title: Metabolic and hormonal assessment of patients on maintenance hemodialysis for 10 years or more and their importance in long-term survival.
abstract: We studied metabolic and hormonal patterns in 11 patients on hemodialysis for over 10 years (group A) to determine whether some metabolic abnormalities worsen with long-term dialysis or whether a particular endocrine-metabolic pattern discriminates long-term hemodialysis survivors. Data were compared to those of 14 subjects of similar age and sex on dialysis for 1-3 years (group B) and to those measured in the same patients during the 1st year of dialytic treatment. As to glucose metabolism, group A showed elevation of fasting plasma glucose and a decrease of glucose constant decay (K) and insulin production (IIG) values as compared to the 1st year of dialysis. No difference was found between group A now and group B. However in the 1st year of dialysis group A showed significantly higher K values than group B. As regards lipid metabolism, group A presented higher alpha-lipoprotein values and high-density lipoprotein-cholesterol/cholesterol, high-density lipoprotein-cholesterol/apoprotein A, and apoprotein A/apoprotein B ratios, while low-density lipoprotein-cholesterol and apoprotein B values and beta/alpha-lipoprotein ratio were lower. These data demonstrate less vascular risk in group A. We explain these results as depending on natural selection. Multivariate analysis of survival confirmed that survival in hemodialysis patients is influenced negatively by glucose and lipid metabolism abnormalities. As to Ca-P metabolism, group A showed higher carboxy-terminal parathyroid hormone and alkaline phosphatase values than group B. However, these data may be superimposed to those determined in the same patients in 1981, when we began the regular use of 1 alpha,25-(OH)2-vitamin D3.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Servizio Emodialisi, Ospedale di Palmanova, USL No. 8, Bassa Friulana, Regione Friuli-Venezia Giulia, Italia.
authors.forename: V
authors.initials: V
authors.lastname: Allegra
authors.forename: F
authors.initials: F
authors.lastname: Amendolagine
authors.forename: G
authors.initials: G
authors.lastname: Mengozzi
authors.forename: L
authors.initials: L
authors.lastname: Jesu
authors.forename: A
authors.initials: A
authors.lastname: Vasile
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014511:Uremia / Q000401:mortality / Q000628:therapy
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008055:Lipids; D010281:Parathyroid Hormone; D010710:Phosphates; D002116:Calcitonin; D002118:Calcium