The authors' reply: Use of erythropoiesis-stimulating agents in obese hemodialysis patients

No abstract available.

Obesity may be erythropoietin dose-saving in hemodialysis patients

BACKGROUND: In dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt. METHODS: This multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated. RESULTS: Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0–11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI. CONCLUSION: Our study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

pattern of dyslipoproteinemia in non- dialyzed chronic renal failure patients

Dyslipidemia is a common finding among patients with chronic renal failure [CRF] Lipid abnormality in CRF is a risk factor for atherosclerosis which is one of the leading causes of death in uremia. In biochemical lipid studies, the absolute and relative Concentrations of individual fractions of circulating triglyceride and cholesterol in different lipoprotein classes are more significant than their serum total levels. However, such studies are obviously rare. The aim of this study was to determine plasma triglyceride and cholesterol contents of VLDL. LDL and HDL classes in patients with chronic renal failure [not yet undergoine dialysis] due to chronic renal disease and to compare the data with their similar results in matched normal subjects. Twenty five male patients with chronic renal disease and CRF were recruited from Mansoura University Hospitals. Also twelve healthy male subjects matched for age and body weight were simultaneously investigated as a normal control After 12 hr overnight fast, blood samples were drawn into EDTA tubes and plasma were separated. Different plasma lipoproteins were layered by high performance density gradient ultracentrifugation. This was followed by measurement of triglyceride and cholesterol fractions in the different lipoprotein layers by the respective enzymatic-colon metric method. There were significant increases in plasma VLDL-TG, LDL-TG and HDL-TG values in CRF above the corresponding normal values. This induced significantly higher than normal circulating TG concentrations. At the same time, there were significantly lower LDL-C and HDL-C concentrations and significantly higher VLDL-C mean value in uremic patients than the corresponding value in the control. The sum of the different lipoproteins cholesterol concentrations gave insignificant change in total serum cholesterol concentration in CRF patients in comparison to normal control. All lipoproteins participate in carrying the excess triglyceride. Cholesterol bounds to lipoproteins was subnormal as regard LDL and HDL but higher than normal with VLDL. HypertrigIyceridemia enhances atherosclerosis of cerebral and/or coronary arteries in CRF

Total and LDL combined vitamin E concentrations in plasma patient with non insulin dependent diabetes mellitus

Patients with diabetes mellitus are susceptible to oxidant-antioxidant imbalance. Diabetic complications such as nephropathy, neuropathy and retinopathy increase 'this susceptibility. Other traditional atherogenic risk factors such as hypertension, cigarette smoking and dyslipidemia can also induce oxidant stress. It is possible that the existence of two or more of the atherogenic risk factors may enhance oxidant-antioxidant imbalance. However, this proposal has not been fully studied. Aim: To determine plasma vitamin E concentrations, both total and the fraction within LDL particles in patients with sole noninsulin-dependent diabetes mellitus [N-1DDM] or N1DDM associated with one or more of the other risk factors of atherosclerosis. This study was conducted on 60 patients with NIDDM [32 males and 28 females]. They were classified into four groups: [1] sole diabetic [n=20], [2] diabetic-hypertensive [n=10], [3] cigarette smoking diabetic [n=10] and [4] diabetic with multiple atherogenic risk factors [n=20]. Also, twenty clinically healthy individuals were investigated as a control group. Vitamin E was measured by high performance liquid chromatography [HPLC] while a plasma thiobarbituric acid reactive substance [malondialde-hyde] was determined colorimetrically. Plasma total vitamin E [VE] and vitamin E in LDL [VE-LDL] concentrations were significantly decreased while plasma malondialdehyde [MDA] levels were significantly increased in sole N1DDM, diabetic hypertensive, smoking diabetic and diabetic with multiple atherogenic risk factors groups in comparison to the corresponding values of the control group. These changes were noted more frequently and more severely in patients with multiple risk factors than those with single DM or DM with another risk factor. In these groups, vitamin E content in HDL showed significant negative correlation with LDL-C concentrations and significant positive correlation with HDL-C concentrations. Multiple regression analysis showed that vitamin E in HDL particles was an independent risk factor for coronary heart disease. The subnormal vitamin E content in LDL panicles may be a result of enhanced LDL oxidation in patients

Significance of circulating levels of N-Terminal pro-brain natriuretic peptide and cyclic guanosine monophosphate as prognostic markers of congestive heart failure

Brain natriuretic peptide [BNP] represents a new biochemical marker for left ventricular systolic dysfunction [LVSD], especially the amino terminal fragment of its prohormone; NT-proBNP. In this study, plasma levels of NT-proBNP, as well as its second messenger cyclic guanosine monophosphate [cGMP], were evaluated for their diagnostic and prognostic potential and their impact on treatment strategies in patients with congestive heart failure [CHF]. Patients and Eighty patients with CHF [Class II-III] were included in the study in addition to ten healthy subjects [control group]. Ten of the patients were treated with standard therapy [ST] of digoxin and furosemide. Other patients were receiving one or more of the following treatments in addition to the ST; angiotensin-converting enzyme inhibitor [captopril], aldosterone antagonist [spironolactone] and vasodilator [isosorbide dinitrate]. Plasma level of NT-proBNP showed a highly significant increase in all CHF patients with LVSD, compared to normal controls. Poor prognosis was obtained in patients treated with ST alone assuming insufficient effect of ST to improve cardiac remodeling. Treatment with either captopril or spironolactone, together with ST, were nearly equally effective in ameliorating LVSD, as reflected by the significant decrease in NT-proBNP, compared to ST alone. The combination of captopril with spironolactone and/or isosorbide dinitrate exhibited a more powerful effect in lowering NT-proBNP, indicating relief of the ventricular overload in CHF patients. The vasodilator isosorbide dinitrate was one of the most promising drugs in improving cardiac function and reducing NT-proBNP and hence improving prognosis. Cyclic GMP showed no correlation with plasma NT-proBNP, although it was significantly increased in patients treated with isosorbide dinitrate in combination with captopril and spironolactone, compared to ST group. Moreover, plasma NT-proBNP showed no correlation with the ejection fraction, the measurable value of echocardiography. These results suggest the use of NT-proBNP as a prognostic marker in development of strategies of therapy for CHF. However, the link between neurohormonal activation and homodynamic approaches requires further investigations

Effect of parathyroidectomy on primary hyper parathyroidism

Eight patients with primary hyperparathyroidism were surgically treated during the period from 1990-1992 inclusive in Endocrine surgery Unit of Mansoura University Hospital, Mansoura, Egypt In all patients, the clinical diagnosis was confirmed biochemically. Different method of investigations were performed and this included skeletal survey, ultrasonography and neck scanning patients were classified into two groups. Group I: Included six patients, the cause of primary hyperparathyroidism was hyperplasia.Total parathyroidectomy and auto transplantation in the forearm muscles marked by silver clips was done in four patients, the remaining two patients were subjected to removal of three and half of parathyroids and the remaining half was left in situ. Group II : Included two patients the cause of primary hyperparathyroidism was adenoma and they were subjected to surgical removal of the adenoma with biopsy of the remaining parathyroids in one patient.In all patient [group I and II], There was marked clinical improvement and serum calcium and P. T.H. returned to near normal levels postoperatively while hypocalcaemia was detected in one patient with resected adenoma to whom biopsy of the remaining parathyroids was done

effect of halothane anaesthesia on blood and plasma volumes in bilharzial hepatosplenomegaly

Ten male patients with bilharzial hepatosplenomegaly were the subject of this study. Another ten male patients of nearly the same age and body weight were taken as control. The plasma and blood volumes were estimated before and 30 minutes after 2% halothane anaesthesia without any surgical interference. The plasma volume was determined by Evens blue dye method and the total blood volume was calculated from the haematocrit value. There was no significant difference between the mean blood volumes of the two groups before the administration of halothane. The 2% halothane administration for 30 minutes, significantly increased the mean total blood volumes in both groups, although the difference between the mean percent increases was not significant. The mean haematocit values of both groups did not display any significant change before or following the exposure to halothane. Patients with bilharzial hepatosplenomegaly developed more hypervolaemia during halothane anaesthesia, possibly mainly due to an increase in the plasma volume. The effect of halothane anaesthesia on the blood volume was the subject of conflicting reports. Some authors [Payne and colleagues, 1959, and Grable and associates, 1962] reported an increase in blood volume, while other [Morse and colleagues, 1963] could not detect any change in blood volume following the administration of halothane. Hepatosplenic bilharziasis is a disease associated with changes in haemodynamic pattern [Mousa, 1967] and these changes can be modified by the action of various drugs especially the vasoactive ones. The purpose of this study is to report the effect of halothane anaesthesia on the plasma and blood volumes in hepatosplenic bilharziasis