ABSTRACT
UNLABELLED: The risk of death is higher in dialysis patients compared to age matched healthy subjects, the main reason being cardiovascular. This prospective study investigated if the extent of ultrafiltration was of importance for the outcome. MATERIAL AND METHODS: 88 hemodialysis patients were included and followed prospectively. The outcome was registered in regard to death, acute myocardial infarction or coronary vascular intervention. The extent of ultrafiltration needed at dialysis was calculated as a mean during the observation period as were other variables. The mean extent of ultrafiltration was compared for patients who had survived without end-points (group 1, n=53) versus those who reached any end-point during the period (group 2, n=35). RESULTS: In total, 40% of the patients reached end-point during the observation period. There was no difference at baseline between the groups in regard to age, prevalence of diabetes mellitus or history of previous cardiovascular disease, KT/V, residual renal function ultrafiltration need, C-reactive protein, s-albumin, cholesterol, LDL-cholesterol, HDL-cholesterol, appetite or wellbeing, while triglyceride was lower in group 2 (p=0.035). The observation period for group 1 was at a mean 24.7 months (SD13.1) and for those in group 2 at a mean 13.8 (+/-11.7 months, p<0.001). Patients representing group 1 at 24 and 30 months had less need of ultrafiltration than those in group 2. Thus, the need of ultrafiltration was about 27% lower at 24 months (for 29 persons in group 1: 3.63+/-1.93 weight% versus 4.97+/-1.70 weight% for 9 patients from group 2, p=0.046) and 46% at 30 months (for 18 from group 1: 3.48+/-1.95 versus 6.45+/-1.55 for 3 from group 2, p=0.030). C-reactive protein did not differ significantly between the groups during the period. CONCLUSION: After a prolonged period of 24 months the extent of ultrafiltration need seems to be important for the outcome of the patients. Thereby those with higher need of ultrafiltration had worse prognosis. It seems important to motivate patients to reduce the extent of fluid intake between dialysis to prolong survival.
Subject(s)
Hemodiafiltration , Renal Insufficiency/mortality , Weight Gain , Adult , Aged , Aged, 80 and over , C-Reactive Protein/analysis , Humans , Middle Aged , Proportional Hazards Models , Prospective Studies , Renal Insufficiency/therapyABSTRACT
BACKGROUND: Kidney failure is a common complication in familial amyloidotic polyneuropathy (FAP). It has been suggested that advanced glycation end products (AGEs) play an important role in the development and pathogenesis of FAP. MATERIAL AND METHODS: To evaluate the impact of AGEs on FAP patients' kidney dysfunction, we measured AGE in serum and urine of 28 FAP patients and 18 healthy controls by AGE-specific enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry utilizing antibodies to AGE and the receptor for AGE (RAGE) were used on kidney tissue from 3 FAP patients and 3 diabetic patients to disclose a correlation between amyloid deposits and AGE-RAGE. RESULTS: The glomeruli of FAP patients were heavily deposited with amyloid and the glomerular size was enlarged. The space between Bowman's capsule and glomerulus was totally covered by the enlarged glomerulus. AGE and RAGE were deposited in glomeruli and tubuli and correlated with amyloid deposits. Decreased AGE levels in the liver-transplanted FAP patients' serum compared with that of non-transplanted patients were noted, and AGE concentration in serum tended to be higher in non-transplanted FAP patients compared with normal control subjects. There were no differences in the AGE urine levels in FAP patients compared with controls. No correlation could be found between AGE in urine and serum compared with serum albumin, serum creatinine and creatinine clearance. CONCLUSIONS: The accumulation of AGE, RAGE and amyloid in the kidney of FAP patients suggests that these molecules play an important role in the origin and pathogenesis of renal failure in FAP patients.
Subject(s)
Amyloid Neuropathies, Familial/metabolism , Amyloid Neuropathies, Familial/pathology , Glycation End Products, Advanced/metabolism , Renal Insufficiency/metabolism , Renal Insufficiency/pathology , Amyloid Neuropathies, Familial/complications , Amyloidosis/complications , Amyloidosis/metabolism , Amyloidosis/pathology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Kidney/metabolism , Kidney/pathology , Kidney Function Tests , Male , Middle Aged , Prealbumin/metabolism , Receptor for Advanced Glycation End Products , Receptors, Immunologic/metabolism , Renal Insufficiency/etiologyABSTRACT
This study was designed to provide information on the kinetics of FXIIa activity and C3d release during haemodialysis. Dialysis was performed twice in 9 stable patient for 240 min with the same conditions except for a change in dialysate sodium profile (using a linear sodium programme starting at 138 and ending at 148 mmol/l or vice versa). Using paired statistics there was a significant (p < 0.02) increase in both C3d release and the FXIIa activity. The sodium profiles did not alter the outcome. The increase in FXIIa activity, which is maximal at the end of dialysis, is continuous, unlike the C3d release, which is maximal within 15 min of dialysis and then levels off. Both interactions are induced by the blood membrane contact. These results indicate that the FXIIa activation is not strictly coupled to the activation of the complement system.
