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4P-1185 Nutritional assessment in haemodialysed patients
Thursday October 2, 2003: Poster Session Kidney disease and atherosclerosis patients are lacking. Since recently, the CD40-CD40 ligand system has proved critical for the activation of tissue structural cells that include endothelial cells, epithelial cells and fibroblasts, we also assayed soluble CD40 ligand (sCD40L). Aim: Effects of 6 months treatment with simvastatin on some hemostatic parameters, markers of endothelial cell injury, sCD40L in 14 hyperlipidemic CAPD patients. Methods: Simvastatin (Zocor, MSD) was given in a dose of 10 mg at bedtime. Results: CD40L decreased significantly after 3 months of the therapy. Platelet aggregation was transiently decreased by simvastatin therapy. Fibrinolytic activity index increased significantly after 6 months of simvastatin administration. Vascular cell adhesion molecule-VCAM, thrombomodulin decreased significantly after 3 months of the therapy, whereas intercellular cell adhesion molecule-ICAM decreased after 6 months. Vascular endothelial growth factor-VEGF and its receptor, protein Z, total Tissue Factor Pathway Inhibitor-TFPI, TFPI/Xa complexes, Thrombin Activatable Fibrinolysis Inhibitor-TAFI concentration and activity fell significantly after 6 months of the treatment with simvastatin. Tissue plasminogen activator-tPA concentration increased after 1 month, whereas total homocysteine fell after 6 months of the simvastatin therapy. Truncated TFPI decreased significantly after 1 month of the therapy Conclusion: Simvastatin is an effective hypolipemic agent in CAPD patients. It affects favourably platelet aggregation, extrinsic coagulation pathway, improves fibrinolysis and ameliorates endothelial dysfunction. Treatment with simvastatin might reduce a risk of from thrombotic complications in CAPD patients. 4P-1183
CD40L correlations with some hemostatic parameters in hyperlipidemic patients with chronic renal failure
J. Malyszko, M. Mysliwiec. Nephrology Department, Medical University, Bialystok, Poland Objective: In patients with nephrotic syndrome (NS) or maintained on chronic ambulatory peritoneal dialyses-CAPD, the incidence of myocardial infarction is approximately 3 -5 times higher that in general population. Hyperlipidemia, commonly observed in these patients, may contribute to the progression of atherosclerosis. In NS and CAPD patients, there is an evidence of platelet activation, hypercoagulation and hypofibrinolysis. CD40 ligand is expressed on platelets and released from then on activation. It is proinflammatory for endothelial cell and promotes coagulation. Aim: Associations between CD40L, markers of platelet activation (Pselectin, GPV), some hemostatic factors (prothrombin fragments 1+2, TAT, PAP, TAFI, VEGF, TFPI, factor VII), markers of endothelial dysfunction (vWF, thrombomodulin, VCAM, ICAM, E-selectin) in hyperlipidemic patients with NS (n=24), on CAPD (n=45) and in healthy volunteers-CG (n=25). Results: CD40L was significantly elevated in NS and CAPD patients when compared to the CG. In CG CD40L correlated significantly with VEGF (r=0.48, p<0.05), TFPI (r=0.53, p<0.05), GPV (r=0.67, p<0.01), factor VII (r=0.59, p<0.05), arachidonic acid-induced platelet aggregation in PRP (r=0.56, p<0.05). CD40L correlated with P-selectin (r=0.49, p<0.05) and VCAM (r=0.54, p<0.05) in NS. In CAPD CD40L correlated with P-selectin (r=0.45, p<0.01), E-selectin (r=0.44, p<0.05), platelet aggregation induced by ADP (r=0.52, p<0.01), arachidonic acid (r=0.55, p<0.01), ristocetin (r=0.48, p<0.01) in PRP and by ADP (r=0.56, p<0.01), arachidonic acid (r=0.58, p<0.01), collagen (r=0.58 p<0.01) in the whole blood. Conclusion: Significant correlations between CD40L and platelet aggregation or markers of platelet activation may support the role for CD40L-mediated platelet activation in thrombosis, inflammation and atherosclerosis. Elevated CD40L may indicate an increased risk of cardiovascular events. Renal transplant recipients with coronary artery disease exhibit impairment in fibrinolysis and structural changes in carotid arteries
J. Malyszko 1 , S. Brzosko 1 , T. Hryszko 1 , U. Lebkowska 2 , M. Mysliwiec 1 . 1 Nephrology Department, 2 Radiology Department, Medical University, Bialystok, Poland Cardiovascular disease (CVD) is the main cause of mortality and morbidity among patients after renal transplantation (Tx). Intima media thickness (IMT) of the common carotid artery is related to CVD. Hemostatic disturbances, observed commonly in Tx, may contribute to the pathogenesis of CVD in
this population. The aim of the study was to evaluate some hemostatic factors (prothrombin fragments 1+2 -F1+2, thrombin-antithrombin complexes-TAT, plasmin-antiplasmin complexes-PAP, fibrinogen, euglobulin clot lysis timeECLT, thrombin activatable fibrinolysis inhibitor (TAFI), thrombomodulin, in Tx population with and without coronary artery disease (CAD) as well as their correlations with IMT. The study was performed on 41 Caucasian, clinically stable Tx (21 patients without CAD, 20 patients with CAD) on triple immunosuppressive regimen (CSA, prednisone and azathioprine) with stable graft function. Patients with CAD were significantly older, with thicker IMT, lower PAP complexes, platelet count, total protein, albumin, higher fibrinogen, cholesterol, triglycerides, prolonged ECLT when compared to those without CAD. In univariate analysis IMT correlated significantly with age, (r=0.6; p<0.001), time on dialysis prior to transplantation (r=0.6; p<0.001), PAP (r=0.5, p<0.001), fibrinogen (r=0.5; p<0.05), hemoglobin (r=0.5, p<0.01). IMT correlated positively at the level of statistical significance with BMI (r=0.3; p=0.08). Multiple regression analysis showed that only PAP, fibrinogen and time on dialysis prior to transplantation were positive independent predictors of IMT. These data show that hypofibrinolysis may contribute to the arterial remodelling in kidney transplant recipients. Dialysis therapy before transplantation makes detrimental changes in arterial vasculature. 4P-1185
Nutritional assessment in haemodialysed patients
L. Lõcsey 1 , B. Borbás 1 , I. Ménes 1 , B. Szlanka 1 , M. Kisgáti 2 , A. Dán 2 . 1 EuroCare, Debrecen; 2 Kenézy Hospital, Debrecen, Hungary Malnutrition, inflammation and atherosclerosis-MIA syndrome frequently occur together in chronic haemodialysis patients. The aim of our study is to make a comparative investigation cardiovascular risks and malnourished assessment in chronic haemodialysed 65 females (63.4±8.2 years) and 46 male (61.3±7.8 years) by using different methods. Subjective global assessment (SGA) measured moderate malnutrition in 56.01% in females, and in 59.37% of male, severe malnutrition (SGA-C) was in 20.01 vs. 9.38% of pts. With adequate dialysis treatment the serum transferrin levels were <1.8 g/l in 63.72% of women, in 61.76% of men. The haematocrit was <0.31 in 6.89% females and 14.7% male. Prealbumin concentrations were lower <199 mg/l in 18.97% females, in 29.11% male. The hypalbuminaemia <38.01 g/l were in 15.52% females, in 29.41% male. Total cholesterol levels decreased <4.8 mmol/l in 37.93 females, 58.82% male. The HDL-cholesterol concentrations were lower <1.4 mmol/l in 77.9% females and 41.18% male. Hypertriglyceridaemia can be found in 41.38% vs. 41.20% of pts. The LDL/HDL ratio was >3.5 in 73.81 vs. 43.79% of patients. C–reactive protein (CRP) concentrations were higher >8.5 mg/l in 39.66% females, in 50.01% male. The lymphocytes counts were smaller <18% in 29.31% vs 41.18% of women/men. The multifrequency bioimpedance analysis (inBody3-BIOSPACE) present good correlation with decreased praealbumin, albumin, transferrin levels, increased CRP and TBW. The higher homocysteine levels (>25 µmol/l) were in cerebro, and cardiovascular complications. Low praealbumin, HDL cholesterol, high LDL, hypertriglyceridaemia, increased CRP concentration, high TBW, LBW, (p<0.01) associated after insufficient and inadequate nourishment in malnutrition with SGA–B and C condition and with low PCR (<0.70) and Kt/V (<1.1). 4P-1186
Effects of immunosuppressive therapy on blood lipid profile after renal transplantation
M. Kanbay, A. Yildirir, H. Muderrisoglu, T. Colak, H. Karakayali, M. Haberal. Baskent University, Turkey Introduction: Hyperlipidemia is an important metabolic disorder that is commonly encountered among renal transplant recipients. This study was conducted to investigate the possible effects of transplantation and immunosuppressive drugs on the lipid profile of these patients. Methods: The records of 169 patients, who had undergone renal transplantation between the years of 1996-1999, were retrospectively investigated. The lipid profile of these patients including total cholesterol (T-C), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglyceride(TG) levels before and at least 6 months after the procedure were noted. The demographics of the patients, etiology of the end-stage renal failure along with their immunosuppressive drugs were also taken into consideration. Results: The study group included 69 (38.5%) women and 100 (61.5%) men with a mean age of 35.7±11.8 years (range 11-62). All patients had used steroids whereas 64.5% had used azathioprine and 35.5% had used tacrolimus and mycothelote mofetil. After immunosuppressive treatment the laboratory analysis yielded significantly increased levels of T-C, LDL and TG levels and
XIIIth International Symposium on Atherosclerosis, September 28–October 2, 2003, Kyoto, Japan
THURSDAY
4P-1184
335
CD40L correlations with some hemostatic parameters in hyperlipidemic patients with chronic renal failure
J. Malyszko, M. Mysliwiec. Nephrology Department, Medical University, Bialystok, Poland Objective: In patients with nephrotic syndrome (NS) or maintained on chronic ambulatory peritoneal dialyses-CAPD, the incidence of myocardial infarction is approximately 3 -5 times higher that in general population. Hyperlipidemia, commonly observed in these patients, may contribute to the progression of atherosclerosis. In NS and CAPD patients, there is an evidence of platelet activation, hypercoagulation and hypofibrinolysis. CD40 ligand is expressed on platelets and released from then on activation. It is proinflammatory for endothelial cell and promotes coagulation. Aim: Associations between CD40L, markers of platelet activation (Pselectin, GPV), some hemostatic factors (prothrombin fragments 1+2, TAT, PAP, TAFI, VEGF, TFPI, factor VII), markers of endothelial dysfunction (vWF, thrombomodulin, VCAM, ICAM, E-selectin) in hyperlipidemic patients with NS (n=24), on CAPD (n=45) and in healthy volunteers-CG (n=25). Results: CD40L was significantly elevated in NS and CAPD patients when compared to the CG. In CG CD40L correlated significantly with VEGF (r=0.48, p<0.05), TFPI (r=0.53, p<0.05), GPV (r=0.67, p<0.01), factor VII (r=0.59, p<0.05), arachidonic acid-induced platelet aggregation in PRP (r=0.56, p<0.05). CD40L correlated with P-selectin (r=0.49, p<0.05) and VCAM (r=0.54, p<0.05) in NS. In CAPD CD40L correlated with P-selectin (r=0.45, p<0.01), E-selectin (r=0.44, p<0.05), platelet aggregation induced by ADP (r=0.52, p<0.01), arachidonic acid (r=0.55, p<0.01), ristocetin (r=0.48, p<0.01) in PRP and by ADP (r=0.56, p<0.01), arachidonic acid (r=0.58, p<0.01), collagen (r=0.58 p<0.01) in the whole blood. Conclusion: Significant correlations between CD40L and platelet aggregation or markers of platelet activation may support the role for CD40L-mediated platelet activation in thrombosis, inflammation and atherosclerosis. Elevated CD40L may indicate an increased risk of cardiovascular events. Renal transplant recipients with coronary artery disease exhibit impairment in fibrinolysis and structural changes in carotid arteries
J. Malyszko 1 , S. Brzosko 1 , T. Hryszko 1 , U. Lebkowska 2 , M. Mysliwiec 1 . 1 Nephrology Department, 2 Radiology Department, Medical University, Bialystok, Poland Cardiovascular disease (CVD) is the main cause of mortality and morbidity among patients after renal transplantation (Tx). Intima media thickness (IMT) of the common carotid artery is related to CVD. Hemostatic disturbances, observed commonly in Tx, may contribute to the pathogenesis of CVD in
this population. The aim of the study was to evaluate some hemostatic factors (prothrombin fragments 1+2 -F1+2, thrombin-antithrombin complexes-TAT, plasmin-antiplasmin complexes-PAP, fibrinogen, euglobulin clot lysis timeECLT, thrombin activatable fibrinolysis inhibitor (TAFI), thrombomodulin, in Tx population with and without coronary artery disease (CAD) as well as their correlations with IMT. The study was performed on 41 Caucasian, clinically stable Tx (21 patients without CAD, 20 patients with CAD) on triple immunosuppressive regimen (CSA, prednisone and azathioprine) with stable graft function. Patients with CAD were significantly older, with thicker IMT, lower PAP complexes, platelet count, total protein, albumin, higher fibrinogen, cholesterol, triglycerides, prolonged ECLT when compared to those without CAD. In univariate analysis IMT correlated significantly with age, (r=0.6; p<0.001), time on dialysis prior to transplantation (r=0.6; p<0.001), PAP (r=0.5, p<0.001), fibrinogen (r=0.5; p<0.05), hemoglobin (r=0.5, p<0.01). IMT correlated positively at the level of statistical significance with BMI (r=0.3; p=0.08). Multiple regression analysis showed that only PAP, fibrinogen and time on dialysis prior to transplantation were positive independent predictors of IMT. These data show that hypofibrinolysis may contribute to the arterial remodelling in kidney transplant recipients. Dialysis therapy before transplantation makes detrimental changes in arterial vasculature. 4P-1185
Nutritional assessment in haemodialysed patients
L. Lõcsey 1 , B. Borbás 1 , I. Ménes 1 , B. Szlanka 1 , M. Kisgáti 2 , A. Dán 2 . 1 EuroCare, Debrecen; 2 Kenézy Hospital, Debrecen, Hungary Malnutrition, inflammation and atherosclerosis-MIA syndrome frequently occur together in chronic haemodialysis patients. The aim of our study is to make a comparative investigation cardiovascular risks and malnourished assessment in chronic haemodialysed 65 females (63.4±8.2 years) and 46 male (61.3±7.8 years) by using different methods. Subjective global assessment (SGA) measured moderate malnutrition in 56.01% in females, and in 59.37% of male, severe malnutrition (SGA-C) was in 20.01 vs. 9.38% of pts. With adequate dialysis treatment the serum transferrin levels were <1.8 g/l in 63.72% of women, in 61.76% of men. The haematocrit was <0.31 in 6.89% females and 14.7% male. Prealbumin concentrations were lower <199 mg/l in 18.97% females, in 29.11% male. The hypalbuminaemia <38.01 g/l were in 15.52% females, in 29.41% male. Total cholesterol levels decreased <4.8 mmol/l in 37.93 females, 58.82% male. The HDL-cholesterol concentrations were lower <1.4 mmol/l in 77.9% females and 41.18% male. Hypertriglyceridaemia can be found in 41.38% vs. 41.20% of pts. The LDL/HDL ratio was >3.5 in 73.81 vs. 43.79% of patients. C–reactive protein (CRP) concentrations were higher >8.5 mg/l in 39.66% females, in 50.01% male. The lymphocytes counts were smaller <18% in 29.31% vs 41.18% of women/men. The multifrequency bioimpedance analysis (inBody3-BIOSPACE) present good correlation with decreased praealbumin, albumin, transferrin levels, increased CRP and TBW. The higher homocysteine levels (>25 µmol/l) were in cerebro, and cardiovascular complications. Low praealbumin, HDL cholesterol, high LDL, hypertriglyceridaemia, increased CRP concentration, high TBW, LBW, (p<0.01) associated after insufficient and inadequate nourishment in malnutrition with SGA–B and C condition and with low PCR (<0.70) and Kt/V (<1.1). 4P-1186
Effects of immunosuppressive therapy on blood lipid profile after renal transplantation
M. Kanbay, A. Yildirir, H. Muderrisoglu, T. Colak, H. Karakayali, M. Haberal. Baskent University, Turkey Introduction: Hyperlipidemia is an important metabolic disorder that is commonly encountered among renal transplant recipients. This study was conducted to investigate the possible effects of transplantation and immunosuppressive drugs on the lipid profile of these patients. Methods: The records of 169 patients, who had undergone renal transplantation between the years of 1996-1999, were retrospectively investigated. The lipid profile of these patients including total cholesterol (T-C), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglyceride(TG) levels before and at least 6 months after the procedure were noted. The demographics of the patients, etiology of the end-stage renal failure along with their immunosuppressive drugs were also taken into consideration. Results: The study group included 69 (38.5%) women and 100 (61.5%) men with a mean age of 35.7±11.8 years (range 11-62). All patients had used steroids whereas 64.5% had used azathioprine and 35.5% had used tacrolimus and mycothelote mofetil. After immunosuppressive treatment the laboratory analysis yielded significantly increased levels of T-C, LDL and TG levels and
XIIIth International Symposium on Atherosclerosis, September 28–October 2, 2003, Kyoto, Japan
THURSDAY
4P-1184
335