Favorable changes in lipid metabolism and cardiovascular parameters after icodextrin use in peritoneal dialysis patients.

Better control of cardiovascular function in patients on peritoneal dialysis (PD) is critical because PD patients have a tendency to overhydration, which has been proved to be associated with cardiovascular and patient outcome. In the general population, lipid metabolism is also considered to be an important indicator of future cardiovascular events. Icodextrin has been used to improve ultrafiltration volume without increasing dextrose load. We therefore expected that parameters of lipid metabolism and cardiovascular function could both be improved, or at least maintained, after icodextrin use in PD patients. We therefore analyzed those parameters in 14 prevalent PD patients who required a switch from dextrose to icodextrin solution for the long dwell at 1 year before the switch, at the time of the switch, and at 1 and 2 years after the switch. In the study patients, cardiovascular remodeling evaluated by ultrasonographic left ventricular mass index was diminished, but the intima media area of the cervical artery was elevated after icodextrin use. Intima media thickness did not change over time. Biochemical indices such as brain natriuretic peptide, atrial natriuretic peptide, lipoprotein A, total cholesterol, and triglycerides were all lower after icodextrin use. These results indicate that icodextrin has the potential to improve lipid metabolism, volemic status, and cardiac hypertrophy in prevalent PD patients. However, atherosclerotic vascular change is refractory to improvement.

Longitudinal changes in parameters of cardiovascular function in patients treated for 8 years with hemodialysis or peritoneal dialysis.

Cardiovascular complications are obviously important in the management of dialysis patients, and ultrasonography can be used to evaluate cardiac indices that can predict these complications. However, long-term longitudinal changes in ultrasonographic cardiovascular indices in dialysis patients are not well known. Also, the implications of lipid metabolism for cardiovascular change in dialysis patients is controversial. We therefore analyzed ultrasonographic cardiac parameters and laboratory data for lipid metabolism in patients who had been on peritoneal dialysis (PD) or hemodialysis (HD) for 8 years and also in patients who had been on PD for 4 years followed by another 4 years on HD. We found that lipid metabolism was worse but that cardiovascular indices were more stable over time in PD patients than in HD patients. Mean blood pressure was also better maintained in PD patients. These results indicate that cardiovascular function can be maintained in PD patients over the long term, given that blood pressure is controlled even though dyslipidemia worsens.

Impact of dialysis modality on ultrasonographic cardiovascular parameters in elderly patients.

Cardiovascular complications are the major cause of mortality in end-stage renal disease (ESRD) patients. Some reports show that ultrasonographic parameters for cardiovascular remodeling predict mortality in ESRD patients as well as in the general population. In the present study, we compared long-term longitudinal changes in cardiac parameters between elderly patients on peritoneal dialysis (PD) and those on hemodialysis (HD). We analyzed 19 HD and 7 PD patients who were more than 75 years old at the start of dialysis and who had been treated with the same dialysis modality for more than 4 years. We compared ultrasonographic cardiovascular parameters such as left ventricular mass index (LVMI), left ventricular wall thickness (LVWT), intima media thickness and intima media area (IMA) over the 4 years of PD and HD treatment. As compared with values at the start of dialysis, values for LVMI, LVWT, and IMA were significantly elevated in HD patients after 4 years of treatment. In PD patients, we observed no changes in those parameters over time. Our findings indicate that cardiovascular remodeling is liable to deteriorate in elderly patients on HD, but that cardiac parameters in PD patients remain rather stable.

Effects of a Novel Aldose Reductase Inhibitor, Fidarestat (SNK-860), on Vibration Perception Threshold and Subjective Symptoms in Patients with Diabetic Polyneuropathy : An Open-Label Pilot Study.

OBJECTIVE: To evaluate the effects of fidarestat (SNK-860) on vibration perception threshold, as measured by C64 quantitative tuning fork (64Hz) analysis, as well as its effects on subjective symptoms in patients with diabetic polyneuro-pathy. DESIGN AND SETTING: Open-label, prospective study conducted at 12 hospitals in the central area of Honshu, Japan. INTERVENTIONS: Fidarestat was administered at a dosage of 1mg once daily after breakfast for 28 weeks. MAIN OUTCOME MEASURES: Vibration perception threshold of upper and lower extremities was determined using a C64 quantitative tuning fork, and measured at baseline and after 12 and 28 weeks of treatment. Subjective symptoms, including numbness, spontaneous pain and hypoaesthesia, were evaluated every 4 weeks. RESULTS: Subjective symptoms were evaluated in 22 patients, and vibration perception threshold data were available for 19 patients. Vibration perception threshold at baseline was negatively correlated with the severity of the following subjective symptoms: numbness in the upper limbs, and numbness, coldness and hot flushes, smarting pain causing difficulty walking and hypoaesthesia in the lower limbs. During treatment with fidarestat, vibration perception threshold increased significantly in the upper (p = 0.0017) and lower (p = 0.0001) limbs. The following symptoms were also significantly improved: severity of numbness in the lower limbs, heaviness in the foot, coldness and hot flushes in the lower limbs, smarting pain causing difficulty walking, sensation as if walking on sand, sensation as if walking on an uneven road, spontaneous pain in the lower limbs, and dizziness. Adverse events occurred in four patients. CONCLUSION: Administration of fidarestat after breakfast was effective in significantly alleviating some symptoms of diabetic polyneuropathy. The C64 quantitative tuning fork analysis is useful in the diagnosis of diabetic polyneuropathy, and as a measure of the severity of the neuropathological symptoms of this condition.