The Change of Arterial Stiffness According to Dialysis in Patients with End-Stage Renal Disease

BACKGROUND AND OBJECTIVE: In dialysis patients, the cardiovascular mortality is 10 to 20 times higher than that in the general population. The increased arterial stiffness in patients with end-stage renal disease (ESRD) is an independent predictor of all-cause mortality. The arterial stiffness and atherosclerotic markers were evaluated in patients with ESRD treated with and without hemodialysis (HD) or peritoneal dialysis (PD). SUCJECTS AND METHODS: 14 hemodialysis (mean dialysis duration 19.6 months), 14 peritoneal dialysis (mean dialysis duration 26.1 months) and 14 patients with ESRD prior to initiation of dialysis, and 27 age-sex matched controls were enrolled. The calculated central pulse pressure, plasma homocysteine, serum C-reactive protein, left ventricular mass index and aortic pulse wave velocity (PWV) were measured. RESULTS: Patients with ESRD treated with and without dialysis had greater increases in their arterial stiffness and advanced atherosclerosis compared with the controls. However, there was no difference in the arterial stiffness and atherosclerotic markers before and after the dialysis treatment, or in the dialysis modality (HD, PD) of patients with ESRD. In a multiple regression model, PWV in patients with ESRD was explained by the level of plasma homocysteine (beta=0.396;p=0.027). CONCLUSION: Atherosclerosis and arterial stiffness in patients with ESRD may not be affected by dialysis treatment or modality. In patients with ESRD, the level of plasma homocysteine is independently associated with arterial stiffness.

Varicella Pneumonia in Adult Following Renal Transplantation / 대한이식학회지

Varicella is usually a benign childhood disease, while in the adult is an infrequent but potentially serious infection. Varicella pneumonia is a potentially life-threatening complication that should be suspected in any adult with chickenpox and respiratory symptoms. In the adult it may be complicated by pneumonia with high morbidity and mortality rates. We present a case of varicella pneumonia complicated the course of chickenpox in the living-related donor renal transplant recipient. A 30-year-old male received an allograft kidney from his father following treatment with cyclosporine and low-dose steroids. Allograft function was stable over the next 27 months. He was admitted hospital with a week history of generalized varicelliform rash, malaise, fever, chills and a cough. Three weeks ago, his nephew (7-year-old) had chickenpox who was living together in the same house. On examination he looked severely ill, febrile and his skin was covered with typical chickenpox eruption. Auscultatory examination was unremarkable while chest X-rays revealed bilateral interstitial infiltration. HRCT findings showed multiple variable sized nodules, patchy ground-glass opacities, and some consolidation in both lower lung. Treament with i.v. acyclovir was started and continued for 10 days. The patient response to the treatment was excellent with complete resolution of pneumonia.