present at micro g/dl in body fluids and at mg/kg in tissues are referred to as trace elements and those found at micro g/dl in body fluids or micro g/kg in tissues are referred to as ultra-trace elements. Although these elements constitute a relatively small amount of total body tissues these are essential for many vital processes. To determine the serum level of trace elements i.e Aluminum [Al], Zinc [Zn] and Copper [Cu] in haemodialysis [HD] patients. Methods: Fifty patients of End Stage Renal disease [ESRD] on [HD] for more than three months from dialysis center of Shalamar Hospital Lahore were included in the study. Patients of acute renal failure, duration less than three months were excluded from the study. Fifteen subjects age and gender matched having normal kidney functions were included as controls. Demographic data was collected in a separate form having age, gender, cause of ESRD, duration of dialysis and viral markers. The major causes of ESRD were diabetic and hypertensive nephropathy. The mean age was 46.10 +/- 16.29 years and predominantly patients were from middle class. Mean duration of dialysis was 24.87 +/- 22.1 months and majority of the patients 40 [74.1%] were on twice weekly dialysis. Mean serum Al level was 65.44 +/- 33.41 micro g/L as compared to controls [13.20 +/- 6.155] which was statistically significant [p<0.001]. Mean serum Zn level was 59.17 +/- 32.51 micro g/L and Cu level was 35.35 +/- 31.52 micro g/L which were significantly [p<0.001] lower than controls [107.53 +/- 13.32, 107.00+11.85 micro g/L]. Duration of the dialysis had negative correlation with serum Zn level. It was significantly [p<0.02] low [44.78 +/- 33.061 micro g/L] when duration of dialysis was more than 30 months as compared to duration less than 30 months [66.36 +/- 30.174 micro g/L]. Serum levels of trace elements were significantly different in ESRD patients. Majority of patients had high Al levels and decreased Cu and Zn level. High serum Al levels in patients were due to intake of Al based phosphate binders. Decreased Zn and Cu levels were due to poor intake and dietary restriction. Duration of the dialysis had negative correlation with serum Zn level
RESUMO
Patients with end - stage renal disease [ESRD] develop increased bleeding tendency, which is characterized by defective interaction of platelets with damaged sub endothelium due to impaired platelet functions. This study was earned out to demonstrate the aggregation defects in uraemic patients by using different platelet agonists. A total of 57 subjects were included in the study. These were divided into two groups; 37 patients of ESRD on maintenance haemodialysis and 20 healthy adults as control. Complete blood count [CBC], urea and creatinine were carried out on all the samples. Aggregation studies were performed using chronology 490 - 2D Platelet Aggregometer. Adenosine diphosphate [ADP], collagen, ristocetin and arachidonic acid were used as agonists to perform aggregation studies and correlation of these parameters with Haemoglobin [Hb], Haematocrit [Hct], urea and creatinine were determined. All the subjects included in this study were evaluated for platelet aggregation in vitro. Percentages of maximal aggregation of platelets with ADP, collagen, ristocetin and arachidonic acid were significantly low in uraemic patients as compared to the control group. Aggregation with ristocetin was particularly reduced in uraemic patients [Mean 57.54 +/- 23.85%] in comparison with controls [Mean 84 +/- 6.01%]. Inverse correlation of urea was found with ADP response [p value 0.028] and creatinine with arachidonic acid [p value 0.036] which was statistically significant. No correlation was found between haemoglobin, haematocrit and percentage of maximal aggregation after stimulation with collagen, ADP, ristocetin and arachidonic acid. Aggregation responses were reduced with almost all the agonists, especially ristocetin as compared to control samples. This shows that defective platelet - vessel wall interactions play an important role in uraemic bleeding tendency