POSTOPERATIVE ARTERIAL RELAXATION AND INTRAOPERATIVE VENOUS DILATION AS INTERCONNECTED PROGNOSTIC FACTORS FOR THE MATURATION OF ARTERIOVENOUS FISTULAS.

AIM: To investigate if immediate arterial distention can be used as a predictive factor for the development of a good fistula. MATERIAL AND METHODS: Over a 5-months period (January- May 2015) all the patients who underwent an arteriovenous fistula between the radial artery and the cephalic vein of the forearm at the Second Surgical Clinic of the Iasi Regional Cancer Institute and were willing to participate were enrolled in the study. The diameters of the vessels were measured 1 hour and 8 weeks after surgery. RESULTS: We found statistically significant differences for all measured diameter variations between the calcified artery and normal artery groups (p < 0.001 for the arterial distention at 1 hour and 8 weeks after surgery and p = 0.002 for the venous distention 8 weeks after surgery). A linear regression also showed that the degree of arterial distention immediately after surgery and the venous distention 8 weeks after surgery were statistically correlated. CONCLUSIONS: Arterial distention immediately after surgery and therefore the lack of it due to the presence of arterial calcifications can be used to predict whether or not a good fistula can be achieved at a 1% statistical significance level.

Impact of gender and dialysis modality on early mortality risk in diabetic ESRD patients: data from a large single center cohort.

BACKGROUND: Diabetes mellitus (DM)-associated chronic kidney disease (diabetic renal disease) became the predominant etiology of the end-stage renal disease (ESRD) in the western countries and shows the same trend in the developing countries. Early mortality (EM) after the dialysis initiation, defined as death of all causes within the first 3 months after initiation of renal replacement therapy (RRT), is of concern especially for the high-risk renal patients including diabetics. The goal of the present study was to identify demographic and clinical risk factors associated with EM in a retrospective cohort of Romanian DM patients initiated on dialysis. METHODS: A retrospective case-control study was designed. Clinical recordings from all patients initiated on hemodialysis (HD) or peritoneal dialysis between January 1996 and December 2005 in the Dialysis Center of NIDNMD Paulescu, Bucharest, were collected and analyzed. Patients were classified accordingly in two groups: those who displayed EM formed the "cases" group, while the others were included in the "controls" group. Both univariate (subgroup analysis) and multivariate analyses (logistic regression, Cox regression) were used to analyze the impact of risk factors on EM outcome. RESULTS: Data from 788 patients were included in the analysis. The factors significantly associated with EM in the univariate analysis were female gender, late initiation (LI) of dialysis, old age and HD used as the first/only method. Applying the multivariate analysis, only the use of HD (OR = 4.20, p < 0.0001) and the LI of dialysis (p < 0.0001; 95 % CI 1.36-2.30) were associated with EM, while female gender showed only a trend to a higher EM (OR = 1.29, p = 0.052). CONCLUSIONS: Hemodialysis used as a first/single method for RRT and the LI of dialysis were independent predictors of EM in our ESRD diabetic patients. A possible explanation for the first factor could be our specific center procedure, which allows only the HD as rescue therapy method for the most severe cases, managed in the intensive care unit.

Association of +35A/C (intron3/exon3) polymorphism in SOD1-gene with diabetic nephropathy in type 1 diabetes.

Diabetic nephropathy is a major complication of type 1 diabetes whose pathogenesis is insufficiently known, but oxidative stress and genetic susceptibility seem to be involved. The purpose of this study is to assess the possible association of +35A/C (rs2234694) polymorphism in SOD1-gene with advanced stages of diabetic nephropathy in patients with type 1 diabetes in Romania. There have been enrolled 238 unrelated patients, having type 1 diabetes, divided into group A (106 patients) with diabetic nephropathy - macroalbuminuria or ESRD (End Stage Renal Disease) and group B (132 patients) without diabetic nephropathy. The genomic DNA was extracted from the peripheral venous blood and the genotyping of +35A/C (rs2234694) polymorphism has been made using the PCR-RFLP technique. The statistical analysis has been made using De Finetti's program. There has not been a significant deviation from the Hardy-Weinberg equilibrium for any group (p=0.229 and p=0.894, respectively). The data analysis revealed that the presence of a C-allele confers a significant risk (p=0.008) for the advanced diabetes nephropathy (OR=4.940, 95% C.I.=1.341-18.198), and the CA-genotype (p=0.015) confers a little lower risk (OR=4.491, 95% C.I.=1.203-16.766). This study shows the association of a mutant C-allele of rs2234694 polymorphism in SOD1-gene with the advanced stages of diabetic nephropathy in patients with type 1 diabetes in Romania, suggesting the involvement of the defense against oxidative stress, as an important link in the pathogeny of diabetic nephropathy.

Ambulatory blood pressure monitoring in renal dialysis and transplant patients.

Blood pressure (BP) elevation and left ventricular hypertrophy are important factors in the high cardiovascular mortality rate in patients on the renal replacement program. Ambulatory BP monitoring is widely regarded as superior to random BP monitoring in predicting end-organ damage from elevated BP. One hundred seventeen patients (60 on hemodialysis [35 with long sessions and 25 with short sessions], 29 on continuous ambulatory peritoneal dialysis, and 28 transplant recipients) underwent ambulatory BP monitoring, with target organ assessment by electrocardiography. Mean 24-hour BP for the patients with the long hemodialysis sessions (LHD) was 115.5/66.6 mm Hg, without the regular use of antihypertensive drugs. The parathormone (PTH) level was the major determinant of BP on ambulatory BP monitoring analysis, with interdialytic weight gain and age each having weaker associations. The BPs of the other three patient cohorts were much higher (short hemodialysis session [SHD], 143.2/82.1 mm Hg; continuous ambulatory peritoneal dialysis, 137.1/76.8 mm Hg; transplant recipients, 135.9/79.2 mm Hg). Overall, two thirds of the patients had reduced diurnal BP variability. Electrocardiogram voltage criteria for left ventricular hypertrophy were exceeded in approximately one third to one half of the patients. Our findings show that good control of BP is possible without recourse to antihypertensive drugs in the context of dialysis with slow ultrafiltration.