[Contrast-induced nephropathy and mortality after contrast-based investigation]. / Contrastnefropathie en sterfte na contrastonderzoek.

OBJECTIVE: To evaluate the Dutch CBO guideline 'Preventive measures for iodine-based contrast investigations' in daily practice, and to assess one-year mortality post contrast exposure in patients at high risk of contrast-induced nephropathy (CIN). DESIGN: Prospective cohort study. METHOD: Between July 2011 and May 2013, 497 patients at high risk of CIN were prepared for elective iodine-based contrast investigations according to the Dutch CBO guideline. This group was followed up until May 2014 or, if applicable, until death. CIN incidence and reversibility, and mortality, were assessed. RESULTS: CIN occurred in 20 patients (4%). The incidence was highest in the group of patients with an estimated glomerular filtration rate (eGFR) < 30 ml/min per 1.73 m2 (9/84 patients). CIN was reversible within two months in 19 patients. None of the patients with CIN died during that period. One-year mortality post contrast exposure was 22.5% (median survival: 203 days). CONCLUSION: This cohort study shows a low incidence of CIN, which is largely reversible. Almost a quarter of the cohort died within a year post contrast exposure, not as the result of CIN but probably due to comorbidities. Adherence to the current CBO guideline exposes patients with a reduced life expectancy to excessive preventive measures, while the occurrence of CIN is rare. These data warrant reconsideration of the current CBO guideline.

Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis.

OBJECTIVES: Measurement of endometrial thickness is an important tool in the assessment of women with postmenopausal bleeding, but the role of endometrial thickness measurement by ultrasound in asymptomatic women is unclear. The aims of this study were to determine: (1) the normal endometrial thickness measured by ultrasonography, (2) the prevalence of serious endometrial pathology and (3) the sensitivity and specificity of endometrial thickness measurement by transvaginal ultrasonography (TVS) for diagnosing premalignant and malignant endometrial disease in asymptomatic postmenopausal women. METHODS: A MEDLINE and EMBASE search (from inception to January 2011) was performed. Articles reporting on endometrial thickness measurement in the diagnosis of endometrial carcinoma and atypical hyperplasia in asymptomatic postmenopausal women not using hormone replacement therapy (HRT) were selected. Endometrial thickness and the prevalence of endometrial (pre)malignancies were recorded. If possible, 2 × 2 tables were extracted. RESULTS: Thirty-two studies reporting on 11100 women were included. The estimated mean endometrial thickness was 2.9 mm (95% CI, 2.6-3.3 mm). The pooled estimated prevalences of endometrial carcinoma and atypical endometrial hyperplasia were 0.62% (95% CI, 0.42-0.82%) and 0.59% (95% CI, 0.22-0.96%), respectively. Summary estimates for sensitivity and specificity of TVS endometrial thickness measurement in the prediction of endometrial carcinoma were 0.83 (95% CI, 0.19-1.00) and 0.72 (95% CI, 0.23-0.95) for a 5-mm cut-off and 0.33 (95% CI, 0.04-0.85) and 0.94 (95% CI, 0.92-0.96) for a 6-mm cut-off. CONCLUSIONS: The results from this systematic review do not justify the use of endometrial thickness as a screening test for endometrial carcinoma and atypical endometrial hyperplasia in asymptomatic postmenopausal women not using HRT.

Effect of hemodialysis on serum concentrations of HPLC-analyzed accumulating solutes in uremia.

The concentration changes, during hemodialysis treatment, of 18 characteristic uremia compounds, analyzed by high-pressure liquid chromatography in sera of renal patients were studied. Pre- to postdialysis concentration ratios (dialysis ratio, D) varied from 0.83 to 3.04 for the different solutes. A division into three solute groups, on the basis of their D values, could be rationalized qualitatively from data on protein binding and dialyzer clearance. One group showed low dialysis ratios which could be explained from plasma protein binding. The second group had intermediate D values, comparable to those of creatinine. For some of the members of the third group, high D values might indicate a compartmentalization and resistance to mass transfer across biological membranes. Among the latter are the tubularly secreted hippuric acid and p-hydroxyhippuric acid. For most of the (protein-bound) solutes, protein binding was shown to decrease during hemodialysis. Protein binding levels were higher after dialysis only for hippuric acid and the as yet unidentified fluorescent solute designated UFK8. In conclusion, the change of serum concentrations and of protein binding resulting from hemodialysis treatment are presented and are compared for 18 accumulating solutes in sera of patients with end-stage renal failure.

Liquid-chromatographic profiling of solutes in serum of uremic patients undergoing hemodialysis and chronic ambulatory peritoneal dialysis (CAPD); high concentrations of pseudouridine in CAPD patients.

Using "high performance" liquid chromatography, we studied non-protein-bound fractions and total concentrations of 18 solutes accumulating in sera from a group of 12 patients who were undergoing chronic ambulatory peritoneal dialysis (CAPD) and in predialysis sera from a group of 15 hemodialysis (HD) patients. We monitored longitudinal changes in solute concentrations for two patients with respect to change of therapy between HD and CAPD. The concentrations of pseudouridine (P less than 0.001), uric acid (P less than 0.001), and an unknown fluorescent solute, "UKF3" (P less than 0.01), differed in sera of HD and CAPD patients. When standardized with respect to serum creatinine concentrations, the concentration of the transfer-RNA catabolite, pseudouridine, was significantly (P less than 0.0001) higher in sera of CAPD patients than in HD patients, suggesting an increase in turnover of transfer RNA. In stepwise linear discriminant analysis, the combination of pseudouridine and the probably biochemically related fluorescent unknown, UKF3, contributed most to the differentiation between sera from CAPD and HD patients.