Patients with subclinical hypothyroidism (SCH) have impaired endothelial function probably related to dyslipidemia. The present study compares the effects of simvastatin versus levothyroxine (LT-4) treatment on lipid profile and endothelial function in patients with SCH. Fifty-nine patients with newly diagnosed SCH were enrolled. Patients were randomized into 3 groups to receive no treatment (n = 19), LT-4 (n = 20), or simvastatin (n = 20). We measured endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) at baseline and after 8 months. Serum total cholesterol, triglycerides and LDL-cholesterol were significantly lower following simvastatin. EDV increased significantly in simvastatin treatment group (7.5% +/- 3.3% vs 14.0% +/- 4.5% (P < 0.01). The improvement of EDV correlated with the percent decrease of LDL-cholesterol (rho = 0.68, P < 0.01). Although LT-4 therapy caused a trend towards an increase in EDV compared to baseline, statistical significance was not achieved. EIV remained unchanged in all three groups. Simvastatin but not LT-4 treatment significantly improves EDV of the brachial artery and dyslipidemia in patients with SCH. Improvement in brachial artery endothelial function may be related in part to a hypolipidemic effect of simvastatin treatment.
Our results demonstrate that simvastatin significantly reduces IMT in addition to the significant improvement in serum lipids in female patients with sHT. This reduction of IMT was independent of the decrease in serum cholesterol during simvastatin treatment. Although L-T4 substitution therapy also decreases IMT, it does not appear to significantly improve lipid levels.
Our study showed that interdialytic volume overload increased both LVMI and FGF-23 values. We can consider that interdialytic volume control exerts positive effects on increased FGF-23 levels which predict the negative cardiovascular outcomes.
Introduction: The aim of the study is to analyze the voice changes occurring during a hemodialysis session objectively and to investigate the statistical correlation between voice changes and ultrafiltration, blood pressure, dry weight and the other variables of the patients. Materials and methods: A total of 169 patients were included in the study. Electronic voice recordings of the patients were performed with the aim of making objective voice analysis before and after dialysis. Fundamental frequency measurements occurring at the level of the larynx (Fo) and harmonic-to-noise ratio (HNR) were measured from these voice recordings. Results: When the voice recordings obtained from 169 hemodialysis patients before and after dialysis were investigated, it was observed that a significant increase occurred in the Fo (from 164.52 ± 43.36 Hz to 193.19 ± 47.08 Hz, p50.01). When the change in HNR was investigated, a significant reduction was determined in the post-dialysis measurements (4.6 ± 3.23 dB) compared to the pre-dialysis measurements (16.10 ± 4.06 dB, p50.01). Mean 2.49 ± 0.83 L of ultrafiltration was performed and a significant reduction was observed in post-session body weights of the patients (p5 0.01). There was a highly statistical significance between the measurements of post-dialysis Fo and post-dialysis body weights. A highly significant correlation was determined between the amount of ultrafiltration performed and a significant increase observed in Fo before and after dialysis. Also a significant correlation was determined between the reduction in the mean post-session blood pressures and the reduction in the HNRs. Conclusion: Objective voice analysis is suggesting that it can be a simple and applicable method that can be used to determine the dry weight.
Introduction and Aims: Left ventricular hypertrophy is commonly encountered in the patients with chronic renal failure. Fibroblast Growth Factor (FGF) 23 is correlated with increased atherosclerosis and endothelial dysfunction in each stage of chronic renal failure. The aim of our study is to investigate the correlation between left ventricular hypertrophy, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program. Methods: A total of 97 chronic hemodialysis patients were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples.Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using Devereux Formula. Based on the data obtained from the study, the corelations between LVMI, FGF-23 levels, amounts of inreased interdialytic fluid gains, blood pressure changes and the other biochemical ve clinical parameters were investigated. Results: Mean age of the patients was 64,43±11,28 years (M/F: 47/50) and mean LVMI of the patients was determined to be 184,41±48,62. LVMI of the patients with daily urine output > 250 mL was found to be significantly lower. Positive correlation between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements was also highly significant ( p<0,01). The correlation between mean interdialytic volume excess and LVMI measurements of the patients at a level of 45,9% was found to be highly statistically significant (r=0,459; p<0,01). Positive correlation between FGF-23 levels and LVMI measurements of the patients determined to have a mean level of FGF-23 as 159,79 ±134,99 ng/L was found to be statistically significant (r=0,322; p<0,01). Again it was determined that FGF-23 levels also increased significantly as the interdialytic fluid volume increased (r=0,326; p<0,05). A positive correlation was also determined between FGF-23 levels and interventricular septum thickness (r=0,238; p<0,05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI with multivariate regression analysis. Conclusions:The results of our study showed that hypervolemia developing in chronic hemodialysis patients between two hemodialysis sessions increased both LVMI and FGF-23 values significantly. It is thought that interdialytic volume control exerts positive effects on increased FGF-23 levels considered to be predictor of negative cardiovascular outcomes.
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