Diurnal rhythm of blood pressure, heart rate and adrenergic activity in patients with normotension treated with continuous ambulatory peritoneal dialysis and haemodialysis

PURPOSE

People with normotension and with essential hypertension are subjected to the diurnal rhythm of blood pressure (BP) with higher values during the day than during the night. Among dialysed patients nocturnal reduction of BP is blunted. The aim of the study was to evaluate diurnal BP rhythm and adrenergic activity measured as values of catecholamines.

MATERIAL AND METHODS

Study was performed among dialysed patients with normotension: 13 haemodialysed patients (HD), 8 patients treated by continuous ambulatory peritoneal dialysis (CAPD) and 10 controls (C). Ambulatory BP monitoring (ABPM) was done by using Micro SJ7400 AMP device. Catecholamines concentrations were measured by HPLC-ED method before and after cold pressure test.

RESULTS

There was no significant difference between manual measurements of BP done by dialysis nurses and mean values of 24-hours ABPM in CAPD group and C group and 48-hours ABPM among HD patients. Diurnal BP was blunted in 80% of HD patients during the day of haemodialysis, 70% during the day without haemodialysis and in CAPD group in 50%. Heart rate (HR) variability was comparable in HD and CAPD groups and significant lower than in C group. Baseline noradrenaline (NA) as well as NA (ng/ml) post cold pressure test levels were significantly higher among HD patients (463 +/- 21, 546 +/- 31) and CAPD patients (452 +/- 76, 527 +/- 92) as compared with C (206 +/- 53*, 315 +/- 61*). (x +/- SD), *p<0.001

CONCLUSIONS

Despite increased adrenergic activity and altered diurnal rhythmof BP and HR exist in dialysed patients we didn't find directly relationship. Another or composed factors couldaffect diurnal rhythm of BP and HR.

Chlamydia trachomatis infection in chronically hemodialyzed patients

PURPOSE

In the general population there is association between Chlamydia trachomatis (Ch. trachomatis) infection and reactive arthritis (RA). RA is a systemic illness characterized by inflammatory synovitis. Arthritis tends to be oligoarticular and involves mainly the lower limbs. The aim of this study is to assess the age and sex specific prevalence of Ch. trachomatis infection in dialysis population and to find possible relationship between manifestation of infection and renal osteodystrophy.

MATERIAL AND METHODS

The study was conducted in 53 patients: 22 women (W) and 31 men (M), with a mean age of 58.1 +/- 15 years, treated with HD for 28.5 +/- 28.2 months. The Ch. trachomatis infection was assessed by the detection IgG antibodies for Ch. trachomatis. Also some other biochemical parameters of osteodystrophy, inflammation and malnutrition were measured.

RESULTS

The presence of a high titre of anti-Ch. trachomatis antibodies was found in 22 patients--41% [G IgG (+)]. Mean level of anti-Ch. trachomatis antibodies was significantly higher in G IgG (+) than in seronegative patients [G IgG (-)]: 19.0 +/- 8.6 vs 4.0 +/- 2.1 U/ml, p<0.001. There was no difference in mean age of seropositive and seronegative patients for Ch. trachomatis (62.4 +/- 13.1 vs 56.2 +/- 15.9 years). We did not observe in both groups of patients any differences in mean level of C-reactive protein (CRP): 12106.2 +/- 10791.0 vs 14015.3 +/- 11194.3 ng/ml. The mean ferritin level was significantly higher in G IgG (+): 624.3 +/- 375.7 vs 418.3 +/- 341.4 ng/ml, p<0.05. Significant negative correlations were found in G IgG (+) between IgG antibodies and transferrin saturation (r=-0.645719, p<0.001) and between CRP and calcium (r=-0.4526, p<0.05). IgG antibodies were detected frequently in W (60%) than in M (29%). Mean level of IgG was significantly higher in seropositive W than in seropositive M (23.3 +/- 7.8 vs 12.1 +/- 4.2 U/ml, p<0.0001). The seropositive W were older (67.9 +/- 11.8 vs. 53.8 +/- 11.0 years, p<0.02) and seropositive W were shorter treated with HD (18.1 +/- 16.6 vs 43.7 +/- 30.6 months, p<0.02). The mean serum calcium conc. and phosphorus were significantly lower in seropositive W (2.1 +/- 0.1 vs 2.3 +/- 0.2 mmol/l, p<0.05 and respectively 1.3 +/- 0.3 vs 1.8 +/- 0.2 mmol/l, p<0.005). Likewise the mean transferrin saturation (TS) was significantly lower in that group (25.7 +/- 7.3 vs 38.0 +/- 11.3%, p<0.01). There were no differences between seropositive men and women in mean serum concentrations of CRP, iPTH, albumin and hemoglobin. We found in seropositive W significant negative correlation between IgG antibodies and age (r=-0.633, p<0.02).

CONCLUSIONS

The patients treated with HD were quite frequently shown significantly elevated level of IgG antibodies for Ch. trachomatis. It could have be connected with past infection. The antibodies were more commonly detected in women, particularly in younger patients. No relationship between osteodystrophy and Ch. trachomatis infection was found.

Changes of endogenous erythropoietin level and iron status during a 30-month hemodialysis treatment of a group of patients

In our earlier paper we found that among 50 hemodialysis patients (HD pts) 48% (24 pts) control anemia with hemoglobin (Hb) concentration >9.5 g/dl and hematocrit (Hct) >30% without recombinant human erythropoietin (rHuEpo) therapy. These HD pts had significantly higher mean endogenous erythropoietin (eEpo) level and lower iron reserves (IR) than HD pts who need rHuEpo therapy. The aim of this study was to judge whether the possibility to control anemia in pts not requiring rHuEpo therapy changes during a 30-month HD treatment. Serum eEpo and ferritin were measured every 6 months. After 30 months of HD treatment 18 pts remained in this group--5 pts died, 1 underwent transplantation. During the study period 4/18 pts permanently had a very low level of eEpo (under detection limit), 7/18 had the level of eEpo within normal range for healthy control, 7/18 pts had a high level of eEpo (up to 3 times higher than the mean for healthy control). Pts who had the highest level of eEpo had the lowest IR. After 30 months IR were significantly lower than at the beginning of observation (292 +/- 87 vs 143 +/- 127 mg). Important negative correlation between eEpo and IR was observed throughout the whole period of study: r = -0.4820, p < 0.02 at the start of the study, and r = -0.6126, p < 0.007 after 30 months of treatment. The study shows that the possibility to control anemia in pts not treated with rHuEpo did not change significantly during 30 months of HD treatment. Endogenous Epo level in HD pts not treated with rHuEpo varied between different pts: it was permanently low in some pts, permanently high in others and stayed normal in remaining pts.

[Effect of vitamin E-modified membrane on expression of coreceptors CD4, CD8 on lymphocytes in chronic hemodialysis patients]

Chronic renal failure induces a clinical state of cellular and humoral immunodeficiency that also depends on the time duration of blood contact with the wide spectrum of dialysis membranes use during long-term hemodialysis treatments. In end stage renal failure (ESRD) patients it is possible to induct state of chronic inflammation mostly caused by leukocytes and complement activation. It is postulated that the vitamin E-coated dialysis membrane minimalizes unbiocompatible reactions that generate smaller amounts of reactive oxygen species (ROS). The purpose of this study was to analyze the effect of classical and vitamin E coated cellulose membranes on the expression of CD 4 and CD 8 adhesion molecules on lymphocytes during HD in 10 patients using flow cytometric analysis. The study protocol included the measurement of molecules expression using cellulose membrane (Clirans RS15, TERUMO Corp., Japan), and the same membrane coated by vitamin E (Excebrane, Clirans E15, TERUMO Corp., Japan) during 20 dialysis sessions with each kind of membrane. During dialysis with classical cellulose membrane, significant decrease of lymphocyte serum level and increase of lymphocyte CD4 expression was observed. During the session with vitamin E coated membranes we did not observe any significant changes in serum CD4, CD8, CD4+8+ lymphocyte level, and also lymphocyte CD4, and CD8 expression on lymphocytes. Our findings suggest the potential role of vitamin E-coated cellulose membrane to minimalize negative reaction of the T lymphocyte subpopulation in ESRD patients treated on long-term dialysis.

[Relationships between hyperparathyroidism and Helicobacter pylori infection in long-term hemodialysis patients]

In the accessible literature we did not find data about the connection between Helicobacter pylori (H. pylori) infection and parathyroid hormone (PTH) abnormalities in patients on hemodialysis (HD pts). It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. We speculate that it should be connected with susceptibility to H. pylori infection in HD pts. The aim of our study was the assessment of relationships between PTH abnormalities and parameters of H. pylori infection expressed by concentration of IgG antibodies against H. pylori and histologically performed urease test. The study was conducted in 65 (37 M, 28 F) stable HD pts. They were dialyzed for 6 to 288 months (102.9 +/- 84.5). Simultaneously in 25 HD pts qualified for renal transplantation biopsy specimens taken during gastroscopy were examined by a histological test and urease test (CLO-test). According to the PTH concentration HD pts were divided into 3 groups with PTH < 100 pg/ml; with PTH 100-350 pg/ml and with > 350 pg/ml. Positive IgG H. pylori test > 24 U/ml was found in 60 (92%) HD pts. Mean IgG H. pylori concentration was similar in tree groups of HD pts. (82 vs 91 vs 88 U/ml) and did not differ significantly from control group. We found significant negative correlation between IgG H. pylori concentration and time on dialysis therapy (r = -0.50067, p = < 0.0001). Positive test in biopsy specimen was found in 14 HD pts (56%). PTH level in this group of HD pts not differ significantly from PTH level in pts with negative test (426 vs 398 pg/ml) and IgG H. pylori concentration was significantly higher in positive pts than in negative pts (104 vs 48 U/ml).

CONCLUSION

We did not find significant relationship between PTH abnormalities and H. pylori infection in HD pts. Longer period of dialysis therapy is connected with decreased ability to produce antibodies againts H. pylori.

Subcutaneous r-HuEPO therapy in CAPD patients: dose determination and clinical experience

We present our results on the efficacy and safety of low dose r-HuEPO given subcutaneously in the treatment of anaemia in CAPD. We have studied 10 stable patients (5 males, 5 females) on CAPD. In our study subcutaneous r-HuEPO was administered twice a week for 6 months. Mean initial dose of r-HuEPO was 67.3+/-21.7 U/kg/week, and maintenance dose was 35.8+/-12.1 U/kg/week. The target Hb concentration was 10-12 g/dl. All patients responded to r-HuEPO. During treatment significant increases of haemoglobin concentration (p<0.05), haematocrit (p<0.05), red cell count (p<0.05) and reticulocyte count (p<0.05) were observed. We found no significant changes in total white cell or platelet counts. Long-term r-HuEPO treatment did not influence significantly plasma levels of electrolytes (Na, K, Ca), urea and creatinine. We found no significant changes in ultrafiltration volumes. In the present study the mean systolic and diastolic blood pressures did not change. Liver function tests were normal at the beginning and at the end of the study. r-HuEPO treatment was associated with a decrease of ferritin (455+/-90 vs. 224+/-83 microg/l. Oral or intravenous iron substitution became necessary in 6 patients. Side effects in our study were minimal; one patient had myalgia after the first seven doses but this disappeared as treatment was continued. Two patients reported pain (mild) at the injection site. In the present study, the correction of anaemia was accompanied by a substantial improvement in the quality of life, mainly in capacity for work, household and social activities.

[Effectiveness of peritoneal dialysis using dialysis fluid of modernized composition]

In six patients with terminal renal failure the effectiveness was assessed of intermittent peritoneal dialyses (IPD) using the dialysing fluid of modernised composition. On the basis of the obtained results the values were calculated of the total sodium (TMTNa) and potassium (TMTK) elimination glomerular filtration rate, and the sodium elimination index. The values were calculated of the dialysing clearance of urea, creatinine, potassium, and inorganic phosphorus. The correlations were analysed between the dialysing clearance of studied substances and the body area of patients, the duration of dialysis, and glomerular filtration rate. The results were compared with the effectiveness of peritoneal dialysis carried out with the dialysing fluids of formerly used electrolyte composition.

[Arrhythmia in patients on dialysis treatment for chronic renal failure]

In 6 patients treated with repeated peritoneal dialyses 48-hour ECG monitoring was carried out. In no patient significant heart rhythm disturbances were demonstrated during the dialysis and 24 hours after its completion. On the ground of pathological results of Valsalva's manoeuvre function disturbances of the autonomic nervous system were disclosed but these showed no correlation with premature ventricular and supraventricular++ ectopic beats appearing periodically in some patients. The study showed that under conditions of sufficient control of electrolyte balance (especially potassium) the patients treated with peritoneal dialyses are not a group at risk for arrhythmia development.