[Renal effects of GLP-1 agonists in type 2 diabetes]

The prevalence of type 2 diabetes mellitus (DM2) is increasing, generating a great impact both at individual and public health level. Nearly half of the patients with DM2 develop impaired renal function, so nephron-protection is highly important. The robust body of evidence that shifted the therapeutic focus from glycemic to cardio-renal metabolic therapy in DM2 led to the inclusion of new therapies with cardiovascular and renal benefits in international guidelines. Type 1 glucagon (GLP-1) receptor agonists have showed favorable effects on renal function and their potential protective actions are multifactorial, beyond glycemic control. These benefits have been demonstrated in efficacy and safety clinical studies, as well as in cardiovascular outcomes and real-life studies. This comprehensive review describes the direct and indirect effects of these molecules, as well as evidence obtained from pivotal clinical (LEADER, SUSTAIN 6 and REWIND) and real-life studies demonstrating their beneficial effects on renal function, and also introduces expectations of future results from ongoing studies with renal endpoints.

[Relación entre enfermedad cardiovascular y renal en una muestra de pacientes con diabetes del mundo real]

Objetivos:

La enfermedad renal es una de las complicaciones microvasculares de la diabetes mellitus (DM) con escasa pesquisa y gran relación con enfermedad cardiovascular (ECV). El objetivo de este trabajo es caracterizar la prevalencia de enfermedad renal en una población de pacientes con diabetes tipo 2 que concurren a control ambulatorio por cardiología, determinar su grado de pesquisa y su posible efecto en el alcance de los objetivos terapéuticos y en el uso de los antidiabéticos con efecto protector cardiorrenal.

Métodos:

Estudio de corte transversal, observacional y multicéntrico realizado en 44 centros de Argentina entre mayo y julio de 2019.

Resultados:

Se incluyó a 693 pacientes con una prevalencia de ECV establecida de 47.5% (329 pacientes) y de enfermedad microvascular de 42.3%. La albuminuria se valoró sólo en el 46.2% de los pacientes y fue significativamente mayor en el grupo con IR. La ECV en pacientes con IR fue mayor que en aquéllos sin IR (64.8% vs. 42.2%; p = 0.0001). La presencia de albuminuria se acompañó de mayor prevalencia de ECV. El alcance de los objetivos terapéuticos fue escaso y no se reconocieron diferencias en función de la IR, a excepción del objetivo de LDL. Se observó baja prescripción de fármacos antidiabéticos con probado beneficio cardiorrenal.

Conclusiones:

El trabajo resalta la importancia de la búsqueda activa de la enfermedad renal en pacientes con diabetes, lo que revela el bajo alcance de los objetivos terapéuticos y la prescripción de fármacos antidiabéticos con beneficio cardiorrenal.

[Insulin therapy in special conditions]

Hyperglycemia during hospitalization is a common condition associated with poor prognosis. To date, insulin is the best strategy to treat hyperglycemia in these patients. An adequate glycemic control is associated with better clinical results. Nevertheless, glycemic goals are still controversial due to the increase of hypoglycemia and other adverse events. Diabetes mellitus is still the main cause of chronic renal failure in our country and its treatment deserves a special analysis considering that insulin pharmacokinetics is altered. Recommendations in this setting are based in expert panel opinions, focusing mainly in intermediate or long acting insulins combined with regular insulin and/or rapid acting analogues. During pregnancy, NPH and regular insulin are safe and effective. It is worth mentioning that the development of new long and rapid acting molecules yielded lower glycemic variability, better post-prandial control and less hypoglycemia. The aim of this study is to provide a review of the proper use of insulin in these special conditions.

Glycaemic changes in patients with chronic kidney disease

In Argentina, there have been no studies aimed at establishing the prevalence of dysglycaemia (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes mellitus [DM]) in patients with chronic kidney disease (CKD). Our group decided to conduct an observational study to evaluate the frequency with oral glucose tolerance test (OGTT) in CKD patients with no previous data for dysglycaemia in their medical records. OGTT was performed in 254 patients (60.62% male) with stage 3, 4 and 5 CKD under conservative treatment, haemodialysis or transplantation. Results for DM were found in 10 patients according to fasting glucose alone (3.94%; 95% CI: 1.35-6.53%), 11 patients with exclusively the second hour criterion (4.33%; 95% CI: 1.63-7.03%), 15 with both criteria (5.91%; 95% CI: 2.81-9.00%) and 36 patients with at least one criteria (14.17%; 95% CI: 9.69-18.66%). In a multivariate analysis, DM was associated with waist circumference (OR=1.033 per cm; 95% CI, 1.005 to 1.062; P=.019) and with conservative treatment vs. replacement therapy (OR=0.41; 95% CI: 0.19-0.92; P=.028). IGT was evident in 24.6% and 20.3 on conservative vs. replacement therapy, with no statistically significant difference. IFG (ADA criteria) was 19.75 vs. 9.24% in conservative vs. replacement therapy, with a statistically significant difference. OGTT is suggested for all CKD patients since it is able to detect the full range of unknown dysglycaemias, which avoids underdiagnoses and favours performing treatments to prevent progression in DM risk groups (IFG and/or IGT). It also aids in the selection of the most appropriate medication for transplantation or treatment initiation in new cases of undiagnosed DM to decrease morbidity and mortality.

Adrenocortical function in hypotensive patients with end stage renal disease

BACKGROUND

Sustained hypotension among patients with end stage renal disease on dialysis (ESRDh) varies from 5.0% to 12.0%. Despite their role in the regulation of blood pressure (BP) corticoadrenal hormones have been poorly investigated.

OBJECTIVES

This study aims to detect adrenal insufficiency in ESRDh and follow their clinical outcome.

METHODS

Fifty ESRDh and 30 healthy volunteers were studied. In all cases basal blood and saliva were obtained. Synthetic ACTH (25μg) was injected intramuscularly and at 30min saliva was collected. Circulating ACTH, renin, cortisol and aldosterone were measured and steroids were also assessed in saliva by immunoassay.

RESULTS

Fifteen ESRDh achieved steroid responses not different than healthy volunteers; four had primary adrenal insufficiency; six had secondary adrenal insufficiency; nine had selective hypoaldosteronism and sixteen secondary hyperaldosteronism. The years on dialysis did not differ among subgroups. ROC analysis defined the following cut-offs for basal cortisol to predict adrenal insufficiency: in serum ⩽232.0nM (sensitivity (S) 100.0% and specificity (E) 90.0%); in saliva ⩽4.4nM (100.0% S and E). Basal aldosterone cut-off values to predict hyperaldosteronism were: in serum >500.0pM and saliva >60.0pM (100.0% S and E, for both). For the prediction of hypoaldosteronism the basal serum aldosterone was ⩽260.0pM (100% S; 53% E) and in saliva it was ⩽20.1pM (100% S; 58.5% E). Three patients with primary adrenal insufficiency and six with secondary adrenal insufficiency improved general clinical condition and normalized BP on steroids. One patient died before initiation of steroid therapy.

CONCLUSION

Adrenal function should be assessed in ESRDh in order to unmask adrenal insufficient states.

Endothelial Lipase Activity Predicts High-Density Lipoprotein Catabolism in Hemodialysis

Objective—

A novel phospholipase assay was used to measure for the first time the behavior of endothelial and hepatic phospholipase activities in postheparin human plasma of hemodialyzed patients and its relationship with atherogenic and antiatherogenic lipoprotein levels.

Methods and Results—

Endothelial and hepatic phospholipase activity was assessed in a total SN1-specific phospholipase assay, using (1-decanoylthio-1-deoxy-2-decanoyl-sn-glycero-3-phosphoryl) ethylene glycol as the substrate. Hemodialyzed patients presented lower values of total and hepatic phospholipase activity than controls: 4.4 (1.9–9.0) versus 7.5 (3.6–18.0) and 2.6 (0.7–6.2) versus 6.6 (1.3–15.2) μmol of fatty acid released per milliliter of postheparin plasma per hour, respectively ( P <0.001); however, endothelial lipase (EL) phospholipase activity was increased in patients: 1.7 (0.8–3.0) versus 1.1 (0.1–2.7) μmol of fatty acid released per milliliter of postheparin plasma per hour ( P =0.008). EL was negatively associated with high-density lipoprotein (HDL)-cholesterol ( r =–0.427; P =0.001), and apolipoprotein A-I levels, total phospholipase, and hepatic lipase activity were directly associated with low-density lipoprotein-cholesterol and apolipoprotein B. The association of EL and HDL-cholesterol remained significant when adjusting for waist circumference (β=–0.26; P =0.05), and the effect of hepatic lipase on low-density lipoprotein-cholesterol continued after adjusting for age (β=0.46; P = 0.001).

Conclusion—

Our results support the hypothesis that EL is the predominant enzyme responsible for lipolytic catabolism of HDLs in hemodialyzed patients and resolve the apparent paradox observed between low hepatic lipase activity and decreased HDL-cholesterol levels observed in these patients. In addition, the ability to assess total hepatic lipase and EL phospholipase activity in plasma will increase our knowledge of the mechanisms involved in controlling HDL levels and cardiovascular risk in hemodialyzed patients, as well as other populations with low levels of HDL-cholesterol.

[Relation between paraoxonase activity, other HDL components and inflammatory state in hemodialyzed patients]

Advanced Chronic Renal Disease (CKD) is closely associated with a pro-inflammatory condition, with an increase in triglyceride-rich lipoproteins and decrease in HDL level. HDL contains antioxidant enzymes such as paraoxonase (PON), whose activity is diminished in CKD. The aim of our study was to evaluate the relationship between PON activity with HDL cholesterol, apo A1 and hs-CRP levels, which are known to be inflammatory markers in hemodialyzed patients. Forty-two patients were studied; age, median (range) = 50 (25-67) years old, gender M/F = 22/20, duration of hemodialysis = 4.4 ± 0.5 years, BMI: 23 ± 0.5 kg/m2. After a 12 h fast, a blood sample was obtained and classic components of lipid profile were determined, as well as apoproteins A1 and B, PON by means of its arylsterase activity and hs-CRP levels. On the basis of the latter, patients were divided into two groups: hs-CRP ≤ 1 (low risk, range: 0.1 to 1.0 mg/l) and > 1 mg/l (moderate and high risk, 1.1 to 10.7 mg/l). No difference was found in triglycerides, LDL cholesterol and apo B in the groups. Patients with hs-CRP > 1 showed lower HDL cholesterol (40 ± 2 mg/dl) and apo A1 (118 ± 4 mg/dl) than patients with hs-CRP ≤ 1 (50 ± 4 and 133 ± 5, respectively); p < 0.05. PON was lower in hs-CRP > 1 = 90.5 ± 24.0 µmol/ml.min than in hs-CRP ≤ 1 = 105.2 ± 18.0. Consequently, inverse correlations were obtained between apo A1 and hs-CRP, r = -0.381, p = 0.013 and between PON and hs-CRP, r = -0.32, p = 0.042. Furthermore, increase in hs-CRP correlated positively with BMI r = 0.318, p = 0.042. Since apo A1 has an anti-inflammatory role and PON an antioxidant activity, the decrease in HDL and its components, cholesterol, apo A1 and PON, in subjects with higher chronic inflammatory condition might explain, in part, the increased cardiovascular risk in these patients.

Assessment of salivary urea as a less invasive alternative to serum determinations

OBJECTIVE

Experimental studies describe how urea is excreted through salivary glands and correlates with serum levels independently of salivary flow rate. This study confirms that salivary urea (SaU) is a reliable biomarker of uraemic state. In order to validate the SaU methodology, the following factors were taken into account: the independence of urea levels from saliva flow rate in healthy subjects and patients with chronic renal failure and the agreement between SaU and serum urea (U) levels in the entire population. In addition, reference intervals and cut-off values for SaU and U were established.

MATERIAL AND METHODS

Urea levels were determined in 268 matched whole saliva (SaU) and serum (U) samples obtained simultaneously from 78 healthy individuals and 154 patients with chronic renal failure. A serum enzymic colorimetric assay was adapted to SaU determinations.

RESULTS

SaU was independent of salivary flow rate. The agreement between SaU and U was confirmed by Bland-Altman analysis with a significant correlation between them (r = 0.91, p = 0.0001). The reference interval of SaU ranged from 1.66 to 7.5 mM. The cut-off values for SaU and U were 7.5 mM and 8.2 mM, respectively (sensitivity and specificity 100% for both).

CONCLUSIONS

SaU testing is harmless and useful for ruling out azotemic states in outpatients. Our results support the inclusion of SaU as a diagnostic test in the clinical laboratory.

Prevalence of impaired fasting glycemia, impaired glucose tolerance, and type 2 diabetes in hemodialyzed patients when applying new diagnostic criteria

OBJECTIVE

Recently, the American Diabetes Association (ADA) proposed a new diagnostic entity for diabetes mellitus that has not been applied in renal failure patients so far. Our goal was to apply the new impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) criteria in a group of hemodialyzed patients to provide data on glucose alterations in chronic renal failure.

DESIGN AND PATIENTS

We evaluated 74 hemodialyzed patients, (38 women, 36 men) without diagnosed diabetes. Blood was collected at fasting and at 120 minutes after a 75-g glucose intake, and insulin levels were determined. The weight, height, waist circumference, and hip circumference of each patient were measured, and the body mass index (BMI) and waist-hip ratio were calculated.

RESULTS AND CONCLUSION

Values of fasting plasma glycemia and 120-minute oral glucose tolerance test were (mean +/- SD) 78 +/- 9.4 mg/dL and 121 +/- 39 mg/dL, respectively. Among the 74 subjects studied, 5 patients had IFG, none of them showing a glucose level above 110 mg/dL. If the ADA 1997 criteria were applied, these patients would be classified as normal. On the other hand, 15 of the 74 patients showed IGT, this prevalence being higher compared with that of the general population. Finally, in 5 of the 74 patients the presence of type 2 diabetes was shown by the second test. According to sex, no differences were observed in the prevalence of IFG, IGT, or diabetes. Glucose alterations are characteristics that need to be identified in chronic renal failure patients. Our results suggests that the glucose tolerance test might be evaluated during hemodialysis treatment to define its prevalence.

Chronic renal failure in diabetic patients increases lipid risk factors for atherosclerosis

Diabetic patients are at high risk of cardiovascular disease and the risk is amplified in the presence of nephropathy, which may be partially attributed to modifications in lipoproteins. Moreover, lipoprotein profile may be affected by incipient nephropathy, glomerulopathy, and mild or severe renal failure. The aim of our study was to evaluate whether chronic renal failure (CRF) changes lipoprotein profile and apo A-I urinary excretion in diabetic subjects with glomerulopathy in comparison with non-diabetic subjects with glomerulopathy and CRF. Diabetic (n=25) and non-diabetic (n=10) patients with glomerulopathy and CRF showed significantly higher LDL-cholesterol, non-HDL-cholesterol and HDL-triglyceride levels than diabetic individuals without CRF (n=10). Arylesterase and paraoxonase activities did not show any difference between groups. Apo A-I could not be detected in urine samples from diabetic patients without CRF. All diabetic subjects with glomerulopathy and CRF who presented proteinuria above 6.5 g/24 h showed detectable urinary apo A-I (range=13.1-61.0 mg/24 h). Similarly, all non-diabetic patients with glomerulopathy and CRF who had proteinuria above 8.0 g/24 h also evidenced detectable apo A-I in urine (range=25.6-557.3 mg/24 h). Urinary apo A-I showed positive and significant correlations with urea (r=0.73, p<0.05) and proteinuria (r=0.97, p<0.0001), and a negative correlation with albumin plasma levels (r=-0.68, p<0.05). In conclusion, the presence of CRF in diabetic patients was associated with a more atherogenic lipoprotein profile.

Utility of non-high-density lipoprotein cholesterol in hemodialyzed patients

Non-high-density lipoprotein-cholesterol (HDL-C) is proposed as a strong predictor of cardiovascular disease (CVD). Measuring non-HDL-C, as total cholesterol minus HDL-C, is convenient for routine practice because, among other advantages, fasting is not required. There are limited data of non-HDL-C in end-stage renal disease patients. We applied non-HDL-C calculation to 50 chronic renal patients receiving maintenance hemodialysis (HD) and 20 healthy subjects, apart from measurement of low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL) HDL, intermediate-density lipoprotein-cholesterol (IDL-C), apoprotein (apo) B, and triglycerides. HD patients presented higher plasma triglycerides and IDL-C and lower HDL-C than the control group, even after adjustment for age (P < .05). VLDL-C increased in HD patients (P < .001) while differences in non-HDL-C did not reach significance (P = .08). To detect which parameter constitutes a better marker of CVD risk among HD patients, a receiver-operating characteristic (ROC) analysis was performed considering HD patients in the highest risk group for CVD. In the ROC graphic, the plots of VLDL and IDL-C exhibited the greater observed accuracy and the best performance, while non-HDL-C showed a curve close to the 45 degrees line indicating that this parameter is a poor discriminator for evaluating CVD risk among HD patients. Non-HDL-C calculation, expressing all apo B-containing lipoproteins, may miss the significant contribution of each atherogenic lipoprotein, such as increase in IDL. This observation would not be in agreement with the currently proposed application of non-HDL-C a useful tool for risk assessment among HD patients.

[Effect of the temperature of the dialysis bath in diabetics]

During the dialysis procedure, arterial hypotension is one of the most common problems and it has been object of many studies. In hemodialysis, changes are produced in body volume through ultrafiltration that generate an increase in the production of thermic energy, which is removed during the treatment. The hypovolemia resulting from the removal of volume activates the sympathetic system, avoiding in this way heat loss and increasing body temperature that promotes vascular vasodilatation and interferes with the compensatory constrictive response to volume fall with consequent arterial hypotension. Patients with autonomic neuropathy would be the most affected by volume depletion and they are usually the ones that show the highest frecuency of hypotension episodes, typical of patients with diabetes. It has been proved before that the use of a cold bath does not decrease the efficiency of the dialysis treatment and improves the cardiovascular stability as well, mostly in patients proned to it, such as diabetics, elderly, and patients with cardiac failure. In this study, it was observed that patients showed low basal temperatures before dialysis treatment and that the use of bath temperature of 35.5 degrees C increased the temperature post dialysis less than with the standard bath at 37 degrees C. The bath at 35.5 degrees C decreased the episodes of arterial hypotension, with an improvement in patient's welfare, and lower requirement of attention and treatment costs.

European monitoring of resistance to insecticides in Myzus persicae and Aphis gossypii (Hemiptera: Aphididae) with special reference to imidacloprid

The susceptibility to several insecticides of 16 and 8 strains of Myzus persicae Sulzer and Aphis gossypii Glover, respectively, received from different European countries in 2001 was investigated. Most of the strains were derived from places known for their aphid resistance problems to conventional insecticides before imidacloprid was introduced. In many regions and agronomic cropping systems imidacloprid has been an essential part of aphid control strategies for a decade, and therefore the susceptibility of aphid populations to imidacloprid using FAO-dip tests and diagnostic concentrations in a leaf-dip bioassay was checked. Additional insecticides tested were cyfluthrin (chemical class: pyrethroid), pirimicarb (carbamate), methamidophos and oxydemeton-methyl (organophosphates). Diagnostic concentrations (LC99-values of reference strains) for each insecticide were established by dose response analysis using a new leaf-disc dip bioassay format in 6-well tissue culture plates. Virtually no resistance to imidacloprid in any of the field-derived populations of M. persicae and A. gossypii was detected. In contrast, strong resistance was found to pirimicarb and oxydemeton-methyl, and to a lesser extent also to cyfluthrin. Two strains of A. gossypii exhibited reduced susceptibility to imidacloprid when tested directly after collection. However, after maintaining them for six weeks in the laboratory, the aphids were as susceptible as the reference strain. The diagnostic concentration of methamidophos did not reveal any resistance in M. persicae, but did so in four strains of A. gossypii.

Lipoprotein alterations in hemodialysis: differences between diabetic and nondiabetic patients

Both renal failure and type 2 diabetes may contribute synergistically to the dyslipemia of diabetic renal failure with the development of atherosclerosis as the possible consequence. It has not yet been conclusively evaluated whether diabetic patients with end-stage renal failure under maintenance hemodialysis (HD) show accentuated alterations in plasma lipids and lipoproteins in comparison to nondiabetics under HD. These abnormalities would involve hepatic lipase activity and the regulation of triglyceride-rich lipoprotein metabolism. The purpose of the present study was to evaluate whether type 2 diabetic patients undergoing HD exhibited a lipid-lipoprotein profile different from that of nondiabetic hemodialyzed patients. We compared plasma lipids, apoprotein (apo) A-I and B, and lipoprotein parameters among 3 groups: 25 type 2 diabetics, 25 nondiabetics, both undergoing HD, and 20 healthy control subjects. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) were isolated by sequential ultracentrifugation. Hepatic lipase activity was measured in postheparin plasma. Both groups of HD patients showed higher triglyceride and IDL cholesterol (P <.001), and lower high-density lipoprotein (HDL) cholesterol (P <.01) and apo A-I (P <.001) levels compared to the control group, even after adjustment for age and body mass index (BMI). However, no differences were found in lipid, lipoprotein, and apoprotein concentrations between diabetic and nondiabetic HD patients, except for high LDL triglyceride content of diabetic HD patients (P <.01). Nondiabetics undergoing HD also presented higher LDL triglyceride levels than controls (P <.05). LDL triglyceride correlated with plasma triglycerides (r = 0.51, P <.001). A lower LDL cholesterol/apo B ratio was found in each group of HD patients in comparison to controls (P <.02). Comparing the diabetic and nondiabetic patients, hepatic lipase activity remained unchanged, but significantly lower than control subjects (P <.001). Hepatic lipase correlated with log-triglyceride (r = -0.31, P <.01), IDL cholesterol (r = -0.41, P <.001), and LDL triglyceride (r = -0.32, P <.01). In conclusion, both diabetic and nondiabetic HD patients shared unfavorable alterations in lipid-lipoprotein profile not different between them but different from a healthy control group. The only difference between the groups of HD patients was a significant LDL triglyceride enrichment, which correlated negatively with hepatic lipase activity. Lipoprotein abnormalities in HD patients would enhance their risk for the development of atherosclerosis.

Acaricide toxicity and resistance in larvae of different strains of Tetranychus urticae and Panonychus ulmi (Acari: Tetranychidae)

The toxicities of eight structurally different acaricidal compounds to six-legged larvae (first motile stage) of three laboratory strains of the two-spotted spider mite, Tetranychus uritcae, and the European red mite, Panonychus ulmi, were evaluated following spray application. The larvae of five field-derived strains of T urticae originating from France, Italy, Brazil, California and Florida were also tested for their susceptibilities to discriminating concentrations of several acaricides resulting in 95% mortality when applied to the organophosphate-resistant laboratory reference strain WI. The spray bioassay used was robust and gave repeatable results with a wide range of acaricidal compounds, irrespective of their mode of action (ovo-larvicides or primarily acting on motile life stages). Compounds tested were abamectin, azocyclotin, chlorpyrifos, clofentezine, deltamethrin, fenpyroximate, hexythiazox and pyridaben. Larvae of one of the laboratory strains of T urticae, AK, originally collected in Japan in 1996 and maintained without further selection pressure, exhibited 2000- and > 4000-fold resistance to the mitochondrial electron transport inhibitors pyridaben and fenpyroximate, respectively. Another strain of T urticae, AU, obtained from Australia and maintained in the laboratory under selection with hexythiazox and clofentezine since 1987 showed > 770- and > 1000-fold resistance to clofentezine and hexythiazox, respectively. The same resistance pattern was observed against larvae of a laboratory strain of P ulmi, CE, also selected with hexythiazox. Larvae of one of the field-derived strains of T urticae, BR, showed a lower susceptibility to a number of compounds, whilst the others were susceptible to all compounds except the organophosphates.

HDL oxidability and its protective effect against LDL oxidation in Type 2 diabetic patients

Low density lipoprotein (LDL) oxidation is a crucial step in the atherosclerotic process. High density lipoprotein (HDL)-associated enzymes such as paraoxonase could exert a protective effect on LDL oxidation in the arterial wall, an effect which could be impaired in Type 2 diabetes mellitus (T2DM). We studied copper-induced oxidation in LDL and HDL isolated from 17 T2DM patients with fair glycaemic control and HDL-cholesterol within normal range and 17 healthy normolipidaemic control subjects. To evaluate the effect of HDL on LDL oxidation in diabetic and control subjects, we assessed copper-induced oxidation in HDL/LDL mixtures, with each lipoprotein isolated from the same subject. Relationships with HDL chemical composition, alpha-tocopherol content and serum paraoxonase activity were investigated. Oxidation was promoted by lipoprotein incubation with copper and then thiobarbituric acid reactive substances (TBARS), conjugated diene production and electrophoretic mobility in agarose gel were measured. In T2DM subjects HDL oxidation was higher than in controls. However, HDL from diabetics was as effective as control HDL to inhibit LDL oxidation. Neither HDL chemical composition nor serum paraoxonase activity showed any difference as compared to control subjects. In contrast, HDL from T2DM subjects showed a higher alpha-tocopherol content which positively correlated with HDL oxidability. Paraoxonase activity positively and strongly correlated with HDL inhibitory effect on LDL oxidation in patients and controls belonging to the heterozygous activity phenotype. Besides, LDL oxidability showed no differences between patients and controls. These results suggest that fairly-controlled T2DM patients with HDL-cholesterol levels within normal range show: 1) normal HDL ability to inhibit LDL oxidation related to normal paraoxonase activity; 2) higher HDL oxidability in spite of its high alpha-tocopherol content, which could favour tocopherol-mediated peroxidation and 3) normal LDL oxidability possibly due to the lack of significant lipoprotein structural alterations.

[Current situation of diabetic patients in hemodialysis in Buenos Aires]

The aim of this study was to evaluate the clinical and biochemical characteristics and the different types of treatment of diabetic patients in hemodialysis (HD) due to their end-stage renal disease (ESRD). The protocol was organized as a multicentric, case-control study and comprised twenty-nine HD centres from the city and province of Buenos Aires (PRODIHEM). The population sample included all diabetic patients in HD (n = 103) and the non diabetic patients hemodialyzed in the morning hours (n = 230) as controls. In this sample, the recorded prevalence for diabetes mellitus was 12%. Among diabetic patients, 61% were non insulin dependent, 23% were insulin dependent and 16% were of the non insulin dependent type treated with insulin (Fig. 1). The results obtained in this study show that the current situation of diabetic patients in HD is far from being satisfactory: they require HD treatment at an early age; the disease is commonly associated with various comorbid factors not always appropriately treated; they show a fast deleterious progress towards ESRD, and they have a short halflife period in HD. The results also showed that there are no defined and common criteria for the treatment and control of these patients; thus, due to their poor clinical performance, only a small percentage reach a priority for a renal transplant.