In hemodialysis patients, oxidative stress results from an imbalance between the production of reactive oxygen species and antioxidant defense mechanisms. Recently, a new dialysis multi-layer membrane has been developed, by modifying the inner surface of regenerated cellulose to support a vitamin E coating. The aim of our study was to investigate the effects of hemodialysis treatment with vitamin E-modified membrane on anemia and erythropoietin requirement in a group of chronic uremic patients. Ten uremic, non diabetic, patients on standard bicarbonate dialysis were treated with vitamin E-bonded dialysis membrane for 12 months. Hematological parameters, erythropoietin requirement, serum vitamin E and serum malonyldialdehyde (MDA) were evaluated before starting the study and monthly. No significant changes in hemoglobin level, RBC count, hematocrit and EPO requirement were observed. Basal vitamin E levels were in the normal range (13.0 +/- 2.88 mg/L vs. 14.79 +/- 3.12 mg/L; NS). On the contrary, basal MDA levels were higher than those observed in the control group (1.87 +/- 0.36 vs. 1.13 +/- 0.18 mmol/mL; p < 0.01) and a significant decrease of MDA levels was found after 1 month of Excebrane treatment (1.39 +/- 0.25 nmol/mL; p < 0.02). In conclusion, the role of the "oxidative hemolysis" in the pathogenesis of anemia in CHD patients is still not clearly defined, but it could be of minor clinical relevance. Although the effectiveness of vitamin E-coated membranes as a scavenger of ROS allows a better control of intradialytic oxidative stress, it doesn't seem to contribute to clinical management of anemia in these patients.

In a group of 48 chronic hemodialysis patients, serum levels of coenzyme Q10 (CoQ) have been measured and appeared abnormally low in 62% of cases. Figures were positively correlated to those of serum vitamin E (vit E), although the latter were within a normal range. The chronic hemodialysis (CHD) patients with normal serum values of CoQ exhibited higher blood triglycerides. Pathologically low levels of serum vit E were found only in uremic subjects on conservative regimen with dietary restrictions and low compliance to protein-caloric intake. The reduced CoQ levels may contribute to the defective serum antioxidant activity and the increased peroxidative damage in uremic patients on CHD.

Plasma antithrombin III (AT III) levels were measured as antigen concentration (radial immunodiffusion) and as heparin cofactor (amidolytic method) in 9 patients on continuous ambulatory peritoneal dialysis (CAPD). The loss of albumin, proteins, AT III antigen and AT III functional activity was calculated from the peritoneal dialysate and the corresponding serum levels were measured. The same determinations were performed on serum and urinary samples from 9 patients with nephrotic syndrome. Mean plasma levels of AT III antigen and AT III heparin cofactor in CAPD patients were normal, whereas nephrotic patients showed a reduction in these values within a wide range. However, the loss of AT III antigen was similar in both groups and was strictly correlated to the loss of albumin. Most AT III in the peritoneal dialysate from CAPD patients was still active, whereas in nephrotic patients only 26% of the excreted AT III was functionally active. The difference in plasma AT III was functionally active. The difference in plasma AT III levels between these two groups, in spite of the roughly similar amounts recovered in the dialysate and in the urine, might be explained by an additional AT III loss in nephrotic patients due to renal metabolism.

QUESTIONS @ POINT OF CARE an initial damage with rare microaneurysm and intraretinal hemorrhages, without edema or exudates. The echocardiogram showed normal values for the whole cardiac measurement except for the initial left ventricular hypertrophy (LVH), with a normal result of 60% for the left ventricular ejection fraction (LVEF) and without valvular abnormalities. Finally, the results of the arterial venous Doppler ultrasound examination of the neck and lower limbs and of the upper and lower limbs electromyography (EMG) were normal. The glycemic parameters were kept under control with metformin 1000 mg twice a day. The patient was a nonsmoker, not addicted to alcohol, but his overweight suggested that a prompt lifestyle change was mandatory. He started taking omega-3 (1000 mg twice a day) and a combination of ezetimibe-simvastatin 10/20 mg once a day. What do we know about diabetic nephropathy and its natural history? The incidence and prevalence of type 2 diabetes mellitus (T2DM) will continue to increase and it's widely recognized that the number of adults with diabetes worldwide will rise from 382 million in 2013 to 592 million in 2035, especially in developing countries (1). Diabetic nephropathy (DN) is one of the most frequent microvascular complications of diabetes. Whereas in the USA has been estimated that 50% of prevalent patients under dialysis are affected by diabetes (2), in Italy the prevalence of diabetic patients on dialysis has been estimated at 25.3% (3). Fortunately, only one-third of patients with T2DM experience DN (4). According to medical literature, diabetes leads to significant renal abnormalities in a period of approximately 20 years and the reduction in estimated glomerular filtration