Anemia is a common complication in dialysis patients because of their relative erythropoietin deficiency. Despite treatment with erythropoiesis-stimulating agents (ESAs), some patients experienced ESA hyporesponsiveness. We evaluated the clinical and laboratory factors that affect ESA hyporesponsiveness and investigated the relationships between hepcidin, inflammatory markers, and the iron profiles of hemodialysis patients. Sixty-eight patients receiving hemodialysis at a single institution were evaluated in a cross-sectional study. The patients were divided into tertiles based on the ESA hyporesponsiveness index (EHRI), defined as the weekly ESA dose per kilogram of body weight divided by the hemoglobin level. The mean EHRI values for each tertile were 3.3 ± 1.2 (T1), 10.2 ± 2.9 (T2), and 24.5 ± 11.6 (T3). The mean serum erythropoietin levels were significantly higher in the Q3 and Q4 groups. Thus, patients with ESA hyporesponsiveness showed relative resistance to erythropoietin therapy. In univariate and multivariate analyses, patients in the third tertile of EHRI showed significantly higher mean interleukin-6 (IL-6) levels. Serum C-reactive protein (CRP) levels showed a similar trend, but the differences were not significant. Serum hepcidin levels tended toward lower mean values in the third tertile of EHRI. No relationship was observed between hepcidin and inflammatory markers or iron status. In conclusion, IL-6, but not CRP, is a strong predictor of ESA hyporesponsiveness in hemodialysis patients who have sufficient iron. It may be difficult to use hepcidin as an independent clinical marker because of the many factors that influence it and their interactions.

Gross vascular calcification seen on imaging studies is common in hemodialysis (HD) patients, and is a significant predictor for cardiovascular mortality in HD patients. We have reported that arterial microcalcification (AMiC) of the vascular access is associated with increased aortic stiffness. This study investigated the impact of vascular access AMiC on cardiovascular mortality in HD patients. The study included 149 HD patients (mean age: 59.1 ± 13.9 years, 86 men and 63 women, 65.8% diabetic) who underwent vascular access surgery. Radial or brachial artery specimens were obtained intraoperatively, and pathologic examination was performed using von Kossa stain to identify AMiC. We compared all-cause and cardiovascular mortality between patients with and without AMiC. The mean follow-up was 37.8 ± 34.5 months, and AMiC was present in 38.8% (n = 57) of patients. The presence of diabetes (odds ratio: 16.49, 95% confidence interval: 1.81-150.36, P = 0.013) was the only independent risk factor for vascular access AMiC. During the observational period, there were 27 cardiovascular deaths. Kaplan-Meier analysis showed an increased cardiovascular mortality risk (log rank = 4.83, P = 0.028) in AMiC patients, and Cox regression analysis confirmed that AMiC was an independent predictor for cardiovascular mortality (hazard ratio: 2.35, 95% confidence interval: 1.09-5.09, P = 0.030). In conclusion, vascular access AMiC is a strong risk factor for cardiovascular mortality in HD patients.

The aim of this study was to evaluate the relationship between arterial microcalcification (AMiC) and erythropoiesis-stimulating agents (ESA) hyporesponsiveness in hemodialysis patients. The presence of AMiC was confirmed by pathologic examination of von Kossa-stained arterial specimens acquired during vascular access surgery. We assessed the ESA hyporesponsiveness index (EHRI), defined as the weekly ESA dose per kilogram body weight divided by the hemoglobin level. AMiC was detected in 33 (40.2%) of 82 patients. Patients with diabetes had a higher incidence of AMiC than patients without diabetes. The serum levels of albumin and cholesterol were higher in patients without AMiC than in patients with AMiC. The serum levels of intact parathyroid hormone were lower in patients with AMiC than in patients without AMiC. The serum levels of phosphate and calcium-phosphorus product did not differ between the two groups. The mean EHRI value was higher in patients with AMiC than in patients without AMiC. In multivariate analyses, ESA hyporesponsiveness and diabetes showed a significant association with AMiC. In conclusion, ESA hyporesponsiveness may be a clinical relevant parameters related to AMiC in hemodialysis patients.

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Stress-induced cardiomyopathy is frequently confused with acute coronary syndromes. We encountered a 64-year old female patient with panhypopituitarism initially suspected as atypical stress-induced cardiomyopathy due to her history and initial echocardiographic findings. She was finally diagnosed as non ST-segment elevation myocardial infarction based on the findings of coronary angiogram, intravascular ultrasound and subsequent echocardiogram.

Hypokalemia is a significant problem in CAPD patients. The impact of hypokalemia on treatment outcome was not known. The study objective was to compare the nutritional status as measured by Multifrequency bioimpedance spectroscopy (BIS) and quality of life between peritoneal dialysis patients who has hypokalemia and normokalemia. There were http://dx.Cytochrome P450 4F2 (CYP4F2) catalyzes the o-hydroxylation of arachidonic acid (AA) to 20-HETE. We previously generated a CYP4F2 transgenic (TG) mouse model, and demonstrated that overexpressed CYP4F2 elevates 20-HETE production and blood pressure in the TG mice, indicating 20-HETE plays a

Department of internal medicine, college of medicine, the catholic university of koreaMalnutrition was reported to occur in 23-76% and known as an important predictor of increased mortality in maintenance hemodialysis (HD) patients. This study was performed to evaluate the association of nutrition with interdialytic weight gain (IDWG) and depression in HD patients. Sixty-five HD patients for at least 3 months were enrolled. We investigated malnutrition by OSND (Objective score of Nutrition on dialysis) score and depressive disorder by Montgomery depression rating scale and Hamilton depression rating scale. We compared the clinical and biochemical profiles according to the presence of malnutrition. Mean age of the patients was 55.7712.6 years and patients with diabetes accounted 55.4%. Mean duration of HD was 36.2732.0 (4-129) months. Depressive disorder was diagnosed in 21 (32.3%), Malnutrition (OSND scoreo22) in 24 (36.9%) and large IDWG (41 kg/day) in 40 (61.5%) out of the 65 HD patients. Patients with malnutrition had lower incidence of large IDWG (45.8% vs 70.7%, p¼ 0.046) and depression (19.5% vs 54.1%, p¼ 0.004) than those without. BMI (21.273.0 vs 23.473.0 kg/m 2 ,p¼0.006), TSF (triceps skin fold thickness, 8.874.2 vs 15.076.2 mm, po0.001), MAC (mid-arm circumference, 23.672.7 vs 26.473.0 cm, p¼ 0.001), serum albumin (3.670.3 vs 3.870.2 g/dL, p¼0.029) and total cholesterol (142.5729.2 vs 169.7731.2 mg/dL, p¼ 0.001) were also lower in patients with malnutrition, compared to the patients without malnutrition. There was no difference in age, gender, diabetes and HD duration between the two groups. In multivariate analysis, Depressive disorder was an independent risk factor for malnutrition.Fig. Multivariate analysis of risk factors for malnutrition in chronic HD patients (n¼65) (R 2 ¼ 0.285). In conclusion, we suggest that the depressive disorder may be considered in HD patients at the time of the assessment of nutritional status in maintenance HD patients. In addition, it is hard to use large IDWG as an indicator of nutrition in maintenance HD patients.http://dx.Acid-base unbalance is most common problem in severe ill patient, especially in condition of abnormal renal function state. Acid-base unbalances are respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. Metabolic acidosis is frequently appeared in clinical state. Arterial blood gas analysis is considered as a basic test to the intensive care unit patient and emergency state. Recently some researches were done, comparing with arterial blood gas analysis and venous blood gas analysis. Because of venous blood sampling is safer than arterial blood gas analysis, and beside not so different among them for detecting pH, pCO 2 , HCO3, except pO 2 measuring. This research was done in emergency room, and for explaining no different between arterial blood gas analysis and peripheral blood gas analysis result in acid-base unbalance state patient. Especially in kidney functions decreased state. : The study was done from March, ...