RESUMO
Background: In renal transplantation, hypomagnesemia is a frequent disturbance associated with the use of calcineurin inhibitors [Cyclosporine and Tacrolimus] and sirolimus. They may cause obligatory renal loss and decrease transcriptional expression of the Mg transporter in the distal collecting tubule
Objective: Evaluation of serum Magnesium in patients during the first four days post renal transplantation and to find any correlation with different variables
Patients and Method: A cross sectional descriptive study was performed at Nephrology and Kidney Transplantation Center- Medical City-Baghdad, Iraq from first of January, 2012 to first of December, 2012. Serum Magnesium was followed in forty patients underwent renal transplantation during the first four days post transplantation. Other variables also was studied to find any correlation with serum Magnesium, include [age, sex, duration dialysis of, calcineurin inhibitors [types and dose], diabetes mellitus, loop diuretics, urine volume. electrolytes [serum Potassium and s. Calcium] and s.creatinine
Result: The mean serum Magnesium was [2.87 +/- 0.5 mg/dl] pre transplantation, on 1[st] day it was [2.3 +/- 0.49] and 4[th] day [2.31 +/- 0.67]. The mean Post transplantation serum Magnesium was significantly lower than pre transplantation, [P<0.01]. Serum Magnesium had statistically significant direct correlation with serum Potassium and s.creatinine and statistically significant inverse correlation with s. Calcium and urine volume. It was significantly lower in those using loop diuretics at 1[st] day post-transplant [P=0.039]. Tacrolimus was associated with lower serum Magnesium level than cyclosporine
Conclusion: Serum Mg post transplantation was significantly lower than pre transplantation level, and sometime may reach to significant hypomagnesemia. This was significantly correlated with S.K, S.Ca, and S Creatinine
RESUMO
Background: Aortic valve calcification in End Stage Renal Disease [ESRD] patients occurs ten to twenty years earlier than general population. It is associated with myocardial, coronary arteries and conduction system calcification and it is associated with rapid development of aortic valve stenosis
Objective: To study the incidence of aortic valve calcification in hemodialysis patients and to look for risk factors associated with this calcification
Patients and Methods: Forty six patients with End Stage Renal Disease [ESRD] on regular haemodialysis in Baghdad Teaching Hospital / Dialysis Unit and forty six patients with no renal disease as control group were studied between February 2005 - January 2006. Duration of dialysis, blood flow rate during dialysis, serum Calcium, serum Phosphorous and their products were included in this study. Echocardiography was done for all patients
Results: The incidence of Aortic Valve Calcification [AVC] in ESRD patients on haemodiaysis was 30% and it was higher than that of general population [p value 0.0085] . It occurs 10-15 year earlier than in patients with no renal disease. End Stage Renal Disease patients with AVC were older than those with non calcified valves. Only 7.4% of those ESRD patients with AVC have hemodynamic AV stenosis [p value 0.5]. The mean duration of haemodialysis in ESRD patients with AVC was longer than that of ESRD patients without AVC which was statistically significant. Also there was statistically significant association between blood flow rate during haemodialysis and AVC. There was statistically significant association between Calcium phosphate products and AVC in ESRD patients
Conclusion: There is ahigher incidence of aortic valve calcification in ESRD patients on haemodialysis . This calcification occurs earlier than that in patients with no renal disease .The duration of haemodialysis is a risk factors for AVC
RESUMO
Background: Vitamin D deficiency and insufficiency are common in patients with End Stage Renal Disease [ESRD]. Vitamin D has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Iraqi patients on hemodalysis
Objective: This study was conducted to determine the vitamin D status of Iraqi patients with ESRD on hemodialysis
Patients and Methods: This study is a cross sectional study conducted at The Dialysis Center/ Baghdad Teaching Hospital. An eighty four patients with End Stage Renal Disease [ESRD] on regular Hemodialysis [HD] enrolled in the study from January to February 2013. The basic data of the patients had been obtained [age, weight, duration on HD [months], infection with HCV, drugs doses for calcium and alphacalcidol Blood samples were collected at the start of the HD session from the vascular access for calcium, phosphorus, albumin, cholesterol, uric acid and Vitamin 25[OH] D3 blood levels. These samples were sent for analysis to the Teaching Laboratories at Medical City. Patients were considered as vitamin D3 insufficient if the levels were between 10 and 30 ng/ml deficient if the levels were less than 10 ng/ml and sufficient if it was >30 ng/ml We assess the correlation between vitamin D3 level and other variables tested in the study
Results: The mean age of the patients was 49.8 +/- 13.2 years, of these, 40 [47.6%] were females and 44 [52.4%] were males. Fifty five [65%] patients were infected with hepatitis C virus and 29 [35%] were not. the median dose of calcium carbonate was 1086.1 +/- 400 mg per day, The median dose of alphacalcidol wasl.9 +/- 1.1 mcg/week. Mean weight was 68.8 +/- 17.5 kg. Median duration of HD was 24.8 + 20.8 months [range 2-72 months]. The patients were on twice a week [6-8 hours/week] HD sessions. Mean of serum albumin, corrected calcium, phosphorus, Uric acid cholesterol were 3.0 +/- 0.8 g/dl., 8.6 +/- 1.4 mg/dl, 3.9 +/- 1.4 mg/dl, 6.1 + 2.4 mg/dl, 149.9 + 39.2 mg/dl respectively. Mean vitamin 25 [OH] D3 level was 33.02 + 7.2 ng/ml. 60 [71.4%] patients were vitamin D3 sufficient, 23 [27.4%] patients were vitamin D3 insufficient and only one [1.2%] patient was vitamin D3 deficient. There was a significant correlation between vitamin 25 [OH] D3 levels and albumin, duration of HD, virology status while there was no correlation between weight, sex ,age, activity, calcium, cholesterol, uric acid, phosphorus ,dose of alphacalcidol or calcium carbonate and vitamin 25 [OH] D3 level
Conclusion: The vitamin D insufficiency found in about one quarter of patients on hemodialysis while deficiency found only in 1.2% of patients and more than two third of patients had sufficient vitamin D3. There was a significant correlation between vitamin 25 [OH] D3 levels and albumin, duration of HD, virology status