No abstract

BackgroundUremia is a vasculopathic process, and both cardiac calcification and vascular calcification seen from the early stages of chronic kidney disease. Osteoprotegerin could play a crucial role in atherosclerotic plaque formation, maturation and calcification. The goal of this study was to determine the relationship of serum osteoprotegerin with vascular calcification in patients with end stage kidney disease who were maintained on regular hemodialysis.MethodsSixty clinically stable chronic renal failure patients undergoing regular hemodialysis were enrolled in this cross sectional study. Thirty patients (mean age 56.7 ± 10.5 years) with abdominal aortic calcification were selected by basal abdominal X-ray who underwent multi-slice computerized tomography scan to measure coronary artery calcification score; and thirty patients (mean age 56.5 ± 8.4 years) without abdominal aortic calcification. All patients were evaluated by serum calcium, phosphorus, albumin, lipid profile, intact parathyroid hormone (iPTH), serum creatinine, serum urea, serum uric acid, serum C-reactive protein, and hemoglobin. Serum osteoprotegerin samples were collected before dialysis and estimated by the ELISA kit.ResultsSerum osteoprotegerin level was significantly higher in patients with vascular calcification than in those without calcifications. Serum osteoprotegerin correlated positively with serum phosphorus, calcium phosphorus product, alkaline phosphatase, iPTH, C-reactive protein, serum uric acid, low-density lipoprotein (LDL) and left ventricular mass index (LVMI) (p < 0.005), and negatively with hemoglobin, ejection fraction (p < 0.005) and HDL (p < 0.05).ConclusionsThese findings suggest that osteoprotegerin may be involved in the development of vascular calcification in hemodialysis patients.

Introduction: 4 to 8% of patients with type 1 diabetes mellitus (DM) will develop end-stage kidney failure (ESKF) over 20-30 years from diagnosis. Pancreas-kidney transplantation (SPK) remains the definitive treatment for type 1 DM patients with ESKF, and is the most common form of solid-organ pancreas transplantation (SOPT) worldwide. SOPT rates have increased over the past decade in most major transplant centres worldwide alongside an increased number of patients on the waiting list. We recently reviewed current Australian pancreas transplant clinical guidelines to ensure ongoing utilitarian and equitable use of donor organs concluding that the evidence base surrounding donor and recipient eligibility criteria needs updating. Differences, for example exist in allocation cutoffs for donor age and/or body mass index (BMI) in national allocation policies across different jurisdictions. We therefore aimed to examine the variation in donor and recipient factors included in allocation protocols worldwide to establish a platform to generate further research. Methods: We developed a survey using Microsoft Excel and Qualtrics covering donor and recipient variables and cutoffs for eligibility for donor pancreas acceptance at time of offer, and for recipient entry into the SOPT waiting list. Questions included recipient/donor age, BMI, specific recipient endocrinology, nephrology, cardiac or vascular criteria for SPK transplantation, social and external factors as well as any criteria governing use of marginal donor pancreata. Surveys were emailed to 97 solid organ pancreas transplant units in 22 countries worldwide. An email reminder was sent approximately one month later if no results were received before then. Results were grouped by country with individual unit results being de-identified. Results: 13 units have responded thus far comprising Australia and New Zealand (2), Canada (1), Eurotransplant (4), Israel (1), Italy (1) and the United Kingdom (4). The greatest variation was in recipient age eligibility for transplant workup (median of 55 years (50-65)) and donor age eligibility for organ acceptance (median of 55 years (45-60)). These differ from Australian guidelines which accept recipients aged below 50 and donors aged below 45. Less variation was seen in recipient and donor BMI eligibility (median 32 (30-35) and median 32 (30-35) respectively). Of the responding units, only Italy had similar recipient age criteria to Australia. Germany and Canada had similar donor age criteria to Australia with the majority having higher recipient and donor age cutoffs. Variation was also seen in social factors with only half of responding units stating alcohol excess and smoking comprised an absolute contraindication to being waitlisted. Median accepted cold ischaemic time was 12 hours (10-18). Only units in the United Kingdom provided an external source for their unit protocol (national guidelines). Conclusions: This survey confirms the considerable variation between SOPT units worldwide with regards to donor/recipient eligib...

No abstract

No abstract