L. Lőcsey

Decreased paraoxonase 1 (PON1) lactonase activity in hemodialyzed and renal transplanted patients. A novel cardiovascular biomarker in end-stage renal disease

BACKGROUND Human paraoxonase-1 (PON1) has also been described as a lactonase. Decreased PON1 lactonase activity was found to be a predictor of cardiovascular disease. Homocysteine thiolactonase activity may prevent proteins from homocysteinylation and is thought to be a protective factor against the progression of atherosclerosis. Previous studies have demonstrated decreased PON1 paraoxonase activity in hemodialyzed (HD) and renal transplant (TRX) patients; however, lactonase activity has not been investigated. We aimed to determine the paraoxonase and lactonase activities and to clarify the relationship between lactonase activity and a set of cardiovascular risk factors, such as homocysteine, cystatin C and asymmetric dimethylarginine (ADMA) levels, in HD and TRX patients and in healthy controls. METHODS One hundred and eight HD and 78 TRX patients and 63 healthy controls were involved in the study. Paraoxonase and lactonase activities (paraoxon and gamma-thiobutyrolactone as substrates) were measured spectrophotometrically. ADMA level was determined with sandwich enzyme-linked immunosorbent assay. RESULTS Both HD and TRX patients had significantly lower lactonase activities compared to the control group (P<0.05). Significantly lower paraoxonase activities were found in HD patients compared to the TRX group (P<0.05). Significant negative correlation was found between lactonase activity and ADMA level in the whole study population (P<0.001), while paraoxonase and lactonase activities showed significant positive correlation (P<0.001). Multiple regression analysis identified paraoxonase activity and homocysteine level as independent predictors of lactonase activity. CONCLUSION Lactonase activity is a potential new predictor of cardiovascular risk in renal failure. Measurement of lactonase activity is recommended in future studies on HD and TRX patients.

Effect of Nutritional Status on Human Paraoxonase-1 Activity in Patients with Chronic Kidney Disease

Background/Methods: The association between nutritional status, antioxidant human paraoxonase-1 (PON1) activity and low grade inflammation in hemodialized (HD) patients with chronic kidney disease (CKD) is unclear. The aim of this study was to determine PON1 paraoxonase and lactonase activities, ADMA, adiponectin and leptin concentrations, and to clarify the relationship between paraoxonase activity and a set of cardiovascular risk factors in malnourished, normal weight and obese HD patients; 114 HD patients with end-stage renal failure were enrolled. Results: Leptin levels were significantly higher and PON1 paraoxonase activities were significantly lower in obese patients compared to the other groups. Plasma adiponectin concentration was significantly lower in obese subjects compared to malnourished patients. Paraoxonase activity was negatively correlated with CRP level in HD and malnourished patients. Furthermore, we found significant inverse correlation between paraoxonase activity and BMI in the whole patient group. In multiple regression analysis, PON1 lactonase activity, CRP level and leptin concentration proved to be independent predictors of paraoxonase activity. Conclusion: Despite the previous findings of reverse epidemiology for the mortality rate of HD patients, further studies are needed to clarify the effects of nutritional state on atherosclerosis in obese and malnourished patients with end-stage renal failure.

Insertion/deletion polymorphism of the angiotensin-converting enzyme predicts left ventricular hypertrophy after renal transplantation.

BACKGROUND Kidney transplant recipients show a higher risk for cardiovascular complications, such as left ventricular hypertrophy and heart failure, leading to the premature death in many cases. METHODS We investigated the contribution of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism to the development of left ventricular hypertrophy (LVH), an indicator of heart disease progression among kidney transplant recipients. RESULTS We observed a significant correlation between graft function and left ventricular mass index. The occurrence of LVH or severe LVH was significantly greater among patients with at least one D-allele (ID or DD). CONCLUSION The use of ACE inhibitors or angiotensin receptor blockers seemed to be advantageous for patients with the ID and especially, the DD genotype.

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

Absztrakt Bevezetes: A Debreceni Egyetemen 1991-ben vegeztek el az első veseatultetest. Hazank 2013-ban csatlakozott az Eurotransplanthoz. Celkitűzes: A szerzők elemeztek a tapasztalatokat. Modszer: 2008. januar 1. es 2013. augusztus 31. kozott (A csoport = 163) es 2013. szeptember 1. es 2015. oktober 22. kozott vegzett cadavervese-atultetesek (B csoport = 90) adatait elemeztek. Eredmenyek: Az elődonorok aranya 3,5%-rol 9,1%-ra nőtt. 2013 ota a recipiensek 25%-a 60 evesnel idősebb, a >30 kg/m2 testtomegindex aranya 31%-ra, a diabetesesek aranya ketszeresere emelkedett. Az ureteroneocystostomia mellett bevezetesre kerult a veg az oldalhoz ureteroureteralis anastomosis. Indukcios kezeles mellett az akut rejectios epizod jelentősen csokkent (34%-rol 8%-ra). A technikai szovődmenyek aranya nem valtozott. A bakterialis fertőzesek aranya csokkent (41%-rol 33%-ra). Az 1, 3 es 5 eves veseallograft-tulelesek 86,6%, 85% es 82,7%, valamint 88%, 84% es 84% voltak a ket csoportban. Kovetkeztetesek: Az extended criteri...

Three-Year Longitudinal Clinical Trial of Arterial Function Assessed by a Oscillometric Non-Invasive Method in Comparison With Carotid Sclerosis and Transferrin Kidney-Transplanted Patients

Chronic kidney disease remains one of the main risk factors of cardiovascular disease. However, patients with kidney transplantation have better life expectancy and better quality of life compared with patients on dialysis. In patients with a well-functioning graft, the main cause of death is cardiovascular in origin. Metabolic pathways have complex effects on arterial function that can be monitored by conventional ultrasonography and with the assessment of arterial stiffness by oscillometric non-invasive technique. Forty-one primer cadaver kidney-transplanted patient were involved in a 3-year longitudinal clinical trial (21 female, 20 male; average age, 40.16 ± 12.56 years). Arterial stiffness parameters referring to rigidity of the arterial wall (pulse wave velocity [PWV], augmentation index, and pulse pressure) were investigated. Correlation between stiffness, and laboratory parameters (serum creatinine, urea, hemoglobin, albumin, cholesterine, triglycerides, transferrin, uric acid, glomerular filtration rate, and C-reactive protein) were analyzed. A non-invasive oscillometric method--Tensiomed Arteriograph--was applied to assess the arterial stiffness parameters. Statistical analysis was performed with the use of Statistica for Windows, version 8.0. A value of P < .05 was considered statistically significant for all statistical tests. We found a positive correlation between PWV and left ventricular wall thickness and a negative correlation between PWV and ejection fraction. We also found a positive significant correlation between serum level of transferrin and PWV. There was simultaneous significant progression concerning PWV and carotid artery sclerosis in a 3-year follow-up. There was no fatal cardiovascular event during the study period among our patients. All of our patients involved in this study are still alive. Our findings suggest that arterial stiffness monitoring is a reliable method to assess global cardiovascular risk among kidney-transplanted patients. The oscillometric method is convenient, fast, painless technique to monitor arterial function, which, in the case of pathological findings, proposes more frequent cardiovascular control.

Prospective study of changes in arterial stiffness among kidney-transplanted patients.

BACKGROUND Chronic kidney disease is one of the main risk factors for cardiovascular disease. Changes in stiffness parameters can predict the higher risk of the development of cardiovascular disease. METHODS Cadaveric donor kidney transplant patients (n=184) were followed in a cross-sectional single-center study. Arterial stiffness parameters were measured by arteriography. We analyzed the correlation between stiffness parameters and immunosuppressive therapy, the main operation parameters, patient age, elapsed time since transplantation, carotid artery stenosis, and septual wall thickness. We enrolled 24 patients in a 3-year longitudinal study to analyze changes in stiffness parameters. RESULTS Our cross-sectional study showed pulse wave velocity (PWV) to be significantly related to the age of the patient (P=.0001; r=0.41). There was no significant correlation between the stiffness parameters and type or dosage of immunosuppressive drugs and number of transplantations. We noted significant correlations between pulse pressure (PP) and pulse wave velocity (PWV), and augmentation index (AI) (P=.01). Patients with abnormal PWV (>12 m/s) showed significantly higher systolic blood pressures, body mass indexes, PP, and AI (P<.01). Our 3-year longitudinal study revealed a significant elevation in PWV. CONCLUSIONS Improving endothelial function and prevention of atherosclerosis may help to reduce cardiovascular complications. Among chronic kidney disease patients, early transplantation is a possible way to prevent cardiovascular events. It is better to perform the transplantation at as early an age as possible.

Az angiotenzinkonvertálóenzim-gén I/D polimorfizmusának hatása a vesetranszplantált betegek cardiovascularis rizikójára és a grafttúlélésre

Absztrakt Bevezetes: A vegstadiumu vesebetegsegben szenvedők kezeleseben a veseatultetes hosszabb tulelest biztosit, mint a vesepotlo kezelesek egyeb formai. A recipiens varhato tuleleset leginkabb a magasabb sziv-er rendszeri eredetű halalozas befolyasolja. A transzplantalt vese karosodasanak leggyakoribb oka az idult allograft-nephropathia. Celkitűzes: A szerzők a recipiens es a beultetett vese hosszu tavu tulelesevel egyertelmű osszefuggest mutato biomarkerek azonositasat tűztek ki celul. Modszer: A retrospektiv vizsgalatba 72 beteget vontak be. Meghataroztak az angiotenzinkonvertaloenzim-gen I/D polimorfizmusat, az enzim aktivitasat, a vesefunkciot, valamint a sziv morfologiai jellemzőit. Eredmenyek: Az angiotenzinkonvertaloenzim-gen DD genotipusa egyarant osszefuggest mutatott az idult allograft-nephropathia es a sulyos foku bal kamrai hypertrophia előfordulasaval. A vesefunkcio es a szivizom-hypertrophia merteke kozott szoros osszefuggest talaltak. Kovetkeztetesek: Eredmenyeik szerint az angiotenzin...

A vesetranszplantáció pozitív hatásai a betegek angiológiai státuszára. Az artériás funkció (stiffness) noninvazív mérésének lehetséges szerepe az előrejelzésben

Absztrakt Bevezetes: A cardiovascularis betegsegek kialakulasa szempontjabol a kronikus veseelegtelenseg a legfőbb kockazati tenyezők egyike. Annak ellenere, hogy a kronikus dializiskezelessel szemben a vesetranszplantalt betegek eletkilatasai es eletminősege jelentősen jobb, a jo graftműkodes mellett bekovetkezett halalozas leggyakrabban cardiovascularis eredetű. A komplex reszfolyamatok erelmeszesedesre gyakorolt hatasa tetten erhető a megszokott diagnosztikus eszkozokkel, es noninvazivan merhető az arterias stiffness (erfali merevseg) vizsgalataval. Celkitűzes: Arterias funkcios parameterek valtozasanak noninvaziv klinikai vizsgalata kozvetlenul a vesetranszplantaciot kovetően. Modszer: Prospektiv, koveteses vizsgalatban 17 (8 nő, 9 ferfi; eletkor: 46,16 ± 12,19 ev) cadavervese-transzplantacion atesett beteg noninvaziv modon rogzitett arterias funkcios parametereit, laboreredmenyeit, klinikai allapotat vizsgaltak a perioperativ időszakban, abbol a celbol, hogy eszlelhető-e mar a műtet utan kozvetlenul ...INTRODUCTION Development of atherosclerosis is accelerated in kidney transplant patients. Impaired metabolic pathways have complex effect on the arterial wall which can be measured by non-invasive techniques. Only few data are available on the change of stiffness parameters in the postoperative course. Therefore, in this study the authors analysed the stiffness parameters of kidney transplant recipients during the perioperative period. AIM Non-invasive clinical trial of the arterial functional parameters in the early postoperative period. METHOD Seventeen successful primary kidney transplant patients with uneventful postoperative period (8 females, 9 males; age, 46.16 ± 12.19 years) were involved in this short-term prospective longitudinal study. The authors analysed correlations between non-in vasively assessed stiffness parameters (pulse wave velocity PWV, augmentation index - AIx). Stiffness parameters were measured with a TensioMed Arteriograph. These parameters were assessed before the transplantation, as well as 24 hours, 1 and 2 weeks after surgery under standard conditions. RESULTS It was found that PWV (p = 0.0075) and AIx (p = 0.013) improved significantly. There was no significant change in case of PP and the other monitored parameters. Serum creatinine decreased (p = 0.0008) and glomerular filtration rate increased significantly (p = 0.0005). CONCLUSIONS Along with the available data in the literature, the findings suggest that kidney transplantation has a positive effect on the arterial function. Improvement can be detected non-invasively with Arteriograph in the early postoperative period.INRODUCTION The efficiency of healing is determined by the ability of the patients to comprehend and to apply properly the information provided by the doctors. This ability is influenced by age, intelligence and social background, but above all by health literacy. AIM The aim of the present study was to translate and adapt the Hungarian version of the Short-Test of Functional Health Literacy, which is a performance based measure and the perception-based Chew screening questions for health literacy in Hungary. METHOD The sample consisted of 302 people, and it was closely representative for the Hungarian population. RESULTS The reliability of the reading part of the Short-Test of Functional Health Literacy was excellent, and it was also acceptable regarding the Chew screening questions, but it showed low internal consistency concerning the numeracy part of the Short-Test of Functional Health Literacy. Based on the Short-Test of Functional Health Literacy reading scores, participants were categorized into three groups: 8% had inadequate, 6% marginal and 86% adequate health literacy levels. Regarding participants without a chronic illness tended to possess higher health literacy levels based on all the three measurments. CONCLUSIONS The availability of these measures of health literacy in Hungary can play a crucial role in doctor-patient communication as well as health promotion, that can contribute to develop health literacy policies leading to reduced health care costs in the future.

[Favourable effects of kidney transplantation on vascular condition of patients: Potential prognostic significance of non-invasive measurement of arterial stiffness].

Absztrakt Bevezetes: A cardiovascularis betegsegek kialakulasa szempontjabol a kronikus veseelegtelenseg a legfőbb kockazati tenyezők egyike. Annak ellenere, hogy a kronikus dializiskezelessel szemben a vesetranszplantalt betegek eletkilatasai es eletminősege jelentősen jobb, a jo graftműkodes mellett bekovetkezett halalozas leggyakrabban cardiovascularis eredetű. A komplex reszfolyamatok erelmeszesedesre gyakorolt hatasa tetten erhető a megszokott diagnosztikus eszkozokkel, es noninvazivan merhető az arterias stiffness (erfali merevseg) vizsgalataval. Celkitűzes: Arterias funkcios parameterek valtozasanak noninvaziv klinikai vizsgalata kozvetlenul a vesetranszplantaciot kovetően. Modszer: Prospektiv, koveteses vizsgalatban 17 (8 nő, 9 ferfi; eletkor: 46,16 ± 12,19 ev) cadavervese-transzplantacion atesett beteg noninvaziv modon rogzitett arterias funkcios parametereit, laboreredmenyeit, klinikai allapotat vizsgaltak a perioperativ időszakban, abbol a celbol, hogy eszlelhető-e mar a műtet utan kozvetlenul ...INTRODUCTION Development of atherosclerosis is accelerated in kidney transplant patients. Impaired metabolic pathways have complex effect on the arterial wall which can be measured by non-invasive techniques. Only few data are available on the change of stiffness parameters in the postoperative course. Therefore, in this study the authors analysed the stiffness parameters of kidney transplant recipients during the perioperative period. AIM Non-invasive clinical trial of the arterial functional parameters in the early postoperative period. METHOD Seventeen successful primary kidney transplant patients with uneventful postoperative period (8 females, 9 males; age, 46.16 ± 12.19 years) were involved in this short-term prospective longitudinal study. The authors analysed correlations between non-in vasively assessed stiffness parameters (pulse wave velocity PWV, augmentation index - AIx). Stiffness parameters were measured with a TensioMed Arteriograph. These parameters were assessed before the transplantation, as well as 24 hours, 1 and 2 weeks after surgery under standard conditions. RESULTS It was found that PWV (p = 0.0075) and AIx (p = 0.013) improved significantly. There was no significant change in case of PP and the other monitored parameters. Serum creatinine decreased (p = 0.0008) and glomerular filtration rate increased significantly (p = 0.0005). CONCLUSIONS Along with the available data in the literature, the findings suggest that kidney transplantation has a positive effect on the arterial function. Improvement can be detected non-invasively with Arteriograph in the early postoperative period.INRODUCTION The efficiency of healing is determined by the ability of the patients to comprehend and to apply properly the information provided by the doctors. This ability is influenced by age, intelligence and social background, but above all by health literacy. AIM The aim of the present study was to translate and adapt the Hungarian version of the Short-Test of Functional Health Literacy, which is a performance based measure and the perception-based Chew screening questions for health literacy in Hungary. METHOD The sample consisted of 302 people, and it was closely representative for the Hungarian population. RESULTS The reliability of the reading part of the Short-Test of Functional Health Literacy was excellent, and it was also acceptable regarding the Chew screening questions, but it showed low internal consistency concerning the numeracy part of the Short-Test of Functional Health Literacy. Based on the Short-Test of Functional Health Literacy reading scores, participants were categorized into three groups: 8% had inadequate, 6% marginal and 86% adequate health literacy levels. Regarding participants without a chronic illness tended to possess higher health literacy levels based on all the three measurments. CONCLUSIONS The availability of these measures of health literacy in Hungary can play a crucial role in doctor-patient communication as well as health promotion, that can contribute to develop health literacy policies leading to reduced health care costs in the future.