Comparison of dialysate and plasma NTproBNP in prediction of clinical outcomes of diabetic and nondiabetic peritoneal dialysis patients
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BACKGROUND: Plasma level of N-terminal pro-brain natriuretic peptide (P-NTproBNP) is a useful marker in prediction of mortality in peritoneal dialysis (PD) patients. However, the predictive value of spent dialysate counterpart (D-NTproBNP) of plasma NTproBNP on mortality and dropout is not known. MATERIALS AND METHODS: Simultaneous P-NTproBNP and D-NTproBNP assays were performed after an overnight dwell in 44 scheduled ambulatory PD patients. Patients were followed for ~ 47 months. Deceased patients or patients who were transferred to hemodialysis were regarded as dropouts. RESULTS: 14 patients (31.8%) dropped out at ~ 4 years (9 deaths and 5 transfers to hemodialysis). Diabetics, males, and patients with higher membrane permeability had higher dropout rates. Patients with P- and D-NTproBNP higher than median values had higher mortality and dropout rates (Kaplan-Meier test, log-rank Test p < 0.05). Odds ratios of D-NTproBNP for death and dropouts were (3.807 (0.907 - 15.971), p = 0.068) and (2.87 (1.009 - 8.138) p = 0.048), respectively; odds ratios of P-NTproBNP for death and dropouts were (4.652 (0.914 - 23.693), p = 0.064) and (2.67 (0.924 - 7.716), p = 0.07), respectively; in ROC analysis for death, AUC for P- and D-NTproBNP were 0.762 (0.578 - 0.946, p = 0.016) and 0.765 (0.590 - 0.940, p = 0.015), respectively. Exclusion of diabetic patients from the analyses resulted in significant changes in the predictive value P- and D-NTproBNP. Although death and dropout rates were still higher in nondiabetic patients with higher NTproBNP levels, the differences between groups lost statistical significance. CONCLUSIONS: Both P-NTproBNP and D-NTproBNP are significant predictors of outcomes of interest. Predictive value of NTproBNP might be different in diabetics and non-diabetic CAPD patients.
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Course of encephalopathy in a cirrhotic dialysis patient treated sequentially with peritoneal and hemodialysis.

End-stage kidney disease and advanced cirrhosis are sometimes seen concomitantly. There is no consensus on dialysis modality in terms of determining the optimal way of treating these patients. It has been suggested that peritoneal dialysis is a better choice for these patients, but efficacy of hemodialysis in stable cirrhotic patients has not been evaluated sufficiently. We report a case with advanced cirrhosis and end-stage kidney disease who was faced with hepatic encephalopathy episodes up on starting renal replacement therapy. The case is also interesting in that it reveals effects of hemodialysis and peritoneal dialysis on hepatic encephalopathy episodes and quality of life of the patient.

Effects of resveratrol on blood homocysteine level, on homocysteine induced oxidative stress, apoptosis and cognitive dysfunctions in rats.

We aimed to examine the protective effects of resveratrol against homocysteine induced oxidative stress, apoptosis and cognitive impairment. Rats were randomly divided into three groups. Control group received standard rat food; homocysteine group (Hcy group) received daily methionine at a dose of 1g/kg-body weight dissolved in drinking water for thirty days; third group (Hcy+Res group) received same amount of methionine plus 20mg/kg/day resveratrol intraperitoneally for thirty days. Cognitive performances of the animals were tested by Morris water maze test. Then all animals were sacrificed to study lipid peroxidation (LPO), DNA fragmentation and p53 mRNA expression in the rat brain. The aortas of the sacrificed rats were processed for histopathological examination. Apoptosis in the aortas was assessed by TUNEL staining. Resveratrol significantly decreased serum levels of homocysteine, reversed Hcy induced LPO increase, decreased DNA fragmentation and p53 mRNA expression in the rat brains, and improved homocysteine induced impairment of long term spatial memory. Resveratrol could inhibit homocysteine induced apoptosis and histopathological deterioration in the rat aortic sections. In conclusion, resveratrol is effective in preventing homocysteine induced vascular and neural defects. In hyperhomocysteinemic rat model, our findings consequently warrant in future studies to reveal the true improvement mechanism of resveratrol.