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Ocular Changes in Egyptian Children on Regular Hemodialysis  [PDF]
Somaya Mohamed Abd El-Ghany, Manal Abd El-Salam, Mona Mohamed Farag, Ola Ali El-Ashwah
International Journal of Clinical Medicine (IJCM) , 2019, DOI: 10.4236/ijcm.2019.106028
Abstract: Background: Chronic Kidney disease (CKD) may cause ocular disorders for many reasons such as uraemia, haemodialysis and hypertension. Aim: To study the ocular changes in a group of Egyptian children with chronic kidney disease on regular hemodialysis. Subjects and Methods: This cross-sectional comparative study was conducted on 30 children on regular hemodialysis and another 30 age and sex-matched healthy children as controls. Their ages ranged from 4 to 17 years. Complete ophthalmological examination including; visual acuity and refraction, anterior segment examination, intraocular pressure (IOP), fundus examination and colored photography were assessed in the same line with routine laboratory investigations for children on regular hemodialysis and their controls. The relation of ocular disorders with related clinical and biochemical variables was measured statistically. Results: The most common eye abnormalities recorded were decreased visual acuity in Lt eye (73.3%) and Rt eye (60%), followed by corneal & conjunctiva calcification were (16.7%) and (13.3%) respectively and fundal changes (13.3%) of the study population. A significant positive relation was found between fundal changes particularly tortuous blood vessel abnormalities with the duration of hemodialysis and serum creatinine level. Conclusion: Ocular abnormalities are common than expected in children on regular hemodialysis. Visual acuity disorder is the major ocular abnormalities recorded in those patients. Regular ophthalmologic assessment is recommended in children to prevent longer-term visual complications.
Correlation of Serum Magnesium with Serum Parathormone in Regular Hemodialysis Patients  [PDF]
Hamid Nasri,Shahin Shirani M.D.,Azar Baradaran
Journal of Biological Sciences , 2006,
Abstract: To consider the relationship of serum magnesium with the activity of the parathyroid gland in maintenance hemodialysis patients we designed a study to investigate the role of serum magnesium in regulating the parathyroid secretion. The study was conducted on patients undergoing maintenance hemodialysis treatment. Predialysis serum calcium, phosphorus, magnesium, alkaline phosphatase, intact serum PTH (iPTH), serum 25-hydroxy vitamin D (25-OH Vit D) and plasma HCO3– were measured. The Urea Reduction Rate, duration and dosage of hemodialysis treatment were calculated also. In this study no significant correlation of serum magnesium with duration of hemodialysis treatment, alkaline phosphatase, plasma HCO3–, serum calcium and phosphorus patients were seen. In all patients a near significant inverse correlation of serum magnesium with iPTH (r = -0.30 , p = 0.079 ) was found, also a significant positive correlation of serum magnesium with serum 25-hydroxy vitamin D levels ( r = 0.40, p = 0.009 ) was seen. Earlier research concluded that some factors other than serum magnesium may be more important in the regulation of parahormone secretion in hemodialysis patients. A positive and strong association between serum magnesium with 25-hydroxy vitamin D level, needs to more attention to this aspect of hemodialysis patients.
Bone Densitometric Analysis in Egyptian Hemodialysis Patients  [cached]
Ehab I. Mohamed1,Eman S.D. Khalil
International Journal of Biomedical Science , 2008,
Abstract: End-stage renal failure (ESRF) is the ultimate consequence of chronic renal failure, in which case dialysis is generally required. In dialysed patients, almost all patients have abnormal bone histology and their lower values of glomerular filtration rate have been associated with lower bone mineral density (BMD) at all sites. The objective of the present study was to investigate the effect of hemodialysis (HD) on body-composition (BC), specially segmental and total BMD, in Egyptian ESRF patients. Forty ESRF patients [20 male/20 female; mean age (±SD): 52.11 ± 12.97 yr] undergoing regular HD 3 times/week (duration: 6.50 ± 5.68 yr) using bicarbonate dialysis and polysulphon membrane, and other 40 age- and sex-matched healthy controls volunteered in the study. Blood samples were obtained for monitoring serum levels of calcium (Ca), inorganic phosphate (P), osteocalcin (OC), and parathormone (PTH) for all participants. BC was evaluated by dual X-ray absorptiometry. HD patients manifested lower segmental and total BMD values in comparison with age-matched healthy controls (Z-score: -0.17±1.12) due to significantly higher levels of P (4.04 ± 1.33 vs. 3.39 ± 0.51 mg/dl, p < 0.001), PTH (538.17 ± 363.99 vs. 48.86 ± 19.64 ng/L, p < 0.0001), and OC (50.39 ± 34.91 vs. 16.32 ± 5.37 mg/L, p < 0.0001). Pelvis, lumbar spine, and total BMD (g/cm2) for HD patients were significantly correlated with HD duration (yr) (R = 0.94, 80, and 92, respectively, p < 0.0001). Thus, BC analysis is of utmost importance for efficiently providing tailored individual mineral supplementation to HD patients.
Association of Serum Phosphorus Variability with Coronary Artery Calcification among Hemodialysis Patients  [PDF]
Mengjing Wang, Haiming Li, Li You, Xiaoling Yu, Min Zhang, Ruijiang Zhu, Chuanming Hao, Zhijie Zhang, Jing Chen
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0093360
Abstract: Coronary artery calcification (CAC) is associated with increased mortality in patients on maintenance hemodialysis (MHD), but the pathogenesis of this condition is not well understood. We evaluated the relationship of CAC score (CACs) and variability in serum phosphorus in MHD patients. Seventy-seven adults on MHD at Huashan Hospital (Shanghai) were enrolled in July, 2010. CAC of all the patients were measured by computed tomography and CACs was calculated by the Agatston method at the entry of enrollment. Patients were divided into three categories according to their CACs (0~10, 11~400, and >400). Blood chemistry was recorded every 3 months from January 2008 to July 2010. Phosphorus variation was defined by the standard deviation (SD) or coefficient of variation (CV) and it was calculated from the past records. The ordinal multivariate logistic regression analysis was used to analyze the predictors of CAC. The mean patient age (± SD) was 61.7 years (±11.3) and 51% of patients were men. The mean CACs was 609.6 (±1062.9), the median CACs was 168.5, and 78% of patients had CACs more than 0. Multivariate analysis indicated that female gender (OR = 0.20, 95% CI = 0.07–0.55), age (OR = 2.31, 95% CI = 1.32–4.04), serum fibroblast growth factor 23 (OR = 2.25, 95% CI = 1.31–3.85), SD-phosphorus calculated from the most recent 6 measurements (OR = 2.12; 95% CI = 1.23–3.63), and CV-phosphorus calculated from the most recent 6 measurements (OR = 1.90, 95% CI = 1.16–3.11) were significantly and independently associated with CACs. These associations persisted for phosphorus variation calculated from past 7, 8, 9, 10, and 11 follow-up values. Variability of serum phosphorus may contribute significantly to CAC and keeping serum phosphorus stable may decrease coronary calcification and associated morbidity and mortality in MHD patients.
Does vascular calcification correlate with pulse wave velocity in hemodialysis patients?  [cached]
Biagio Raffaele Di Iorio,Emanuele Cucciniello
Nephrology Reviews , 2009, DOI: 10.4081/nr.2009.e4
Abstract: Vascular calcifications have been previously shown to be an independent predictor of mortality in dialysis patients and a similar association has been shown for arterial stiffness. Nonetheless, the relationship between vascular calcifications and pulse wave velocity (PWV) have so far been little explored. The goal of this study is to verify the correlation among vascular calcifications and rigidity of arterial wall in patients at dialysis start. Accordingly, we investigated the association between aortic PWV and coronary calcification measured by computed tomography (TC-score) in 105 adult incident hemodialysis patients. PWV resulted increased in patients with the higher TC-score values; indeed, at univariate analysis PWV directly correlated with age (p=0.016), presence of diabetes (p lower than 0.0001), serum phosphorus (p=0.0066), C-reactive protein (CRP) (p=0.046), LDL-cholesterol (p=0.043), TC-score (p lower than 0.0001), and inversely correlated with systolic blood pressure (p=0.036). At multivariate analysis, age, diabetes, serum phosphorus, CRP, LDL-cholesterol and vascular calcifications were determinants of arterial stiffening. Using the table “two for two”, we showed 6 false negative patients (high TC-score and low PWV) and 12 false positive patients (low TC-score and high PWV). The sensibility was 76% and the specificity 85%; the accuracy was 83%, the predictor positive value was 61% and the predictor negative value was 92%. Overall, a strong association between TC-score and PWV was seen.
Magnesium and Muscle Cramps in End Stage Renal Disease Patients on Chronic Hemodialysis  [PDF]
Patrick G. Lynch,Mersema Abate,Heesuck Suh,Nand K. Wadhwa
Advances in Nephrology , 2014, DOI: 10.1155/2014/681969
Abstract: We evaluated the frequency and severity of muscle cramps, and the effect of dialysate magnesium on muscle cramps in 62 stable ESRD patients on chronic hemodialysis. Each subject was surveyed twice within a 6-month period. A single nephrology fellow conducted all in-person surveys. During the first survey, the patients were dialyzed with dialysate magnesium of 0.75?meq/L (0.375?mmol/L). Prior to the second survey, the dialysate magnesium was increased to 1.0?meq/L (0.50?mmol/L). The severity of cramps was scored on a 1–10 scale, with 10 indicating maximal severity. The number of patients with muscle cramps was significantly lower with dialysate magnesium of 1.0?meq/L (0.50?mmol/L) (56% versus 77%, ). No significant difference was observed in interdialytic weight gain, intradialytic ultrafiltration, dry weight, or intradialytic hypotension. The mean ± SD severity score of muscle cramps decreased from to (). Seven of 31 (23%) patients in the group with low dialysate magnesium while 0/20 (0%) patients receiving high magnesium dialysate terminated hemodialysis early due to cramps (). Both the number of patients reporting muscle cramps and the severity score decreased with higher dialysate magnesium which contributed to better adherence to hemodialysis treatments. 1. Introduction Painful muscle cramps, usually in the lower extremities are common in patients receiving chronic hemodialysis (HD) [1]. These cramps frequently occur toward the end of the dialysis sessions, sometimes precede hypotension, and are associated with higher fluid removal during HD [1]. Recurrent muscle cramps frequently lead to noncompliance with the prescribed HD treatment [2] and impact patients’ quality of life [3]. Varying the magnesium (MG) concentration to a low or no MG containing dialysate has been shown to increase the incidence of muscle cramps [4]. Intravenous MG given during an episode of severe muscle cramping while on HD was shown to ameliorate the symptom [5]. Previous therapies including quinine, vitamins C and E [6], L-carnitine [4], MG [7–9], and the use of sequential compression devices [10] have been investigated to ameliorate the frequency and intensity of muscle cramps with mixed efficacy. MG functions as a cofactor in the energy metabolism, nucleotide and protein synthesis, and as a regulator of sodium, potassium, and calcium channels [11]. Severe hypomagnesaemia can cause muscle cramps, tremors, tetany, and cardiac arrhythmia [11]. In patients on HD, the serum MG concentration parallels the dialysate MG level. MG readily crosses the dialysis membrane with its
The Contribution of Arterial Calcification to Peripheral Arterial Disease in Pseudoxanthoma Elasticum  [PDF]
Georges Leftheriotis, Gilles Kauffenstein, Jean Fran?ois Hamel, Pierre Abraham, Olivier Le Saux, Serge Willoteaux, Daniel Henrion, Ludovic Martin
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0096003
Abstract: Background and aims The contribution of arterial calcification (AC) in peripheral arterial disease (PAD) and arterial wall compressibility is a matter of debate. Pseudoxanthoma elasticum (PXE), an inherited metabolic disease due to ABCC6 gene mutations, combines elastic fiber fragmentation and calcification in various soft tissues including the arterial wall. Since AC is associated with PAD, a frequent complication of PXE, we sought to determine the role of AC in PAD and arterial wall compressibility in this group of patients. Methods and Results Arterial compressibility and patency were determined by ankle-brachial pressure index (ABI) in a cohort of 71 PXE patients (mean age 48±SD 14 yrs, 45 women) and compared to 30 controls without PAD. Lower limb arterial calcification (LLAC) was determined by non-contrast enhanced helicoidal CT-scan. A calcification score (Ca-score) was computed for the femoral, popliteal and sub-popliteal artery segments of both legs. Forty patients with PXE had an ABI<0.90 and none had an ABI>1.40. LLAC increased with age, significantly more in PXE subjects than controls. A negative association was found between LLAC and ABI (r = ?0.363, p = 0.002). The LLAC was independently associated with PXE and age, and ABI was not linked to cardiovascular risk factors. Conclusions The presence of AC was associated with PAD and PXE without affecting arterial compressibility. PAD in PXE patients is probably due to proximal obstructive lesions developing independently from cardiovascular risk factors.
Health Related Quality of Life among Egyptian Patients on Hemodialysis  [PDF]
Heba Sayed Assal,Hanaa M. Emam,Nagwa Abd EL-Ghaffar
Journal of Medical Sciences , 2006,
Abstract: The present research was carried out to evaluate the physical (PCS) and mental (MCS) component summary scales in hemodialysis patients as compared to healthy subjects at a baseline and two years later. 130 patients on hemodialysis (mean age 40.6±8.1 years) were enrolled in the study between February 2003 to February 2005. The short-form with 36 (SF-36) questionnaire was given every 6 months to hemodialysis patients. Results were compared to the general population and changes in QoL over time were determined. Mean PCS was 34±15.46 and mean MCS was 38.80±15.17 compared to the general population there were significant decline in PCS and MCS at baseline and two years later. There was no significant correlation between causes of End-Stage Renal Disease (ESRD) and Quality of Life (QoL), except for diabetes mellitus as regard MCS. High levels of serum albumin and hemoglobin was associated with highly significant quality of life. Serum albumin was a good predictor for quality of life in this study. Adequacy of dialysis treatment in hemodialysis patients was determined by serum albumin, hematocrit, KT/V and Urea Reduction Ratio (URR). Present results showed the negative impact that ESRD and hemodialysis treatment have on self-assessed physical and mental health and it is important to treat all factors that induce hypoalbuminemia as well as anaemia.
Association of Fetuin-A Levels with Carotid Intima Media Thickness and Valvular Calcification in Hemodialysis and Peritoneal Dialysis Patients  [PDF]
Solak, Yal??n,?nal, Ali,Atalay, Hüseyin,Kayrak, Mehmet
The Turkish Nephrology, Dialysis and Transplantation Journal , 2013, DOI: 10.5262/tndt.2013.1001.07
Abstract: BACKGROUND: Fetuin-A is a negative acute-phase reactant which prevents vascular calcification. Coronary artery disease (CAD) is the most important cause of mortality in patients undergoing renal replacement therapy (RRT). The key element of cardiovascular disease (CVD) seen in end-stage renal disease patients who are on dialysis treatment is accelerated calcific atherosclerosis. There are a limited number of studies in which HD and PD is compared in terms of fetuin-A level.OBJECTIVE: We aimed to investigate the association of serum fetuin-A level with valvular calcification and predictors of CAD in hemodialysis (HD) and peritoneal dialysis (PD) patients.MATERIAL and METHODS: 39 HD (24 males, 15 females) and 39 PD (25 males, 14 females) patients were included in the study. We determined carotid artery intima media thickness (CIMT) and evaluated heart valve calcification via echocardiography. We also measured serum fetuin-A level, CRP, ferritin, fibrinogen and serum albumin level. According to fetuin-A level, patients were stratified into quartiles.RESULTS: Fetuin-A level was significantly lower in HD patients when compared with that of PD patients (28.6±5.934 ng/ml, 32±4.8 ng/ml respectively p<0.001). There was a significant negative correlation between CIMT and fetuin-A level. CIMT was found to be lower in PD patients than in HD patients. We found a positive correlation between fetuin-A and dialysis adequacy and albumin level. There was a negative correlation of fetuin-A with age, fibrinogen, ferritin and CRP. Fetuin-A level was lower in patients with aortic calcification.CONCLUSION: Fetuin-A level was found to be lower in HD patients. Fetuin-A may be a novel marker for CVD in patients undergoing RRT.BACKGROUND: Fetuin-A is a negative acute-phase reactant which prevents vascular calcification. Coronary artery disease (CAD) is the most important cause of mortality in patients undergoing renal replacement therapy (RRT). The key element of cardiovascular disease (CVD) seen in end-stage renal disease patients who are on dialysis treatment is accelerated calcific atherosclerosis. There are a limited number of studies in which HD and PD is compared in terms of fetuin-A level.OBJECTIVE: We aimed to investigate the association of serum fetuin-A level with valvular calcification and predictors of CAD in hemodialysis (HD) and peritoneal dialysis (PD) patients.MATERIAL and METHODS: 39 HD (24 males, 15 females) and 39 PD (25 males, 14 females) patients were included in the study. We determined carotid artery intima media thickness (CIMT) and evaluated heart valve c
Calcification of coronary arteries and abdominal aorta in relation to traditional and novel risk factors of atherosclerosis in hemodialysis patients  [cached]
Pencak Przemys?aw,Czerwieńska Beata,Ficek Rafa?,Wyskida Katarzyna
BMC Nephrology , 2013, DOI: 10.1186/1471-2369-14-10
Abstract: Background Process of accelerated atherosclerosis specific for uremia increases cardiovascular risk in patients with chronic kidney disease (CKD) and may be influenced by the different structure of arteries. The study assesses the influence of traditional and novel risk factors on calcification of coronary arteries (CAC) and abdominal aorta (AAC) in hemodialysis patients (HD). Methods CAC and AAC were assessed by CT in 104 prevalent adult HD and 14 apparently healthy subjects with normal kidney function (control group). Mineral metabolism parameters, plasma levels of FGF-23, MGP, osteoprotegerin, osteopontin, fetuin-A, CRP, IL-6 and TNF-α were measured. Results CAC and AAC (calcification score ≥ 1) were found in 76 (73.1%) and 83 (79.8%) HD respectively, more frequent than in the control group. In 7 HD with AAC no CAC were detected. The frequency and severity of calcifications increased with age. Both CAC and AAC were more frequently detected in diabetics (OR = 17.37 and 13.00, respectively). CAC score was significantly greater in males. CAC and AAC scores were correlated significantly with pack-years of smoking and plasma osteoprotegrin levels. However the independent contribution of plasma osteoprotegerin levels was not confirmed in multiple regression analysis. Age (OR = 1.13) and hemodialysis vintage (OR = 1.14) were the independent risk factor favoring the occurrence of CAC; while age (OR = 1.20) was the only predictor of AAC occurrence in HD. Conclusions 1. AAC precedes the occurrence of CAC in HD patients. 2. The exposition to uremic milieu and systemic chronic microinflammation has more deteriorative effect on the CAC than the AAC.
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