Serum ghrelin levels: Is there any association with malnutrition and depression in peritoneal dialysis patients?

BACKGROUND: Ghrelin is a physiologic regulatory hormone of appetite and body weight, and its concentrations increase in chronic kidney disease. This study aimed to analyze the effects of malnutrition and depression on the plasma ghrelin levels in peritoneal dialysis (PD) patients. METHODS/PATIENTS: The relationship between fasting serum ghrelin concentration, type of dialysate solution, malnutrition-inflammation score (MIS), and depressive symptoms of 87 PD patients were analyzed. Depressive symptoms were evaluated using the Beck Depression Inventory. RESULTS: No significant relationship between ghrelin concentration and body mass index (BMI), MIS or depression scores was detected. The mean serum ghrelin concentration in patients using amino acid-based solutions was higher than in non-users (p <0.001). The mean serum ghrelin concentration of the patients using icodextrin-based solutions was found to be significantly higher than non-users (8.69 ± 5.04 vs 6.61 ± 2.8 ng/ml respectively, p =0.02). There was no significant difference in MIS between the patients in terms of amino-acid and/or icodextrin usage. CONCLUSIONS: There is no association between BMI, MIS, and depression with ghrelin concentrations in PD patients. Icodextrin and/or amino acid-based solutions usage may increase the serum ghrelin concentration without a significant effect on BMI and measures of malnutrition. HIPPOKRATIA 2018, 22(1): 43-48.

Comparison of performance and abnormal cell flagging of two automated hematology analyzers: Sysmex XN 3000 and Beckman Coulter DxH 800.

INTRODUCTION: The purpose was to evaluate the analytical performances of Sysmex XN 3000 and UniCel DxH 800 comparing the obtained results with manual counting and between each other. Also flagging capabilities of abnormal cells were compared for both analyzers. METHODS: Two thousand one hundred and forty-two whole-blood samples were analyzed for evaluation. The samples flagged due to blast, atypical lymphocyte (AL), immature granulocyte (IG), or nucleated red blood cells (NRBC) were microscopically reviewed (n=102). RESULTS: The within-run and between-day coefficient of variations (CV%) of XN 3000 for hemoglobin, RBC, MCV, WBC, and platelets were lower than 5% and for WBC differentials lower than 10% except monocytes which was 15.6% at low level. The precision results of DxH 800 were also lower than 5.0% except platelets (9.5%) and monocytes (45%) at low level. The comparison of analyzers revealed good agreement (R>.86), except monocytes and basophils. The flagging sensitivities of XN 3000 were higher for IGs, blasts, and ALs than those of DxH 800 and almost similar for NRBC. CONCLUSION: The XN 3000 and DxH 800 are accurate, highly precise systems and can be used effectively in high-volume laboratories. The flagging sensitivity of XN 3000 was higher in detecting blasts, IGs, and ALs than that of DxH 800. The detection of abnormal cells with high sensitivity may improve laboratory workflow with a reduced slide review and accelerated turnaround time.

Effects of peritoneal-and hemodialysis on levels of plasma protein and lipid oxidation markers in diabetic patients.

AIM: The aim of this paper was to evaluate the effects of dialysis procedures on oxidative stress in diabetic patients. METHODS: The study was performed on 15 non-diabetic hemodialysis (HD) patients, 30 non-diabetic perinoteal dialysis (PD) patients, 18 diabetic HD patients (DHD), 15 diabetic PD patients (DPD), and 20 healthy controls. Plasma thiobarbituric acid reactive substances (TBARS), protein carbonyl (PCO), and oxidized LDL (oxLDL) were determined as oxidative stress markers. Plasma thiol (P-SH), erythrocyte glutathione (GSH) levels, and serum paraoxonase (PON1) activities were measured as antioxidants. RESULTS: HD patients have significantly higher oxLDL, TBARS and PCO levels and significantly lower P-SH levels than PD patients. DHD patients have significantly higher PCO levels and PON1 activities and significantly lower GSH levels than non-diabetic HD patients. There was no any difference in oxidative stress parameters between DPD and non-diabetic PD patients. CONCLUSION: Oxidative stress is exacerbated by HD in diabetic patients. Treatment strategy with antioxidants in dialysis patients may be associated with a worsened survival.

Association of glomerular filtration rate and inflammation with left ventricular hypertrophy in chronic kidney disease patients.

BACKGROUND: Although left ventricular hypertrophy (LVH) is an independent predictor of mortality in patients with end stage renal disease, few have examined its prevalence before the initiation of dialysis. The aim of this study was to investigate the relationship between LVH, estimated glomerular filtration rate (GFR), and inflammatory markers in patients with chronic kidney disease (CKD). METHODS: Forty-one CKD patients (18 women, 23 men, mean age 53±17 years) with an estimated GFR between 15 and 59 mL/min (mean 34.2 mL/min) were enrolled and the following tests performed: routine serum biochemical analyses, high sensitivity C-reactive protein (hs-CRP), fibrinogen, ferritin, and homocysteine, and left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and left ventricular fractional shortening (LVFS). RESULTS: LVH was diagnosed in 32/41 patients (78%). CKD patients with LVH (n=32) had significantly higher hs-CRP (p=0.012), fibrinogen (p=0.031), and lower serum albumin (p=0.028) levels than those without LVH (n=9). In all patients, LVMI correlated positively with hs-CRP (r=0.483, p=0.002) and serum fibrinogen (r=0.426, p=0.015). Estimated GFR correlated positively with LVEF (r=0.414, p=0.007) and LVFS (r=0.376, p=0.018). CONCLUSIONS: Important positive associations exist between markers of inflammation and LVMI in patients with CKD. In addition to hs-CRP, elevated fibrinogen may portend the development of LVH in patients with CKD who are not yet on dialysis.

Peritonitis due to Pseudomonas putida in a patient receiving automated peritoneal dialysis.

A patient, who had recently undergone a laparoscopic ovarian cyst operation, receiving nightly automated peritoneal dialysis treatment, was discovered to have peritonitis due to Pseudomonas putida. She was successfully treated with a 21-day course of intraperitoneal ceftazidime and gentamicin, without needing to remove the dialysis catheter. No recurrence was observed over 3 months of follow-up.

Quality of life in chronic kidney disease: effects of treatment modality, depression, malnutrition and inflammation.

In the present study, our aim is to investigate the effects of the treatment modality, depression, malnutrition and inflammation on quality of life (QoL) in chronic kidney disease (CKD). Twenty-six patients with CKD on conservative management, 68 patients on haemodialysis (HD), 47 patients on continuous ambulatory peritoneal dialysis (CAPD) and 66 healthy controls were enrolled in the study. QoL was measured by means of the Short Form-36 (SF-36) and subscale scores were calculated. All patients were evaluated for the presence of depression using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders - Clinician Version. The severity of depression was evaluated by means of the Beck Depression Inventory (BDI). Serum C-reactive protein (CRP), ferritin, albumin, haemoglobin and haematocrit (Hct) levels were measured. All the SF-36 subscale scores were lower in the patient groups compared with control group. The SF-36 scores were higher and BDI scores were lower in the CAPD group than CKD and HD groups. In patients with depression, all SF-36 subscale scores were lower than that of the patients without depression. There was a significant negative correlation between all the SF-36 subscale scores and the BDI scores. There was a significant positive correlation between the SF-36 physical and total summary scores and the Hct value and serum albumin levels, but an inverse correlation between the SF-36 physical, mental and total summary scores and the serum CRP level in the HD patients. The authors suggest that the treatment modality, depression, malnutrition and inflammation have an important role on QoL in CKD.

Diffusion magnetic resonance imaging may provide prognostic information in osmotic demyelination syndrome: report of a case.

Hyponatremia and its rapid correction may cause osmotic demyelination syndrome (ODS) with damage to the pontine and extrapontine areas of the brain. The damage may become persistent or may regress and disappear during follow-up. We describe the case of a 35-year-old woman with chronic renal failure who was admitted to the emergency department with profound hyponatremia which was corrected rapidly after hemodialysis treatment. During follow-up, she developed quadriparesis and dysartria. Magnetic resonance imaging (MRI) demonstrated abnormalities characteristic of ODS in the pons as well as the basal ganglia with increased signal intensity on T2 and diffusion-weighted (DW) MRI and low apparent diffusion coefficient (ADC) values. After the sixth day, her clinical status improved progressively. Control MRI revealed rapid normalization of the ADC values during the first week and month parallel to the clinical improvement. However, the hyperintensities on T2-weighted images persisted. Four months later the MRI findings were completely normal. The close relationship between the ADC abnormality and the clinical status suggests that DW-MRI may be useful in predicting the prognosis of ODS.