Very little is known about bile composition in the end stage of chronic renal sufficiency. Patients with this condition are either assigned to a dialysis-transplantation programme, or are treated temporarily with a low-protein diet. Our study was designed to determine bile composition both in a group of ten patients treated with a low-protein diet over a long period of time, and in 11 patients on regular haemodialysis. The patients on haemodialysis were found to have increased bile cholesterol and an increased saturation index in the bile, i.e. changes implying increased risk of cholecystolithiasis. These changes were further enhanced by the effect of a low-protein diet with subsequent increases in cholesterol values and the bile saturation index, as well as a decrease in primary and an increase in secondary bile acids in the bile, i.e. a change in the spectrum of bile acid characteristic for cholecystolithiasis.
Compared with the placebo group, long term co-administration of a low-protein diet and keto-amino acids in CKD patients with obesity led to decreases of ADMA, visceral body fat and proteinuria. Concomitant decreases of glycated hemoglobin, LDL-cholesterol and pentosidine may also contribute to the delay in progression of renal failure.
Severe gastroduodenal bleeding after renal transplantation is effectively prevented by H2 receptor blockers. New drugs for prophylaxis include proton pump inhibitors. The aim of the present study was to compare the effects of prophylaxis with the H2 blocker ranitidine and with the proton pump inhibitor omeprazole. One hundred seventy-seven consecutive patients were included in a controlled, prospective, randomized study after cadaveric renal transplantation. In one case, ranitidine failed to prevent exsanguination due to duodenal peptic ulcer bleeding. No bleeding was noted in the omeprazole group. There were no significant differences between the groups in hospitalization time, development of renal function, amount of cyclosporin A, prednisone, azathioprine, or methylprednisoline ingested, or laboratory biochemical parameters. We conclude that prophylaxis of severe gastroduodenal bleeding after renal transplantation with omeprazole is effective. Omeprazole is certainly as good as ranitidine; its advantages are a prolonged effect and a simple dosage, independent of graft function development.
The list of indications for initiating regular dialysis treatment includes residual glomerular filtration rate (GFR). Under the current European Best Practice Guidelines for Hemodialysis, residual GFR (and the presence of one or more symptoms of uremia) should not decrease below 15 ml/min. The present article seeks to determine to what extent the modification of diet in renal disease (MDRD) equation enables the detection of this decrease in GFR. We tried to answer this question using a more detailed analysis of the relationship between MDRD and renal inulin clearance (Cin). Residual GFR based on Cin (under conditions of stable plasma levels and water loading) and GFR calculated using the MDRD equation was measured in 79 individuals with chronic renal failure (with mean Cin = 19.1 ± 10.1 ml/min/1.73 m2). Statistical evaluation was performed using regression analysis, the interchangeability of both methods (Bland-Altman) and receiver-operating characteristic (ROC) curve analysis. Regression analysis demonstrated a significant correlation between MDRD and Cin (r = 0.892; p < 0.001). However, the regression equation line for the correlation differs significantly from the identity line (p < 0.001). The value of the regression coefficient (0.722) is significantly lower than 1.0 (CI50 0.63; 0.81). The mean MDRD – Cin difference was 3.26 ± 4.46 ml/min/1.73 m2 and the value was significantly different from zero (p < 0.001). The mean difference +2 SD was 12.2 ml/min/1.73 m2, and the mean – 2 SD was –5.7 ml/min/1.73 m2. ROC curve analysis (for a cutoff Cin = 15 ml/min/1.73 m2) indicates an area under the curve (AUC) of 0.954 ± 0.023. The best combination of sensitivity and specificity was obtained for a MDRD of 19.7 ml/min/1.73 m2, with a sensitivity of 90.5% and specificity of 87.5%. For cutoff value of Cin = 10 ml/min/1.73 m2, the AUC was 0.939 ± 0.026 (CI95 0.863–0.890). A combination of maximum sensitivity and specificity was obtained with an MDRD of 16.5 ml/min/1.73 m2. With this value, MDRD sensitivity was 100% and specificity 81.5%. A significant correlation between the MDRD equation and the measured creatinine clearance (Ccr) was found (r = 0.883, p < 0.001). The mean difference of MDRD – Ccr was –7.2 ± 6.5 ml/min/1.73 m2. This is significantly different from that of MDRD – Cin (p < 0.001). Our results suggest that MDRD and Cin in individuals with chronic renal failure are not interchangeable methods for a GFR <15 ml/min/1.73 m2 determination. However, MDRD may furnish valuable information in terms of detecting a critical decrease in GFR; but, the MDRD equation for this decrease in GFR (15 ml/min/1.73 m2) will provide a somewhat higher value (19.7 ml/min/1.73 m2).
Background: Cardiovascular disease caused by atherosclerosis remains a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). We evaluated the potential association of cardiovascular risk factors including asymmetric dimethyl L-arginine (ADMA) and the soluble receptor for advanced glycation end products (sRAGE) with preclinical atherosclerosis in patients undergoing kidney transplantation. Patients and Methods: In 92 males and 47 females undergoing the first cadaveric renal transplantation, ADMA, sRAGE and common risk factors including lipid parameters were evaluated as potential predictors of preclinical atherosclerosis defined as the Belcaro score (focused on advanced atherosclerotic changes) measured by ultrasound. Results: The prevalence of atherosclerotic changes was approximately 70% in men and women. In logistic regression, age, history of smoking, presence of diabetes mellitus, and plasma triglycerides were the strongest independent predictors for advanced atherosclerosis in the whole group. In unadjusted analyses advanced atherosclerosis was also associated with sRAGE in men and with the atherogenic index of plasma in women. Conclusion: Apart from traditional cardiovascular risk factors, plasma triglycerides were found to be strong and independent predictors of advanced atherosclerosis in patients with ESRD. In addition, sRAGE was associated with atherosclerosis in men and the atherogenic index of plasma in women.
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