Effects of N-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients.

AIMS/HYPOTHESIS: It was suggested that polyunsaturated n-3 fatty acids (n-3 PUFAs) could improve insulin sensitivity and have an anti-inflammatory effects in overall population. This study investigates a possible effect of n-3 PUFAs supplementation on the insulin sensitivity and some inflammatory markers; hence, patients with chronic renal failure (CRF) on maintenance hemodialysis (MHD) are presented with insulin resistance. METHODS: This study explored the ratio between red blood cells (RBC) phospholipid long chain fatty acids (LC FAs) and components of metabolic syndrome (MeS) in 35 patients (mean age 54.50 +/- 11.99 years) with CRF on MHD. Furthermore, the effects of omega-3 FA eight-week's supplementation (EPA+DHA, 2.4 g/d) on the MeS features and inflammatory markers TNF-alpha, IL 6, and hsCRP were examined. RESULTS: Supplementation increased EPA and DHA levels in RBCs (p = 0.009 for EPA and p = 0.002 for DHA). Total n-6 PUFAs: n-3 PUFAs ratio tended to be lower after supplementation (p = 0.31), but not significantly. Data revealed a significant decrease of saturated FAs (SFA) (p = 0.01) as well as total SFA: n-3 PUFAs ratio during the treatment (p = 0.04). The values of serum insulin and calculated IR index-IR HOMA were reduced after supplementation (p = 0.001 for both). There was a significant decrease in the levels of all inflammatory markers (p = 0.01 for TNF alpha, p = 0.001 for IL 6, p = 0.001 for hsCRP, and p = 0.01 for ferritin). In multivariate regression analysis, only the changes in n-6 PUFAs: n-3 PUFAs ratio independently contributed to 40% of the variance in IR HOMA. The impact of changes in PUFAs level in RBCs membrane phospholipid fatty acids on inflammation markers was also registered. The changes in n-6: n-3 PUFAs ratio independently contributed to 18% of the variance in TNF alpha. CONCLUSION: It was concluded that the EPA and DHA moderate dose administration in the patients with CRF on MHD had a beneficial effect on insulin resistance decrease. The anti-inflammatory effects of the supplemented PUFAs were also presented.

[Lipid status in patients on a chronic hemodialysis program]. / Lipidni status bolesnika na hronicnom programu hemodijalize.

Dyslipidemia causes development of atherosclerosis in chronic hemodialysis patients. The goal of this study was to determine values of serum lipids in hemodialysis patients. The study comprised 45 patients, whereas the control group consisted of 45 healthy persons of corresponding age and sex. We determined triacyglycerols, total cholesterol, HDL (high density lipoprotein) and LDL (low density lipoprotein) cholesterol in the serum of patients on an empty stomach. There were 51% of patients with normal findings, and 49% with hyperlipoproteinemia type IV. In regard to the control group triacyglycerol was increased both in patients with hyperlipoproteinemia type IV and in patients with normolipemia. Levels of total cholesterol were higher in patients with hyperlipoproteinemia type IV, while values of HDL cholesterol were decreased in both subgroups of patients in regard to the control group. Values of total cholesterol in relation to HDL cholesterol > 4.5 occurred in 38% of patients. Lipid profile of hemodialysis patients, including those with normolipidemia, points to high risk of cardiovascular diseases.

[Serum phospholipids in patients in a chronic hemodialysis program]. / Fosfolipidi seruma u bolesnika na hronicnom programu hemodijalize.

The aim of this investigation was to determine concentrations of total and single phospholipids and to examine distribution of phospholipid fractions in serum of chronic hemodialysis patients. The investigation included 21 patients, 10 with normal lipid level in serum and 11 with hyperlipoproteinemia type IV. The control group consisted of 17 healthy normolipidemic persons. The gathered results show that in hemodyalisis patients the level of phospholipids (3.10 +/- 0.66 mmol/L) is higher than the level of phospholipids in the control group (2.25 +/- 0.35 mmol/L). Dialysis patients with hyperlipoproteinemia type IV have an increased level of serum phospholipids (3.51 +/- 0.43 mmol/L) in regard to dialysis patients with normolipidemia (2.46 +/- 0.57 mmol/L). The distribution of phospholipid fractions, that is proportional occurrence of lysophosphatidylcholine, sphingophospholipids and phosphatidylcholine is disturbed in dialysis patients no matter what their lipid status is.

[Hepatitis C virus infection in patients on chronic hemodialysis]. / Infekcija virusom hepatitisa C kod bolesnika na hronicnoj hemodijalizi.

Frequency of HCV infection was examined in patients on chronical program of hemodialysis considering the high risk to which they had been exposed because of frequent blood transfusion. We determined anti-HCV antibodies in 57 patients (29 male and 28 female) average age 52.6 years with terminal chronic renal failure. Frequency of anti-HCV antibodies (determined by ELISA Ortho test of first generation) was in correlation with the number of received transfusions and with duration of dialysis treatment and it was compared with anti-HCV antibody findings in hemodialysis staff (the control group of healthy persons). Results of the examination showed that anti HCV antibodies were positive in 38.95% examined patients (n = 57), and it showed that the patients on hemodialysis were a critical group for HCV infection. There was no correlation with the blood groups. Level of transaminases, HBsAg and immunity test in anti-HCV positive patients were in the physiological range. In order to prevent HCV infection in the dialysis centres, it is necessary to conduct routine test in patients and staff, and undertake all measures of protection.

[Lupus nephritis: clinico-morphologic correlation]. / Lupusni nefritis: klinicko-morfoloska korelacija.

The aim of the study was to determine the correlation between some clinical parameters and histopathologic findings in patients with lupus nephropathy. Eighteen patients (17 female and one male) with the diagnosis of lupus nephritis were examined at the Nephrological Clinical of the Faculty of Medicine. Three to eight months passed between diagnosing systemic lupus erithematosus and kidney biopsy. At the time of biopsy the average age of patients was 33.3 +/- 2.9 years (18-52 years). In more than half of the 18 cases the disease was evidenced as nephrotic syndrome, but most of them had renal failure and increased blood pressure. In patients with diffuse proliferative glomerulonephritis proteinuria was significantly higher than in other histopathologic groups. Serum nitrogen was considerably higher while creatinine clearance was much lower in patients with diffuse proliferative glomerulonephritis than in other histopathologic groups. Circulating immune complexes were increased, and the complement (C3 and C4) concentration was slower in patients with lupus nephropathy, but the significant difference was present only when diffuse glomerulonephritis was compared to other histopathologic groups.