Hypertension and hyperparathyroidism are associated with left ventricular hypertrophy in patients on hemodialysis.

Conflicting data for association between left ventricular hypertrophy (LVH) and secondary hyperparathyroidism has been reported previously among dialysis patients. The present study was conducted to evaluate the association of hyperparathyroidism and hypertension with LVH. Charts of 130 patients on hemodialysis for at least six months were reviewed. All were subjected to M-mode echocardiography. Left ventricular mass (LVM) was calculated by Devereux's formula. LVM Index (LVMI) was calculated by dividing LVM by body surface area. Sera were analyzed for intact parathyroid hormone (iPTH). iPTH of > 32 pmol/l and a mean blood pressure (MAP) of > 107 mmHg were considered high. Patients were stratified into groups according to their MAP and iPTH. A total of (47.7%) patients were males and 68 (52.3%) were females. Their median age was 57 years. The median duration on dialysis was 26 months. Forty eight (36.9%) patients had high BP and 54 (41.5%) had high iPTH. Both high BP and high iPTH were present in 38 (29.2%) patients. Analysis of the relationship between LVM, LVMI, MAP and iPTH showed that LVM and LVMI were significantly (P < 0.001) higher in patients with concomitant high BP and high iPTH. LVMI was significantly higher in patients with high iPTH alone. Concomitant high iPTH and high MAP increase the risk of LVH in hemodialysis patients. High iPTH alone might contribute in escalating LVH. Adequate control of hypertension and hyperparathyroidism might reduce the risk of developing LVH.

Vascular calcification in dialysis patients.

UNLABELLED: The risk factors for vascular calcification (VC) in dialysis patients include duration of dialysis, diabetes mellitus, aging, hyperphosphatemia, hyperparathyroidism, and calcium or vitamin D supplementation. This study was performed to evaluate the prevalence of and risk factors for VC in our dialysis population. METHODS: One hundred twenty-nine chronic dialysis patients underwent plain x-rays of the hands for VC. Patients were grouped as either positive (PVC) or negative (NVC) for VC. Age, gender, duration of dialysis, presence of non-insulin-dependent diabetes mellitus (NIDDM), oral calcium, and 1alpha-hydroxyvitamin D3 supplement, serum levels of calcium (Ca), phosphorus (P), calcium phosphorus product (CaxP), alkaline phosphates (ALP) and intact parathyroid hormone (iPTH) were compared between the two groups. RESULTS: Thirty-four patients (26.35%) showed VC. There were no differences between PVC and NVC patients for duration of dialysis (38.4 +/- 27.7 for PVC and 34.6 +/- 31.2 months for NVC, P = .80), levels of serum Ca (P = .26), P (P = .19), CaxP (P = .33), ALP (P = .89), or iPTH (P = .24). Similarly, oral calcium and 1alpha-hydroxyvitamin D3 intake were not different between the two groups (P = .971 and P = .3710 respectively). Compared to NVC patients, PVC patients were older (56.3 +/- 10.4 versus 47.5 +/- 16.1 years, P = .008) and had a greater incidence of NIDDM (17/34 PVC and diabetic versus 20/95 NVC, P = .001). In conclusion, for patients with a medium length of dialysis, the duration of dialysis as well as the doses of calcium salts and of 1alpha-hydroxyvitamin D3 were not significantly associated with vascular calcifications, but it was not possible to exclude a role for these and other factors in patients with longer dialysis.

Profiled hemodialysis reduces intradialytic symptoms.

A prospective study on the effect of profiled hemodialysis on intradialytic symptoms was undertaken among patients recruited between September 2002 and December 2002. Evaluated intradialytic symptoms included hypotension, muscle cramps, dizziness, headache, nausea, discomfort, thirst, and shortness of breath. Symptomatic patients were allocated to one mode of combined sodium and ultrafiltration profile during hemodialysis. The programs were readily available on Fresenius MC 4008 H&E hemodialysis machines. Evaluation was performed before profiling and at 2, 4, and 6 weeks into the profiled hemodialysis. On standard hemodialysis 40 (36.4%) patients were symptomatic. Hypotension was reported in 29 (72.5%) of patients receiving standard treatment. Dizziness, headache, and muscle cramps were reported in 22 (55%), 15 (37.5%), and 9 (22.5%) patients, respectively. These symptoms were significantly (P <.05) improved at 2, 4, and 6 weeks of profiling. Other symptoms, such as discomfort, nausea, vomiting, and thirst, were infrequently reported among patients without or with profiling. There was no significant difference between the applied profiles when compared with each other. In conclusion, sodium and ultrafiltration profiling are effective techniques to reduce acute adverse side effects of hemodialysis. They improve patient well-being and dialysis tolerance, minimize interventions during dialysis.

Xanthomonas maltophilia infection in chronic peritoneal dialysis patients.

Xanthomonas maltophilia infection has only been occasionally reported in patients receiving chronic peritoneal dialysis. We describe four cases of Xanthomonas maltophilia infection associated with chronic peritoneal dialysis. Two patients presented with peritonitis and two with exit site infection. All patients were diabetics, who immediately prior to the study had not received antibiotic therapy. Failure to respond to multiple antibiotic therapy resulted in catheter removal in both patients with peritonitis. In those patients with only exit site infections, dialysis could be continued following antibiotic therapy and catheter replacement in one. Catheter loss in our patients was directly attributed to peritonitis with Xanthomonas maltophilia infection.

Aluminum monitoring for chronic renal failure patients in kuwait.

The importance of monitoring serum aluminum (Al) level in patients undergoing long-term hemodialysis (HD) is well known. This study on 94 HD patients from Mubarak Hospital, Kuwait revealed that serum Al level was significantly higher in HD patients on aluminum hydroxide therapy (n = 57) than those not on this treatment (n = 37) (p = 100 ug/L. Analysis of water and dialysis fluid showed Al levels just above the permissible limit, on certain occasions, suggesting the need for regular monitoring of these substances for Al contamination. Patients on HD for longer than five years and those above the age of 50 years had higher serum Al levels. The most important single factor causing elevated serum Al levels in the study patients was aluminum hydroxide therapy, administered orally as a phosphate binder.

Erythropoietin deficiency and relative resistance cause anaemia in post-renal transplant recipients with normal renal function.

BACKGROUND: Following successful renal transplantation, blood erythropoietin (Epo) levels peak in two phases during the first 2-3 months, and blood haemoglobin/haematocrit (HB/Hct) levels are restored to normal in a period of 2-6 months. However, some transplant recipients continue to remain anaemic in spite of normal graft function and in the absence of recognizable causes. The role of endogenous Epo production in the causation of anaemia in such patients is poorly understood and has been investigated in this study. METHODS: Twenty-three post-renal transplant recipients with stable normal renal function were studied. Eleven of these patients had normal HB/Hct levels (group 1) and served as control for the rest 12 patients with anaemia (group 2). Patients included in group 2 had no readily recognizable cause for their anaemia. Other laboratory and clinical findings were similar in both groups. Patients with erythrocytosis were excluded. Serum Epo levels were measured in all patients. Five patients in group 2 were treated with recombinant human erythropoietin (rHuEpo) and their erythropoietic response was assessed. rHuEpo was discontinued when the target Hb/Hct levels (lowest normal range) were achieved and the patients were followed up for a further period of 9-12 months. RESULTS: Five patients in group 1 had normal expected serum Epo levels whereas the other six patients had inappropriately high serum Epo levels with respect to their Hb/Hct status suggestive of relative ¿EPO resistance'. Serum Epo levels in all patients except two in group 2 were low indicative of 'Epo deficiency'. The two exceptional patients in group 2 had higher serum Epo levels in the presence of anaemia suggestive of relative ¿Epo resistance'. All five patients treated with rHUEpo responded adequately by achieving normal Hb/Hct levels. Three of them were originally ¿Epo deficient' and they reached target Hb/Hct levels in a mean period of 4 weeks, requiring a mean cumulative rHuEpo dose of 428.3 units/kg. The other two patients with higher initial serum Epo levels, and considered to be ¿Epo resistant' required an average of 11 weeks of treatment and a mean cumulative rHuEpo dose of 1582.5 units/kg, indicating an increased Epo demand. On cessation of therapy the Hb/Hct levels fell in all five patients to pretreatment values in 6 months. CONCLUSIONS: There are important variations in the endogenous Epo production in renal transplant patients with normal renal function, the cause of which is not clear. Epo deficiency and relative Epo resistance play a causative role for anaemia in some post-renal transplant recipients with stable normal renal function. They respond adequately to rHuEpo administration.

Hepatitis C virus infection in patients on maintenance dialysis in kuwait: epidemiological profile and efficacy of prophylaxis.

Data on hepatitis C virus (HCV) infection in patients undergoing maintenance hemodialysis (HD) in Kuwait were collected retrospectively in December 1994. Ninety three of 232 patients (40%) studied had hepatitis C antibodies (anti-HCV) when tested by a second generation enzyme linked immuno-sorbent assay (ELISA-II). Since October 1992, all HD patients who tested positive for anti-HCV were dialysed on separate machines and blood transfusions were limited to acute life-threatening emergencies through regular use of recombinant human erythropoeitin. The prevalence of anti-HCV positivity among dialysis patients who received treatment during the "HCV-prophylaxis period" was 33/163 (20.2%), as compared to 46/55 (83.6%) of those who received HD during the 27 months prior to October 1992 (p< 0.0001), and had similar average duration on dialysis (12 + 7 and 13 + 7 months, respectively). Excluding the 15 patients who had anti-HCV on entry to HD during "HCV-prophylaxis period", the estimated incidence of positive anti-HCV seroconversion was 11.5 per 100 patients per year on HD. In the 93 anti-HCV positive patients, alanine aminotransferase (ALT) levels were elevated for more than six months in 32 (34.4%), elevated in multiple peaks in 22 (23.7%) and showed combined variation of the latter two abnormalities in 16 (17.2%). Histological evidence of chronic active hepatitis was present in five of six patients who manifested persistent ALT abnormalities. Vaccination against hepatitis B virus produced positive seroconversion in 76.1% patients, and those with positive anti-HCV were not at a disadvantage. In conclusion, HCV infection is common in patients undergoing HD in Kuwait.Improvement in screening assays, isolation of anti-HCV positivepatients during dialysis and limitation of blood transfusions may decrease the transmission of this disease in this patient population.

Incidence of peritonitis, distribution of causative bacteria and outcome in continuous ambulatory peritoneal dialysis (CAPD) in Kuwait.

In 28 CAPD patients in Kuwait, 69 peritonitis episodes occurred in an observation period of 311 patient treatment months (1 episode per 4.5 PTM). Microorganisms were isolated 53 times (gram-positive 34, gram-negative 17, fungi 2). Peritonitis was the principal cause for stopping CAPD, i.e. on 9 occasions. Gram-negative and fungal peritonitis had particularly high failure rates.