Effect of Sixteen Weeks Combined Training on FGF-23, Klotho, and Fetuin-A Levels in Patients on Maintenance Hemodialysis.

INTRODUCTION: Fibroblast growth factor 23 (FGF-23) and its cofactor alfa klotho, are one of the most important factors, directly and indirectly, involved in the process of calcification and atherosclerosis. This study aimed to evaluate the efficacy of a combination of regular exercise during dialysis on quality of life and markers including FGF-23, alfa klotho, and fetuin-A levels. METHODS: Forty-five hemodialysis patients aged 61 ± 9.02 years and weight 69 ± 11.25 kg were randomly divided into two training, EX (n = 24) and control groups, CON (n = 21). The EX group patients participated in a 16-week combined aerobic and resistance exercise program during dialysis. Bone markers including, FGF-23, klotho, fetuin-A, were measured before and at the end of the study in both groups. Statistical analysis for comparing data change during study by SPSS software and the P value was set at .05. RESULTS: In the control group in the secondary assessment, reduction in quality of life was observed (P < .05). Significant change in growth factor 23, CRP, and fetuin-A was not observed in exercise and control groups (P > .05), however significant rising of klotho was observed in treated patients (P < .05). Also, combined training reduced the amount of phosphorus, parathyroid hormone; significantly (P < .05). CONCLUSION: This study showed that regular exercise during dialysis improves quality of life and physical functions. No significant change in FGF-23 and CRP were observed during the study. However significant rising of klotho and reduction of iPTH and phosphorous levels were observed in treated patients.

In-hospital outcome of patients with post-MI VSD: a single-center study.

INTRODUCTION: Ventricular septal defect (VSD) is a rare but life-threatening complication of acute myocardial infarction (AMI). There is a paucity of data regarding the natural history of this devastating complication of myocardial infarction in the Middle East region with restricted financial resources and unsolved major health problems. AIM: To evaluate the clinical presentation and in-hospital outcome of patients with post-infarction VSD over a 10-year period in a tertiary center in northwest Iran. MATERIAL AND METHODS: Data from 64 consecutive patients with VSD complicating AMI were retrospectively analyzed from March 2005 to May 2015. RESULTS: The mean age of the patients was 71.62 ±9.38 years with 57.8% of them being female. The VSDs were anterior in 52 (82%) patients. More than half of patients were in cardiogenic shock during the initial presentation. Multivessel coronary artery disease was found on coronary angiography in 70.3% of patients. In-hospital mortality was 82.8%. Multivariate analysis revealed cardiogenic shock (HR = 12.5, p = 0.001) as the only independent predictor of in-hospital mortality and surgical treatment as the only predictor of in-hospital survival (HR = 0.2, p = 0.02). CONCLUSIONS: Our study demonstrated that VSD complicating myocardial infarction had an extremely high in-hospital mortality rate. Cardiogenic shock was the only independent predictor of in-hospital mortality and surgical treatment was the only predictor of in-hospital survival.

Relationship between ankle-brachial index and left ventricle ejection fraction in patients on hemodialysis.

INTRODUCTION: Ankle-brachial index (ABI) is a noninvasive test which employs as a diagnostic marker of atherosclerotic peripheral vascular disease in hemodialysis patients. This study aimed to investigate the association between ABI and left ventricular ejection fraction (LVEF) in patients on hemodialysis. MATERIALS AND METHODS: Eighty-six patients with end-stage renal disease undergoing hemodialysis and 100 patients referred for echocardiography without apparent kidney disease were included. Ankle-brachial index was calculated by dividing the highest ankle pressure (the left and right dorsalis pedis and posterior tibial) by the brachial systolic blood pressure on the arm with no arteriovenous fistula. The relationship between ABI and LVEF was investigated. RESULTS: The hemodialysis patients were older on average than the control group (P = .004). The total average of ABI in the hemodialysis group was less than 0.9 in 20 patients (23.3%) and 0.9 to 1.3 in 66 (76.7%). These were 11 (11%) and 89 (89%), respectively, among the controls (P = .02). The mean LVEF was 49.7 ± 8.6% in the hemodialysis patients and 53.8 ± 9.5% in the controls (P = .003). There was a significant correlation between LVEF and ABI in the hemodialysis patients (r = 0.06; P = .001), and ABI could predict the LVEF with sensitivity and specificity of 90% and 94.1%, respectively (positive predictive value, 34.6%; negative predictive value, 48.5%). CONCLUSIONS: These findings show that ABI may be applied in predicting the presence of left ventricular systolic dysfunction in hemodialysis patients. Further studies are recommended to confirm this association.