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Ambulatory blood pressure monitoring in hemodialysis and peritoneal dialysis patients
1696
SPRING
CLINICAL
NEPHROLOGY
MEETINGS
A3
HYPERPROLACTINEMIA AND SEXUAL IMPOTENCE IN MALE PATIENTS ON CHRONIC HEMODIALYSIS Caparoska D., Ivanovski N., GrcevaL., CaparoskaS. University StsCyril and Methodius, School of Medicine, Deptof Urgent Inlernal Medicine & Dept. of Nephrology, Medical Faculty, Skopje, Macedonia Hyperprolactinemia is known to cause impotence in patients with normal renal function. In uremia have also been reported elevated serum prolactin levels(SPLs). This study was undertaken to examine a possible role of &cvatcd SPLs in ii:c . . . .~;SXLL.L LT .:x.c ;ir;:;cnts 0.; chronic hemodialysis (CHD). SPLs in 22 male patients on CHD were evaluated using a homologous doubleantibody radioimmunoassay with prolactin isohormones. Patients were divided in two groups:10 patients were sexually impotent and 12 sexually potent.The SPLs of the impotent patients were found to be significantly elevated in comparison to the levels of the potent patients (p < 0.001). Thus, sexual impotence in male CHD patients seems to be associated with marked hypcrprolactinemia. It is suggested that elevated SPLs may be an important cause of impotence among CHD patients.
INTERSTITIAL EXPRESSION OF VASCULAR MATRIX PROTEIN (VMP) IN POLYCYSTIC KIDNEY DISEASE (PKD)
AMBULATORY BLOOD PRESSURE MONITORING IN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS. Roger W. Coomer, Gerald Schulman, and Julia A. Breyer. Vanderbilt Univ. Med. Ctr., Div. of Nephrology, Nashville, TN. 68 patients (46 HD/22 PD) were monitored for 48 hours, using ambulatory blood pressure monitors. Multiple observations during any hour were averaged to a single observation. Patients with fewer than 23 observations were excluded. After exclusion, 36 I-ID/18 PD patients remained. Each group had an average of 40 observations. Mean blood pressures did not vary signiticantly between I-ID and PD, 140/81(+/-19/12) and 144/89(+/-16/12), respectively. Average daytime (SAM-4PM) and nighttime(SPM-4AM) pressures were 138/81(+/-20112) vs 140/79(+/-23/15) and 144/90(+/-15112) vs 145/88(+/-18114) (SBP/DBP,day vs night, HD and PD, respectively) and did not mer for HD or PD patients. Average pressures for pre-, intra-, and post-dialytic periods were calculated. There was a strong significant correlation between predialysis and mean (excluding predialysis) pressures, Pearson correlation coefficients: 0.73, 0.67,0.69 (p values=0.0001) for SBP, DBP, and MAP, respectively. Neither mean blood pressures or predialysis blood pressures correlated significantly with intradialytic weight gain; Pearson correlation coefficients co.24 (p values > 0.5). In conclusion, the data su=est that comparable blood pressure control was achieved in HD and PD patients. No correlation was found between mean or predialysis blood pressures and intradialytic weight gain in HD patients. A strong relationship was found between predialysis blood pressure and overall mean blood pressure.
COMPARISON OF SURVIVAL OF AN EXPANDED PTFE GRAFT DESIGNED FOR EARLY C ANNULATION TO STANDARD WALL PTFE GRAFTS Daniel W. Covne, Jeffrey A Lowell, David W. Windus, James A Delmez, Surer&a Shenoy, Jean Audrain, and Todd K. Howard, Departments of Internal Medicine and Surgery, Washington University School of Medicine, St. Louis, Mtssouri. Newly placed PTFE arteriovenous g&s requne a period of wound healing and incorporahon of fibrous tissue prior to use, a period typically lasting 2-3 weeks An ideal PTFE graft would be one whrch can be used for vascular access Immediately, obviating the need for temporary dialysis catheters. Recently an expanded PTFE (ePTFE) graft with a mesh cannulation segment (Diastat graft) has been proposed for early cannulation. We reviewed our experience with the ePTFE graft, and compared it to the contemporaneous placement of standard wall PTFE (Goretex) grafts Forty-seven consecutive new or estabhshed chronic hemodialysis patients had g&s (25 ePTFE, 22 standard PTFE) placed between November 1994 and July 1995. There were no significant differences between the groups in age, race, sex, incidence of diabetes, or perrpheral vascular disease. The ePTFE grafts were cannulated significantly earlier after placement than standard wall PTFE grafts (8.8 days versus 36.7 days, p
A.J. Charronl,z, S. Nakamura2, A. Wandinger-Ness3, F.A. Carone2, and R. Bacallaol ‘Division of Nephrology, 2Department of Pathology, Northwestern University Medical School, Chicago, IL and 3Department of Biochemistry, Molecular Biology, and Cell Biology, Northwestern University, Evanston, IL. We have identified a 72 kD protein termed vascular matrix protein (VMP) which may be a phenotypic marker of polycystic kidney disease (PKD). The protein derives its name from its predominant localization to the vascular media. Immunostaining of tissue sections with an affinity purified anti-peptide antibody demonstrated that VMP was associated with fibrillar structures present in vascular media and surrounded vascular smooth muscle cells. The vascular staining pattern was identical in both normal and polycystic kidney tissue sections. However, strikingly anomalous expression of the protein was observed in the interstitium immediately surrounding the earliest detectable renal cysts in early ADPKD kidneys. This interstitial staining was not observed in either normal kidneys or in the phenotypically normal regions of early autosomal dominant polycystic kidneys. Controls stained with preimmune serum or antibody preincubated with an excess of the specific peptide were negative. VMP has been partially purified from human kidney and microsequencing is in progress to allow identification of the corresponding gene.
SPRING
CLINICAL
NEPHROLOGY
MEETINGS
A3
HYPERPROLACTINEMIA AND SEXUAL IMPOTENCE IN MALE PATIENTS ON CHRONIC HEMODIALYSIS Caparoska D., Ivanovski N., GrcevaL., CaparoskaS. University StsCyril and Methodius, School of Medicine, Deptof Urgent Inlernal Medicine & Dept. of Nephrology, Medical Faculty, Skopje, Macedonia Hyperprolactinemia is known to cause impotence in patients with normal renal function. In uremia have also been reported elevated serum prolactin levels(SPLs). This study was undertaken to examine a possible role of &cvatcd SPLs in ii:c . . . .~;SXLL.L LT .:x.c ;ir;:;cnts 0.; chronic hemodialysis (CHD). SPLs in 22 male patients on CHD were evaluated using a homologous doubleantibody radioimmunoassay with prolactin isohormones. Patients were divided in two groups:10 patients were sexually impotent and 12 sexually potent.The SPLs of the impotent patients were found to be significantly elevated in comparison to the levels of the potent patients (p < 0.001). Thus, sexual impotence in male CHD patients seems to be associated with marked hypcrprolactinemia. It is suggested that elevated SPLs may be an important cause of impotence among CHD patients.
INTERSTITIAL EXPRESSION OF VASCULAR MATRIX PROTEIN (VMP) IN POLYCYSTIC KIDNEY DISEASE (PKD)
AMBULATORY BLOOD PRESSURE MONITORING IN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS. Roger W. Coomer, Gerald Schulman, and Julia A. Breyer. Vanderbilt Univ. Med. Ctr., Div. of Nephrology, Nashville, TN. 68 patients (46 HD/22 PD) were monitored for 48 hours, using ambulatory blood pressure monitors. Multiple observations during any hour were averaged to a single observation. Patients with fewer than 23 observations were excluded. After exclusion, 36 I-ID/18 PD patients remained. Each group had an average of 40 observations. Mean blood pressures did not vary signiticantly between I-ID and PD, 140/81(+/-19/12) and 144/89(+/-16/12), respectively. Average daytime (SAM-4PM) and nighttime(SPM-4AM) pressures were 138/81(+/-20112) vs 140/79(+/-23/15) and 144/90(+/-15112) vs 145/88(+/-18114) (SBP/DBP,day vs night, HD and PD, respectively) and did not mer for HD or PD patients. Average pressures for pre-, intra-, and post-dialytic periods were calculated. There was a strong significant correlation between predialysis and mean (excluding predialysis) pressures, Pearson correlation coefficients: 0.73, 0.67,0.69 (p values=0.0001) for SBP, DBP, and MAP, respectively. Neither mean blood pressures or predialysis blood pressures correlated significantly with intradialytic weight gain; Pearson correlation coefficients co.24 (p values > 0.5). In conclusion, the data su=est that comparable blood pressure control was achieved in HD and PD patients. No correlation was found between mean or predialysis blood pressures and intradialytic weight gain in HD patients. A strong relationship was found between predialysis blood pressure and overall mean blood pressure.
COMPARISON OF SURVIVAL OF AN EXPANDED PTFE GRAFT DESIGNED FOR EARLY C ANNULATION TO STANDARD WALL PTFE GRAFTS Daniel W. Covne, Jeffrey A Lowell, David W. Windus, James A Delmez, Surer&a Shenoy, Jean Audrain, and Todd K. Howard, Departments of Internal Medicine and Surgery, Washington University School of Medicine, St. Louis, Mtssouri. Newly placed PTFE arteriovenous g&s requne a period of wound healing and incorporahon of fibrous tissue prior to use, a period typically lasting 2-3 weeks An ideal PTFE graft would be one whrch can be used for vascular access Immediately, obviating the need for temporary dialysis catheters. Recently an expanded PTFE (ePTFE) graft with a mesh cannulation segment (Diastat graft) has been proposed for early cannulation. We reviewed our experience with the ePTFE graft, and compared it to the contemporaneous placement of standard wall PTFE (Goretex) grafts Forty-seven consecutive new or estabhshed chronic hemodialysis patients had g&s (25 ePTFE, 22 standard PTFE) placed between November 1994 and July 1995. There were no significant differences between the groups in age, race, sex, incidence of diabetes, or perrpheral vascular disease. The ePTFE grafts were cannulated significantly earlier after placement than standard wall PTFE grafts (8.8 days versus 36.7 days, p
A.J. Charronl,z, S. Nakamura2, A. Wandinger-Ness3, F.A. Carone2, and R. Bacallaol ‘Division of Nephrology, 2Department of Pathology, Northwestern University Medical School, Chicago, IL and 3Department of Biochemistry, Molecular Biology, and Cell Biology, Northwestern University, Evanston, IL. We have identified a 72 kD protein termed vascular matrix protein (VMP) which may be a phenotypic marker of polycystic kidney disease (PKD). The protein derives its name from its predominant localization to the vascular media. Immunostaining of tissue sections with an affinity purified anti-peptide antibody demonstrated that VMP was associated with fibrillar structures present in vascular media and surrounded vascular smooth muscle cells. The vascular staining pattern was identical in both normal and polycystic kidney tissue sections. However, strikingly anomalous expression of the protein was observed in the interstitium immediately surrounding the earliest detectable renal cysts in early ADPKD kidneys. This interstitial staining was not observed in either normal kidneys or in the phenotypically normal regions of early autosomal dominant polycystic kidneys. Controls stained with preimmune serum or antibody preincubated with an excess of the specific peptide were negative. VMP has been partially purified from human kidney and microsequencing is in progress to allow identification of the corresponding gene.