Parathyroidectomized patients have impaired capacity of peripheral vascular constriction during hemodialysis.

Parathyroidectomy (PTx) seems to improve cardiovascular outcomes and reduce blood pressure levels. However, the effect of PTx on hemodynamic changes during hemodialysis (HD) is still overlooked. This was a prospective cohort design. Patients with end-stage renal disease on maintenance HD were included. Diabetes and nonsinusal rhythm were exclusion criteria. History of PTx was recorded. Finometer monitor was used to access parameters immediately pre- and post-HD sessions. Cardiac index (CI) variation (ΔCI) and peripheral arterial resistance variation (ΔPAR) were the variables of interest. Biochemical and echocardiographic data were also obtained. PTx patients (n = 11) were matched to non-PTx patients (n = 20). ΔPAR was lower in PTx group in comparison with non-PTx group (P = 0.039), which was independent of parathyroid hormone (PTH) levels. Multiple regression analysis showed that PTx, ΔCI, and dialysate calcium remained independently associated with PAR variation and even adjusted for ultrafiltration rate (adjusted r(2) = 0.64). In conclusion, parathyroidectomized patients have impaired capacity of vasoconstriction in response to ultrafiltration, an effect independent of serum PTH levels. Further studies are needed to elucidate mechanisms explaining the interaction between PTx and systemic vascular tonus.

Hemodynamic behavior during hemodialysis: effects of dialysate concentrations of bicarbonate and potassium.

BACKGROUND/AIMS: Ultrafiltration that occurs during hemodialysis (HD) promotes profound alterations in a relatively short period of time. The dialysate content of bicarbonate (DBic) and potassium (DK) may have impact over intradialytic hemodynamics, which goes beyond ultrafiltration, and its impact was evaluated in a prospective cohort. METHODS: 30 patients under HD were submitted to hemodynamic assessment (HA) at the beginning and at the end of HD sessions, through a non-invasive method. Serum minus dialysate potassium concentration was expressed as K-Gap. Cardiac index (CI) and peripheral arterial resistance (PAR) variation (post-HD minus pre-HD) were expressed as ΔCI and ΔPAR. Dialysate content of sodium and calcium were expressed as DNa and DCa, respectively. RESULTS: Mean DNa, DK and DBic were, respectively, 136.4 ± 1.1, 2.1 ± 0.6 and 38.2 ± 2.1 mEq/L. In 15 patients, DCa was >1.5 mmol/L and in the other 15 patients ≤ 1.5 mmol/L. The K-Gap ranged from 1.4 to 5.1 mEq/l (median 3.0 mEq/L). There was a reduction in post-HD CI and systolic blood pressure (ΔCI = -0.72l/min/m(2) and -11.3±15.1mmHg, respectively, p<0.001 for both). Conversely, PAR increased (ΔPAR = 272dyn.s/cm(5), p<0.001). Lower post-HD CI was was associated to higher DBic (p=0.0013) and lower K-Gap (p=0.026). In multivariate analysis, ΔCI was dependent on DBic and K-Gap, whereas ΔPAR was dependent on dialysate calcium during HD. CONCLUSION: We confirmed that Na and Ca dialysate content exerts and important role on hemodynamic during HD. In addition, our findings pointed out that higher dialysate concentrations of bicarbonate and potassium promote lower cardiac performance at the end of hemodialysis session.

Optimization of production of extracellular polymeric substances by Arthrobacter viscosus and their interaction with a 13X zeolite for the biosorption of Cr(VI).

In this work we aimed to optimize the production of extracellular polymeric substances (EPS) by an Arthrobacter viscosus biofilm supported on 13X zeolite to be used in the biosorption of Cr(VI). The optimization parameters were agitation rate, work volume, pH and glucose concentration. Following the optimization of EPS production, the biofilm was used in the biosorption of hexavalent Cr from liquid solutions. Differences between the use of dead or active biomass and between the performance of zeolite in powder or in pellet form were also studied. The optimized EPS production allowed values of metal uptake between 2.72 mg/g(biosorbent) and 7.88 mg/g(biosorbent) for initial Cr(VI) concentrations of 20-60 mg/L. For an initial concentration of 20 mg/L, the optimal conditions of EPS production allowed an increase of 10% on the removal percentage of total Cr, and the use of zeolite as a powder rather than the pelleted form produced an increase of 46.5% in the removal percentage. For the initial concentration of 60 mg/L, the use of active biomass compared to dried biomass allowed a reduction of the time required for the total removal of Cr(VI) from 20 to 13 days.