Our study demonstrated that PON-1 activity was significantly lower in HD patients compared with healthy controls and that PON-1 activity was inversely correlated with EATT in this population.
IntroductionA new form of hepatitis C virus infection, known as occult hepatitis C virus (HCV) infection, is characterized by the presence of HCV_RNA in the liver or peripheral blood mononuclear cells (PBMCs). However, no serological markers of infection occur and there is not as much damage to the liver damage as is produced by chronic hepatitis C. There is a high incidence of HCV infection among hemodialysis patients, there is significant concern about viral transmission. HCV infection is a major problem in hemodialysis (HD) units even though blood products are screened for anti-HCV antibodies and other precautions are taken. The aim of this study was to determine the prevalence of occult HCV infection in PBMC in chronic hemodialysis (CHD) patients in the dialysis unit at Theodor Bilharz Research Institute (TBRI) with HCV antibodies and HCV RNA negativity irrespective of their liver function tests.MethodsFifty-three patients who were repeatedly were anti-HCV negative and serum HCV-RNA negative and on regular hemodialysis for > six months were enrolled in the study, which was conducted in the dialysis unit of Nephrology Department at TBRI; there were 10 healthy matched controls. The patients were classified into two groups according to the result HCV RNA in their PBMCs. Serological markers of HCV infection, including anti-HCV antibody and serum HCV-RNA, were repeatedly negative for all patients included in the study. We collected serum and PBMC samples from the patients on the day they entered the study. The test of all serum samples for anti-HCV antibodies and HCV-RNA was repeated by RT-PCR to ensure that the patients did not have these HCV serologic markers, We also measured their ALT and GGT levels.ResultsOccult hepatitis C virus infection (OCI) was detected in 15.1% of our CHD patients without any evidence of chronic liver disease.ConclusionOccult HCV infection was present among the hemodialysis patients irrespective of whether they had persistent abnormal values of liver enzymes for which no cause had been identified. Further study is required to determine the clinical significance of occult HCV infections in these patients.
This study revealed that the use of 20 % human albumin as an intraoperative volume expander provides no more benefit than the use of 0.9 % normal saline in terms of immediate graft function in living donor renal transplantation.
Background and aim of the study: Sclerostin is produced by osteocytes and has been shown to down-regulate the synthesis of many markers of bone formation by osteogenic cells. The aim of this study to investigate the relationship between serum sclerostin levels and bone mineral disorders and vascular calcification in hemodialysis patients (HD). Methods:This is a cross-sectional study of 70 patients with ESRD on regular HD for at least six months, Theodor Bilharz Research Institute, Giza, Egypt.Twenty-five subjects who matched the ages, genders, and demographics of the study patients were included as a control group.All patients and control groups included in the study underwent a full through history and clinical examination. Serum calcium, phosphorus, alkaline phosphatase and intact PTH (iPTH) levels were measured. Serum sclerostin was measured by an ELISA. Bone Mineral Densitometry Measurements BMD (g/cm2) was determined by dual-energy X-ray absorptiometry (DXA). CT scan was done to detect the presence or absence of vascular calcification and transthoracic echocardiogram to detect the presence or absence of valvular calcification. Results:The mean seumscleostin levels was a statistically significant high in the HD patients when compared with the control group (156.8 ±121.4 Vs.29.38±0.84, p =0.0001 ) and statistically significant high mean ALP in the HD patients when compared with the control group (147.2 ± 94.3 Vs. 38.8 ±23.4, p = 0.0001). The mean BMD was statistically significant low in the HD patients when compared with the controls (0.839±0.086 g/ m2 Vs.1.306 ±0.153 g/ m2, p = 0.0001).The mean seumscleostin levels was statistically significant high in the HD patients with vascular and valvular calcification when compared with HD patients without calcification.Using spearman correlation coefficient analysis, there was statistically significant negative correlations between serum sclerostin levels and iPTH(r=-0.362, p =0.0021), ALP (r=-0.301, p =0.0114), and BMD (r=-0.469, p =0.0278 ), and there was a statistically significant positive correlation between serum sclerostin levels and phosphate(r=0.5829, p =0.0001 ).Independent predictors of BMD in HD patients were determined using multi-variate regression analysis. Sclerostin levels, iPTH, ALP, and age were found to be independent predictors of BMD. Conclusion: High sclerostin levels in patients with ESRD on HD were associated with high risk of vascular and valvularcalcification and were independent predictors of low BMD in such population.
Low molecular weight heparin (LMWH) has been suggested as safe, efficient and convenient anticoagulation for haemodialysis (HD) than unfractionated heparin (UFH), with fewer side effects. The objective of this study was to compare LMWH with UFH during haemodialysis in patients with end-stage renal disease (ESRD) to obtain precise estimates of clinically important outcomes, including bleeding rates and thrombosis of the extracorporeal circuit. MethOd In this prospective, randomised, cross-over study we compared the safety, clinical efficacy and cost effectiveness of enoxaparin sodium with unfractionated heparin in 44 patients (31 males,13 females; mean age 53.7.9 ± 14.2 years) with end-stage kidney disease (ESKD) on regular haemodialysis. They were randomly assigned to either enoxaparin sodium (40mg) or standard heparin, and followed prospectively for 16 weeks (48 dialyses sessions) before crossing over to the alternate therapy for a further 16 weeks. Heparin anticoagulation was monitored using activated coagulation times. Clinical clotting and haemorrhaging were evaluated by visual inspection after blood draining of the air trap, blood lines and dialysers. To determine whether the type of anticoagulation had any effect on the adequacy of dialysis using Kt/V and lipid profile were measured. reSuLtS The present study showed that, compared with UFH, the effect of LMWH enoxaparin sodium on the number of haemorrhagic events (relative risk, 1.3; 95% CI: 0.317-5.613; p = 1.000), bleedings evaluated by vascular access compression time (weighted mean difference,-0.65; 95% CI:-1.55-0.82), or extracorporeal circuit thrombosis (relative risk, 0.75; 95% CI: 0.284-1.984; p = 1.000) was not significant. There was no significant difference in Kt/V between the groups (1.5 ± 1.2 for enoxaparin sodium vs 1.4 ± 0.4 for heparin; p = 0.6).There was no significant differences in serum total cholesterol, LDL, HDL and TGs after using either anticoagulant. cOncLuSiOn Enoxaparin sodium should be considered as effective and safe as unfractionated heparin and is more convenient than UFH in haemodialysis patients. But, currently direct costs are about 28% more.
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