ARF development after cardiac surgery often results in high morbidity and mortality. Recognizing risk factors permits the timely institution of proper treatment, which is the key to reducing untoward outcomes.

Chronic renal failure patients on maintenance hemodialysis (HD) have a number of ECG abnormalities and cardiac arrhythmias. Clinical and experimental data have shown that increased QT dispersion is associated with severe ventricular arrhythmias and sudden cardiac death. Therefore, the aim of this study was to investigate whether the uremic patients receiving long-term HD have increased QTc interval and/or QTc dispersion compared to normal subjects and to evaluate the effect of electrolyte changes between the predialysis and postdialysis phases on these parameters. Forty patients with end-stage renal failure on long-term HD (22 men, 18 women, mean age 44 years) were included in this study. Serum concentrations of K+, Na+, Ca++, Mg++, Cl-, phosphate, urea, creatinine, HCO3-, and arterial blood gases (PO2, PCO2), together with blood pH, were monitored and QTc intervals and QTc dispersion were measured from 12-lead ECG in predialysis and postdialysis phases. The hemodialyzed patients had an increased predialysis QTc maximum interval and QTc dispersion compared to normal subjects (480 +/- 51 vs 310 +/- 38 msec, p < 0.001 and 61 +/- 17 vs 42 +/- 14 msec, p < 0.001, respectively). Both QTc maximum interval and QTc dispersion increased significantly at the end of the HD (480 +/- 51 vs 505 +/- 49 msec p < 0.001 and 61 +/- 17 vs 86 +/- 18 msec, p < 0.001, respectively). The serum K+ (5.3 +/- 0.56 vs 3.36 +/- 0.41 mEq/L, p < 0.001), phosphate (7.19 +/- 1.62 vs 3.81 +/- 1.02 mg/dL, p < 0.001), magnesium (0.87 +/- 18 vs 0.75 +/- 0.14 mg/dL) and urea concentrations (174 +/- 22 vs 74 +/- 14 mg/dL, p < 0.001) significantly decreased, whereas the Ca++ (2.21 +/- 0.18 vs 2.47 +/- 0.24 mg/dL, p < 0.001), HCO3- (15.5 +/- 3.2 vs 20.1 +/- 3.4 mmol/L, p<0.001) concentrations and pH (7.27 +/- 1.1 vs 7.43 +/- 1.2, p < 0.001) significantly increased after HD compared to predialysis values. There was significant correlation between the QT dispersion increase and serum electrolyte changes (K+, Ca++, and pH levels) (p < 0.05). The association between serum electrolyte changes, acid-base status and QT measurements might provide new insights into the evaluation of the ionic bases involved in inhomogeneous ventricular repolarization.

Our findings reveal that retrobulbar circulation was disturbed after a single hemodialysis session.

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In order to determine the role of correcting anaemia with r-HuEPO on susceptibility of red cell to lipid peroxidation, 15 patients on maintenance haemodialysis treated with r-HuEPO for at least one year (group I), 15 patients on maintenance haemodialysis without r-HuEPO (group II) and 30 persons as a control group (group III) were included in the study. We measured erythrocyte superoxide dismutase (e-SOD), erythrocyte catalase (e-CAT) activities, plasma malonyldialdehyde (p-MDA) and serum vitamin E levels in all patients. The healthy controls (group III) had significantly lower levels of p-MDA in comparison to those measured in haemodialysed patients (group I-II) (p < 0.0001). e-SOD activity in group III was significantly higher than in groups I and II, respectively (p < 0.0001 and p < 0.00001), and e-SOD activity was significantly lower in group II than in group I (p < 0.0001). e-CAT activity in group III was higher than in groups I and II, respectively (p < 0.0001 and p < 0.00001) and it was significantly lower in group II than in group I (p < 0.0001). Vitamin E concentration in group III was lower than in group I and group II, respectively (p < 0.0001 and p < 0.0001). But there is no difference between groups I and II. This study suggests that r-HuEPO therapy improves anaemia by decreasing lipid peroxidation and increasing antioxidant activity.

The study aimed to evaluate the behavior of α-glutathione S-transferase (α-GST) in the serum of hemodialysis patients with hepatitis C virus (HCV) infection following treatment with high-dose IFN-α-2b. Ten patients with detected anti-HCV antibodies and HCV RNA by RT-PCR were selected and treated with high-dose interferon (IFN)-α-2b, 10 million units s.c. daily for 2 weeks followed by 3 times per week for 6 additional weeks. Blood samples were obtained from these patients at baseline for plasma α-GST and hepatic aminotransferases. Patients were monitored with weekly blood counts and monthly liver enzymes. Biochemical (normal α-GST and ALT) and virologic (negative HCV RNA by RT-PCR) responses were observed in 3 (30%) of the 10 patients. At the end of the follow-up (follow-up duration 44 weeks), 3 patients demonstrated long-term biological and virologic responses and 7 had relapses. In the nonresponders plasma AST and ALT approached normal levels on some occasions despite persistent viral RNA. In contrast to transaminases α-GST remained distinctly elevated in nonresponders and provided a more clear distinction between the responders and nonresponders. In conclusion, plasma α-GST, as a sensitive and reliable marker of response, may have a role in the monitoring of hemodialyzed patients undergoing IFN-α-2b therapy.

Open heart surgery in hemodialysis patients is associated with a higher incidence of risks, but can be performed with acceptable operative complications and mortality with an effective hemodialysis program.

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