N-Acetylcysteine in hemodialysis diabetic patients resets the activation of NF-kB in lymphomonocytes to normal values.

BACKGROUND: Oxidative stress pathways are activated in diabetes, particularly when dialysis is required (DD). NF-kB is activated in this clinical condition. Since N-Acetyl-cysteine (NAC) is an anti-oxidant, we aimed at investigating its effect in modulating NF-kB activation in lymphomonocytes (PBMC) of DD patients. METHODS: Twenty-five DD patients were enrolled in a cross-over designed study. Tests were performed at T0 and after one month (T1) of treatment with NAC and three months after NAC withdrawal. We assessed NF-kB activation by EMSA, levels of advanced oxidation protein products (AOPP) by spectral analysis, total antioxidant capacity (TAC) by colorimetry, and apoptosis by FACS. RESULTS: At T0 a statistically significant increased activation of the subunits of NF-kB, p50/p65, was detected in PBMC of DD patients in comparison to controls (both P<.0001). After one month of NAC both p50-p50/p50-p65 dimers were significantly reduced (P<.004 and .006). Three months after drug withdrawal NF-kB increased again to basal levels (P<.002 and P<.001 vs. end of treatment with NAC). AOPP and TAC levels and the percentage of apoptotic PBMC revealed modifications in accordance with NFkB activation. In a multivariate linear regression model using delta AOPP as the dependent variable and delta p50-p50, delta TAC, and delta APO as independent variables, we found that all three dependent parameters all retained an independent correlation with delta AOPP. CONCLUSIONS: Our data indicate in vivo a modulation by NAC of parameters indicating a redox imbalance in DD patients on hemodialysis. The use of NAC might suggest a potential clinical benefit.

[Quality of life assessment in dialyzed patients in the Cuneo area]. / Valutazione della qualita' di vita dei dializzati del cuneese.

The concept of quality of life includes several aspects of physical and psychological status. In a medical setting the evaluation of quality of life comprises physiopathological and clinical aspects as well as patient well-being and functioning. The aims of this study were to carry out an updated evaluation of the health status and quality of life of chronic dialysis patients in a defined geographic area; to obtain data comparable with other studies or other populations; and to identify possible action or interventions. The tool chosen to achieve these aims was the Italian version of SF36. The SF36 survey was filled in and returned by 78% of patients; the mean rate of missing data was 5%. The results showed that physical aspects were the most compromised, whereas the dialyzed patients' mental status was reasonably intact. Peritoneal dialysis patients had better scores than hemodialysis patients. Age and time on dialysis were closely related to quality of life. The obtained data confirm that end-stage renal disease provokes physical invalidity and disability, severely compromising the health and quality of life of patients and their caregivers. The resulting picture describes a dialysis patient mainly affected by physical problems and difficult management of treatment but with a good mental endurance, who is seeking to regain the autonomy lost due to the disease but also the possibility to socialize and exchange experiences with fellow patients.

Acute renal failure in critically ill patients: indications for and choice of extracorporeal treatment.

The prescription of extracorporeal therapy for patients with acute renal failure involves many options: dialysis sessions may be intermittent or continuous, semicontinuous or slow-extended, with controversial indications still to be defined also depending on technical and logistic issues and related to the multidisciplinary cooperation needed in the management of critically ill patients. All efforts to evaluate extracorporeal treatments in these patients must be targeted not only towards supporting renal function, but towards all functional and metabolic derangements that can result from artificial blood purification, in any way achievable.