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Echocardiographic study of the left ventricle was performed in 57 selected, normotensive hemodialysis patients in comparison to 40 healthy controls matched for sex, age and blood pressure. The statistically significant abnormalities in uremic patients were an enlargement of the left ventricular end-diastolic diameter (LVEDiD) (5.58 +/- 0.60 vs. 5.05 +/- 0.5 cm; P less than 0.001) and an increase in the left ventricular radius to posterior wall-thickness ratio (r/Th) (3.65 +/- 0.68 vs. 3.27 +/- 0.44; P less than 0.001). Enlargement of the ventricle was related to anemia (P less than 0.001) and the hemodynamic effect of arteriovenous fistula. Ventricular radius to wall thickness ratio was inversely related to systolic arterial pressure in controls (P less than 0.001) and patients (P less than 0.01) with a significant upward shift of the regression in dialysis patients (P less than 0.001). In dialysis patients, the left ventricular posterior wall thickness (LVPWT) was inversely correlated to serum parathormone (PTH) level (P less than 0.001), and r/Th ratio was positively correlated to serum PTH (P less than 0.001). Bone biopsy was performed in 28 patients. Histomorphometric indexes of osteitis fibrosa were in dialysis patients, correlated to echocardiographic abnormalities; osteoclasts number was inversely correlated to LVPWT (P less than 0.001) and positively related to r/Th ratio (P less than 0.001). Osteoclastic resorption surfaces and LVPWT were inversely correlated (P less than 0.001), while a positive correlation between r/Th ratio and osteoclastic resorption surfaces was observed (P less than 0.001). Osteoblastic surfaces and tetracycline double-labeled surfaces were also correlated to LVPWT (P less than 0.001) and r/Th ratio (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiographic assessment of left ventricular function was performed in 66, stable hemodialysis patients and 50 normal controls matched for sex, age and arterial blood pressure. On the basis of bone histology, hemodialysis patients were classified into two groups: (1) patients with normal bone resorption; and (2) patients with active secondary hyperparathyroidism characterized by an increased bone resorption. Left ventricular function of these two subgroups were compared together as well as with the echocardiographic characteristics of normal controls. In comparison with normal controls, hemodialysis patients with normal bone resorption had an increased left ventricular volume (P less than 0.001) and left ventricular mass (P less than 0.001) with a similar left ventricular mass-to-volume ratio. Their systolic arterial pressure--mass-to-volume ratio correlation was similar to that of normal controls, indicating an adequate myocardial hypertrophy. Patients with increased bone resorption had high parathormone and alkaline phosphatase levels; though the left ventricular dilation was similar to that of hemodialysis patients with normal bone resorption, the left ventricular mass was lower (P less than 0.001) and was similar to the left ventricular mass of normal controls. In addition, patients with increased bone resorption had a lower mass-to-volume ratio (P less than 0.001) and their systolic arterial pressure--mass-to-volume ratio correlation exhibited a significant downward shift (P less than 0.001), suggesting an inadequate myocardial hypertrophy. Patients with increased bone resorption and secondary hyperparathyroidism had an increased heart rate, a higher systolic arterial pressure and end-systolic stress. Furthermore, they had an increased velocity of fiber shortening (P less than 0.01) and shorter left ventricular ejection time (P less than 0.001). In summary, present data suggest the possibility that parathormone may exert myocardial effects in hemodialysis patients.

Blood pressure, echocardiography, and aortic and peripheral arterial pulse-wave velocity were studied in 40 hypertensive patients on long-term hemodialysis during a 24-week administration of nitrendipine (1,4-dihydro-2,6-dimethyl-4-[m-nitrophenyl] -3,5-pyridine-dicarboxylic acid ethyl methylester) monotherapy. In a double-blind placebo-randomized study, nitrendipine effectively lowered the blood pressure (p<0.001) before hemodialysis without causing postdialysis hypotension. The antihypertensive effect of nitrendipine was greater in patients with significant salt and water retention, as indicated by interdialytic body weight gain (ABW), that is, a significant correlation was observed between ABW and the decrease in blood pressure (r=0.72; p<0.001

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SUMMARYThe aim of this study was to investigate the peripheral blood lymphocyte (PBL) phenotypes and T cell repertoire in patients with HCV infection, with or without mixed cryoglobulinaemia (MC). The patients were: Group 1, 23 patients with HCV infection and MC; Group 2, 14 patients with HCV infection but without MC; Group 3, 10 patients with symptomatic essential MC. Twenty healthy blood donors were used as controls. Blood lymphocyte counts were determined, and flow cytometry was used to measure proportions of B cellsBias in the usage of T cell receptor (TCR) Vb chains was studied in a subgroup of 10 representative patients of Group 1 using a polymerase chain reaction (PCR) analysis of the Vb segments with a series of 20 oligonucleotides specific for the Vb families. The three groups were comparable for blood lymphocyte counts, and we observed no abnormal repartition of the following PBL subsets: T cells (CD3 þ ), CD4 þ and CD8 þ subpopulations, B cells (CD19 þ ), and the NK cells (CD16 þ 56 þ ). In none of the groups could we observe lymphocyte ex vivo activation as assessed by the normal expression of the activation cell markers: CD25 on CD4 þ or CD8 þ T cells, or CD5 on B cells. The repartition of naive and memory (CD45RO ¹ /RO þ ) CD4 þ T cells was normal and we did not observe any amplification of the CD4 þ CD7 ¹ T cell subset differentiated in vivo in Th0/Th2 cells. There was no significant amplification of cytotoxic (SF6 þ ) and immunoregulatory (CD57 þ ) CD8 þ T cells in HCV patients with or without MC. Finally, the usage of Vb families in the TCR repertoire was normal in the patients tested. In patients with chronic HCV infection, with or without MC, we did not find any significant expansion or abnormal activation of T, B and NK cell subsets, dysbalance of the naive/ memory subsets, or expansion of the Th0/Th2 subpopulation. These findings differ from the profound immune alterations that are observed in other chronic infections such as HIV or Epstein-Barr virus. Although this study was restricted to the peripheral blood, it suggests that in chronic HCV infection, MC is not the consequence of a chronic activation or dysregulation of the peripheral blood immune cells.

Clinical and laboratory evidence of liver involvement are frequently found in essential mixed cryoglobulinaemia (EMC). We looked for evidence of hepatitis C virus (HCV) infection in 37 patients with EMC. Anti-HCV antibodies (Ab) were found in 16/37 (43%) patients with EMC using the ELISA 2 test and the RIBA 2 test. The 16 anti-HCV-Ab positive patients (group 1) were compared to the 21 anti-HCV-Ab negative patients (group 2). Group 1 patients had more frequent cutaneous involvement (P = 0.02), clinical, biological and histologic hepatic involvement (P < 0.01), higher serum cryoglobulin and lower CH50 levels (P < 0.001). Serum hepatitis B virus markers were infrequent in both groups and no patient from either group had detectable serum HBV DNA. These preliminary results suggest that HCV may be another cause of mixed cryoglobulinaemia.

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