Hormonal changes in hemodialysis

Relationship of age and psychosocial factors with biological ratings in patients with end-stage renal disease undergoing dialysis

BACKGROUND AND AIMS

Dialysis is a time-consuming procedure and may cause psychological distress. The aim of the present study was to investigate the relationship between age, emotional state, life satisfaction, sexual functioning and the method of dialysis in patients suffering from end-stage renal failure.

METHODS

Eighty-two patients of 97 with end-stage chronic renal failure entered the study; 56 were under hemodialysis (HD), and 26 were under continuous ambulatory peritoneal dialysis (CAPD). Zung Depression Rating Scale (ZDRS), the Life Satisfaction Inventory (LSI), the Lasry Sexual Functioning Scale (LSFS), and a protocol aiming to register sociodemographic variables and variables considering the physical disorders were used.

RESULTS

No significant differences between groups were found in the ZDRS (HD patients: 40.7 +/- 8.2, CAPD patients: 41.88 +/- 10.44; p = 0.57), LSI scores (HD patients: 87.9 +/- 14.7, CAPD patients: 87.03 +/- 5.25; p = 0.7) and LSFS scores. Multiple linear regression analysis showed that LSI scores depended only on gender (females were less satisfied) and individual items on level of albumins and the presence of other physical disorders; ZDRS individual items depended on leukomatine level, gender, diabetes mellitus, albumins, age, creatinine and duration of disease; sexual functioning on age, and urea and sleep on albumin level (all with p < 0.001).

DISCUSSION

No statistically significant differences were detected in depressive symptomatology, sexual function and life satisfaction between patients undergoing HD or CAPD. Some aspects of depressive symptomatology, sexual functioning and life satisfaction may be influenced by age, the kind of treatment and its effectiveness. Age was positively related with satisfaction from general quality of life, frequency of sexual activity, tiredness and feelings of usefulness.

Effect of dialysis modalities on gastric myoelectrical activity in end-stage renal disease patients

Gastric motility is controlled by gastric myoelectrical activity, which propagates from the proximal body to the distal antrum at a frequency of 3 cycles/min. In uremic patients, dyspeptic symptoms are common. To investigate whether dialysis modality affects gastric myoelectrical activity in uremic patients, we performed electrogastrography (EGG) in 41 patients without diabetes with end-stage renal disease (ESRD) undergoing hemodialysis (HD; n = 22) and continuous ambulatory peritoneal dialysis (CAPD; n = 19). EGG was performed noninvasively using abdominal surface electrodes in the fasting state before and 4 hours after HD and at empty and 2 hours after CAPD with 2,000 mL of dialysate. There were no significant differences in age, sex, body weight, duration of dialysis, and percentage of patients with upper gastrointestinal (UGI) symptoms (63.6% versus 42.1%). CAPD patients had significantly lower serum albumin levels (3.4 +/- 0.4 versus 3.9 +/- 0.4 g/dL; P < 0.05), greater serum total-cholesterol levels (189 +/- 33 versus 157 +/- 36 mg/dL; P: < 0.05), and greater percentages of patient with early satiety (42.1% versus 13.6%; P < 0.05) than HD patients. Dominant power significantly increased after HD (251.3 +/- 157.5 versus 512.9 +/- 390.0 dB; P < 0.05) but seemed to decrease after CAPD without statistical significance (416.2 +/- 323.6 versus 283.8 +/- 280.7 dB). There was no difference in the normal slow-wave frequency (NSWF) between HD and CAPD patients (predialysis, 60.7% +/- 29.3% versus 52.2% +/- 36.7%; postdialysis, 56.3% +/- 32.0% versus 50.9% +/- 34.2%). Tachygastria significantly increased after CAPD (pre-CAPD, 2.35% +/- 4.3% versus post-CAPD, 10.0% +/- 14.8%; P < 0.05). There was a significant correlation between changes in tachygastria after CAPD and grade of early satiety in CAPD patients with UGI symptoms (r = 0.74; P: < 0.05). Changes in NSWF after CAPD significantly correlated with age (r = -0.51; P: < 0.05). In conclusion, dialysis modalities seem to have different effects on gastric myoelectrical activity in patients with ESRD.

Gastric dysrhythmia in uremic patients on maintenance hemodialysis

BACKGROUND

Dyspeptic symptoms are common in uremic patients receiving hemodialysis. Investigators have placed emphasis on the changes in histopathology and physiology of the gastrointestinal tract. But not much data about the gastric myoelectric activity are available. The aim of this study was to assess gastric myoelectric activity in uremic patients undergoing hemodialysis.

METHODS

Fifty-eight subjects were enrolled. They were assigned to: group I, uremic patients undergoing hemodialysis with dyspeptic complaints (n = 20); group II, non-uremic patients with matched dyspeptic complaints (n = 20); and group III, healthy volunteers without dyspeptic complaints (n = 18). Gastric myoelectric activity was measured with abdominal surface electrodes in each person. Patients in group I were measured twice, before (group Ia) and after (group Ib) hemodialysis. The data were compared between the groups.

RESULTS

In the prehemodialysis period there was a significantly lower percentage of normal slow-wave frequency when compared with group III (fasting, 66.54%+/-5.39% versus 84.58%+/-3.63%; P < 0.005; fed, 72.25%+/-4.16% versus 89.06%+/-2.57%; P < 0.01). In the post-hemodialysis period the difference was even more profound (fasting, 46.52%+/-4.26% versus 84.58%+/-3.63%; P < 0.001; fed, 51.49%+/-6.89% versus 89.06%+/-2.57%; P < 0.005). Yet, when compared with group II, a significant difference existed only in the post-hemodialysis period (fasting, 46.52%+/-4.26% versus 67.30%+/-3.46%; P<0.001; fed, 51.49%+/-6.89% versus 70.41%+/-4.39%; P < 0.01). Another finding is that hemodialysis decreased the gastric myoelectric activity after hemodialysis (fasting, 66.54%+/-5.39% versus 46.52%+/-4.26%; P < 0.001; fed, 72.25%+/-4.16% versus 51.49%+/-6.89%; P < 0.005).

CONCLUSIONS

Uremic patients undergoing hemodialysis have impaired gastric myoelectric activity. Interestingly, hemodialysis seems to cause deterioration in gastric myoelectric activity.

Thyroid function and plasma selenium in chronic uremic patients on hemodialysis treatment

It has been shown recently that Selenium (Se), an essential trace element for humans, is involved in the regulation of thyroid function, since the enzyme that catalyzes the liver conversion of the thyroid hormone T4 to the more active form T3 is a selenoenzyme. In chronic uremic patients, low blood Se levels as well as thyroid function abnormalities are often found. The present study was carried out to verify whether any correlation exists between Se levels and thyroid function, and to evaluate possible changes in hormonal pattern during Se supplementation in 10 chronic uremic patients on hemodialysis (HD) treatment. Se was supplemented orally as sodium selenite over six consecutive months. Basic plasma Se levels were significantly lower in patients than in normal controls. Right from the start of Se supplementation, plasma Se concentration promptly normalized and leveled off in the normal range throughout the study. Significant increase of FT3 and reduction of TSH levels were detected during Se supplementation. In Se-supplemented patients, a significant direct correlation was also found between reverse T3 (rT3) and TSH, and a significant inverse correlation was found between Se and TSH. Our results suggest that Se deficiency in chronic uremic patients represents a factor influencing the thyroid function and that the Se status should be determined in the evaluation of thyroid metabolism in these patients.

Function of endocrine organs in hemodialyzed patients of long-term erythropoietin therapy

Endocrine abnormalities in patients with chronic renal failure are well documented. The present study aimed to assess the influence of long-term erythropoietin (EPO) therapy on endocrine abnormalities in hemodialyzed patients. Two groups of hemodialyzed patients, each of which comprised 17 subjects, were examined. The first group was treated by EPO (EPO group) while the second one did not receive this hormone (No-EPO group). A complete biochemical and hormonal check-up was performed before and at the 3, 6, 9, and 12 month points of the study period. Normal values for the estimated parameters were obtained in appropriately selected sex- and age-matched healthy subjects. After EPO therapy, an increase of the hematocrit value from 21.8 +/- 0.9 to 32.6 +/- 0.9% was observed, which was accompanied by a significant decline of plasma ferritin and saturation of transferrin. In patients of the No-EPO group, a significant although less marked rise of the hematocrit value (21.4 +/- 0.4 to 24.2 +/- 0.6%) was also noticed. EPO therapy did not change plasma levels of electrolytes (Na, K, Ca, inorganic phosphate), osteocalcin, creatinine, glucose, and alkaline phosphatase as well as plasma concentrations of calcium-related hormones (PTH, calcitonin, 1,25[OH]2D3), vasopressin, and triiodothyronine. EPO treatment induced a significant decrease in somatotropin, prolactin, follitropin, lutropin, ACTH, cortisol, plasma renin activity, aldosterone, noradrenaline, adrenaline, dopamine, glucagon, pancreatic polypeptide, and gastrin plasma levels and an increase in plasma insulin, estradiol, testosterone, atrial natriuretic peptide, thyrotropin, and thyroxine.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum beta-endorphin in non-dialysed and haemodialysed patients with chronic renal failure

Endogenous opioid peptides play an important role in the pathogenesis of uraemic syndrome. The effect of insulin-induced hypoglycaemia on serum beta-endorphin (BE) concentration was studied in 27 uraemic patients and in 14 healthy subjects. Despite elevated basal BE level, that correlated positively with serum creatinine, uraemic patients showed a normal BE secretory pattern. No differences were found between uraemic patients on conservative and those on haemodialysis treatment. The influence of haemodialysis treatment on BE secretion requires further investigations.