Diseases of the peripheral nervous system are the most prevalent in patients with end-stage renal disease (ESRD). Although increased blood levels of lead in ESRD have been reported, the role of lead remains to be elucidated. The purpose of this study was to determine the connection of blood lead concentration with peripheral nerve conduction velocity. One hundred ninety-eight healthy subjects (control group) and 68 patients with ESRD undergoing hemodialysis (ESRD group) were enrolled. Nerve conduction was measured within two hours after hemodialysis. Orthodromic sensory nerve action potentials and compound muscle action potentials were recorded on the median, ulnar, and radial nerves. Hemoglobin-corrected blood lead was significantly higher in ESRD patients than in controls (9.1+/-2.8 microgram/dL vs. 5.9+/-2.3 microgram/dL, p<0.001). 32.4% of 68 ESRD patients with diabetes mellitus were significantly related to poorer motor and sensory nerve conduction velocity (p<0.001). However, blood lead was not a significant predictor of the nerve conduction velocity (p>0.05). Our result suggested that even though the blood lead levels were high in ESRD, they were not associated with the decline of peripheral nerve function. Diabetes mellitus is a primary independent risk of neuropathy in ESRD patients.
Peripheral Nervous System Diseases/blood/etiology/physiopathology ; Peripheral Nerves/physiopathology ; Neural Conduction/*physiology ; Middle Aged ; Male ; Lead/*blood/metabolism ; Kidney Failure, Chronic/*blood/complications/*physiopathology ; Humans ; Female ; Diabetic Neuropathies/blood/physiopathology ; Case-Control Studies ; Bone and Bones/metabolism ; Body Burden ; Adult

BACKGROUND: The time at which renal replacement therapy (RRT) is initiated in patients with end-stage renal disease (ESRD) has a great influence on the prognosis of the patient; however, there are currently no accurate guidelines for the initiation of RRT. Traditionally, nephrologists usually initiate RRT on the basis of the observation of the uremic symptoms and changes in the laboratory parameters, such as the serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest a weekly Kt/Vurea < 2.0 or an nPNA < 0.8 g/kg/day as objective indices for the initiation of dialysis. Thus, a KP index was formulated (weekly Kt/Vurea+2.5 X nPNA) X (1/2) using the above two clinically useful and objective indices to determine the adeguate time to initiate RRT in patients with ESRD. METHODS: Of 186 patients admitted to the renal unit of Soonchunhyang Bucheon hospital, those with ESRD and a weekly Kt/Vurea below 3.0 were selected. The patients with a weekly Kt/Vurea index between 1.0 and 2.0 were classified into one of two groups; KP index > 2.0 and KP index < 2.0. The groups were compared and analyzed in relation to their renal function, biochemical indices and the numbers of patients per group starting RRT. Further, the correlations between the KP and other indices were analyzed in all the patients. The patients were then further divided into another two groups according to their weekly Kt/Vurea and KP index: group one; between 1.5 and 2.0 and group 2; between 2.0 and 2.5. The numbers of patients per group starting RRT were compared. RESULTS: The KP index < 2.0 group showed significantly lower indices for weekly Kt/Vurea, nPNA and %LBM (%) than those of the KP index > 2.0 group, while there were no significant differences between the groups in the serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. Also, there was a statistically significant higher rate of incidence of patients starting RRT in the KP index < 2.0 group than in the KP index > 2.0 group. There was a significant correlation between the KP and other indices in all patients. When comparing the number of patients starting RRT, the weekly Kt/Vurea index demonstrated no significant differences between the 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5 groups, but the number of patients starting RRT in the 1.5 < KP index < 2.0 group was significantly higher than that in the 2.0 < KP index < 2.5 group. CONCLUSION: The KP index is considered a clinically useful index in ESRD patients for determining an appropriate time for the initiation of RRT. Also, the timing of the initiation of RRT should be fixed with regard to the various other indices and clinical features for a desirable prognosis of the patients. In addition, further studies will be required to determine accurate guidelines for an appropriate time for RRT initiation.
Adult ; Aged ; Blood Urea Nitrogen ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Humans ; Kidney/metabolism ; Kidney Failure, Chronic/epidemiology/*metabolism/physiopathology/*therapy ; Korea/epidemiology ; Male ; Middle Aged ; Nutritional Status ; *Renal Dialysis ; Serum Albumin/metabolism ; Severity of Illness Index ; Urea/blood

This study was designed to examine how such factors as hemodialysis parameters, body mass index, renin and aldosterone concentrations, sympathetic nervous activity, and parathyroid hormone concentrations are associated with the control of hypertension in hemodialysis patients. Hemodialysis patients (n=114) were grouped into four categories. Group 1 had normal BP without antihypertensive medication. Group 2 needed one antihypertensive drug, Group 3 needed combination of two or three categories of antihypertensive drugs without minoxidil. Group 4 needed more than three categories of antihypertensive drugs including minoxidil. Parathyroid hormone, beta2-microglobulin, renin and aldosterone, epinephrine, norepinephrine, and hemodialysis parameters were measured. The fractional clearance of urea as Kt/V urea was significantly lower in Group 3 and Group 4 than in Group 2 (p<0.01). Concentrations of parathyroid hormone were significantly higher in Group 4 than the other groups (p<0.01). Pre-hemodialysis norepinephrine concentrations were significantly higher in Group 4 than the other groups (p<0.05). Traditional factors associated with hypertension did not seem to be relevant to the degree of hypertension in hemodialysis patients in the present study. In conclusion, poor Kt/V urea, elevated parathyroid hormone concentrations, and elevated concentrations of plasma norepinephrine seemed to be the factors that might be associated with control of hypertension in hemodialysis patients.
Adult ; Aged ; Aldosterone/*blood ; Analysis of Variance ; Antihypertensive Agents/therapeutic use ; Blood Pressure/drug effects/*physiology ; Epinephrine/blood ; Female ; Humans ; Hypertension/blood/drug therapy/physiopathology ; Kidney Failure, Chronic/blood/physiopathology/therapy ; Male ; Middle Aged ; Norepinephrine/blood ; Parathyroid Hormone/*blood ; *Renal Dialysis ; Renin/*blood ; Sympathetic Nervous System/*physiology ; Urea/metabolism

Insulin-like growth factor (IGF)/IGF binding protein (IGFBP) abnormalities may be important in the pathogenesis of growth failure in chronic renal failure (CRF). We induced experimental CRF by 5/6 nephrectomy in Sprague Dawley rats (100 g) and observed for 2 weeks comparing with sham-operated pair-fed control rats (Sham- C). CRF rats gained 30% less height than Sham- C rats (P<0.01). Serum IGFBP profiles by Western ligand blot revealed that IGFBP4 was elevated two fold in CRF rats (P<0.01 vs. Sham-C). However, IGFBP4 mRNA levels in liver or skeletal muscle were not different in two groups. To determine if the increase of serum IGFBP4 in CRF retarded the growth of cartilage, epiphyseal chondrocytes were isolated from CRF or control rats and cultured in the presence of control or CRF rat sera. Incubation with 10% CRF serum reduced proliferations of normal chondrocytes and L6 rat skeletal muscle cells. In contrast, 10% CRF serum did not inhibit the growth of CRF chondrocytes. Rat sera from two groups were separated into two different fractions, high (>10 kDa, containing IGFBPs) and low (<10 kDa, containing free IGF) molecular weight fractions using a gel filtration column. Both fractions obtained from CRF sera decreased the growth of control chondrocytes up to 40% compared with those from control sera. We suggest that the pathogenesis of growth failure in CRF may be involved in the increase of circulating IGFBP4 as well as the unidentified small molecular weight uremic serum factors which block the growth of chondrocytes in growth plate.
Animals ; Cell Proliferation ; Cells, Cultured ; Chondrocytes/*cytology/metabolism ; Insulin-Like Growth Factor Binding Protein 4/analysis/*blood/genetics ; Kidney Failure, Chronic/*blood/metabolism/physiopathology ; Liver/chemistry ; Male ; Muscle, Skeletal/chemistry ; RNA, Messenger/analysis/metabolism ; Rats ; Rats, Sprague-Dawley ; Somatomedins/analysis/metabolism