Relationship between hyperhomocysteinemia and atherosclerosis in chronic hemodialysis patients.

BACKGROUND: Hyperhomocysteinemia is an independent risk factor of coronary artery heart disease (CAHD) and atherosclerosis in a normal population. However, it is still controversial in end-stage kidney disease patients who underwent long-term dialysis. Carotid intima-media thickness (IMT) is the standard non-invasive measurement of atherosclerosis. The aims of the present study were to determine the homocysteine (Hcy) level, and to evaluate its role as a risk factor of atherosclerosis in hemodialysis (HD) patients. MATERIAL AND METHOD: Clinical data and blood chemistries were assayed in 62 HD patients. Atherosclerosis was defined by clinical presentations of CAHD, cerebrovascular or peripheral vascular diseases, or carotid plaque by ultrasound. IMT was also measured by ultrasound RESULTS: Plasma Hcy level in HD patients was significantly higher in HD patients than normal controls (28.3 +/- 8.3 vs 9.7 +/- 2.9 micromol/l, p < 0.001). Older age (p < 0.001), male sex (p = 0.05), longer duration of HD (p = 0.05), and higher plasma Hcy level (p = 0.01) correlated with atherosclerosis by univariate analysis, but plasma Hcy did not show significant correlation by multivariable analysis. There was also correlation between IMT and atherosclerosis in HD patients (p < 0.001) but no correlation was observed between plasma Hcy level and lMT. CONCLUSION: Hyperhomocysteinemia is not an independent factor in the genesis of atherosclerosis in HD patients. Advanced age plays a major role of hyperhomocysteinemia and IMT is a useful marker of atherosclerosis in these patients.

Development of Thai quality-of-life questionnaires for patients with chronic renal failure.

Chronic renal failure (CRF) is one of a number of major diseases that seriously affects quality-of-life (QOL). In this study, we developed a disease-specific QOL questionnaire in Thai for CRF. A list of items important to QOL of CRF patients was created by interviewing five patients, four nephrologists, and four nephrology nurses to identity items that affect patients’ QOL. Additional items were sought from English questionnaires. Another 50 CRF patients were then interviewed to determine the importance of each item by rating then on a scale of 1 (minimally important) to 5 (extremely important). Patients were also encouraged to add items which were not on the list. For each potential item, a frequency-importance score was calculated by adding each patient’s score. A combination of factor analysis and clinical judgment was then used to develop the final questionnaire, with questions scored on the 5-point Likert scale (ranging from “none of the time” to “all of the time”). Psychometric properties were subsequently evaluated in CRF patients at Siriraj Hospital. The validity of the questionnaire was assessed using the relationship between QOL questionnaire scores and the severity chronic renal failure assessed by the adequacy of dialysis diochemical parameters such as serum albumin, urea and creatinine and nurses’ or patients’ global assessment. Reproducibility and internal consistency were examined twice by interviewing 40 hemodialysis patients who came to hemodialysis clinic and had follow-up one week later. The final questionnaire consisted of 24 questions in five domains (physical symptoms, fatigue, psychological, social and emotional). The scores for all corrected strongly with nurses’ and patients’ assessment scores. The reproducibility of the questionnaire was high (intraclass correlation coefficient between 0.60 and 1.00 for the five domains except for the social domain). A high internal consistency in the questionnaire was found using the o-coefficient of Cronbach (ranging between 0.50-0.86 for the two tests). This questionnaire appears to be valid and reliable for assessing CRF patients.

Non-oliguric renal failure in aminoglycoside nephrotoxicity.

Clinical and laboratory data were reviewed on 35 patients with acute renal failure associated with aminoglycoside administration. The diagnosis of nephrotoxicity was based on azotaemia both with or without a decline in the volume of urine. Clinical nephrotoxicity in these cases most likely occurred in association with surgery, advanced age, diabetes mellitus, jaundice and recent exposure to aminoglycosides. Twenty one of the 35 patients were non-oliguric. The duration of established renal failure after administion of aminoglycosides varied from 4 to 16 days. The common causative drugs were gentamicin (1.5-5 mg/kg/day) and kanamycin (1 gm/day) respectively. The maximum creatinine was 15 mg/dl. Conservative management of renal failure included withdrawal of aminoglycosides or adjusting the dose according to renal function, treatment of underlying diseases and provision of adequate hydration. Sixteen patients improved with normal serum creatinine within 7 days to 2 months after the onset of renal failure. Non of non-oliguric patients required dialysis treatment. Five patients died from septicaemia.