IGF-I, a marker of undernutrition in hemodialysis patients

Article Abstract:

The use of hemodialysis to filter the blood keeps many patients with kidney failure alive, but the technique is not as effective as healthy kidneys, and dialysis patients suffer illness and death from related causes. It is not uncommon for these patients to become malnourished. Often the food intake of dialysis patients is inadequate, but other factors contribute as well. There seems to be a tendency towards catabolism, or metabolic breakdown of body tissues, associated with impaired kidney function. One of the difficulties in treating malnutrition is that it is not easy to recognize in its early stages. It would be beneficial if some substance in the blood could be directly measured to provide an indication of whether the patient's nutrition was inadequate. One substance which might serve such a purpose is insulin-like growth factor-I (IGF-I). In a study involving 61 patients on hemodialysis, IGF-I was correlated with skinfold thickness (a measure of fat stores) and other indicators of malnutrition. The study confirmed that measurements of total serum protein are not good indicators of malnutrition. Serum protein levels may stay within normal limits while the body is wasting away. The serum level of IGF-I seems promising, however, as a marker for malnutrition in hemodialysis patients. Reduced levels of IGF-I correlated well with reduced skinfold thickness. Furthermore, in 16 patients who had had a recent infection, the reduction in IGF-I preceded the reduction in skinfold thickness, suggesting that IGF-I gives an early warning of malnutrition. The evidence also indicates that patients on hemodialysis have a tendency towards elevated IGF-I, and that new norms may have to be established for this group. The authors suggest that 300 micrograms of IGF-I per liter of blood serum is an appropriate cutoff point, and that hemodialysis patients with lower IGF-I should be considered malnourished. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Diagnosis, Growth factors, Insulin-like growth factor 1, Insulin-like growth factor I, Malnutrition

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Plasma and red blood cell carnitine and carnitine esters during L-carnitine therapy in hemodialysis patients

Article Abstract:

Carnitine is a substance that is found primarily in muscle tissue and functions in capacities similar to amino acids and B vitamins. Carnitine can be measured in its free form in blood plasma and in red blood cells (RBC). Abnormal carnitine metabolism has been observed in patients who suffer from end-stage renal (kidney) disease, have received a kidney transplant, or are receiving hemodialysis treatments. Hemodialysis (HD) is vital to persons with advanced kidney failure because it filters wastes and toxins out of the blood. The blood passes through the dialysis machine, which performs the filtering functions of a healthy kidney, and is infused back into the patient. Twenty HD patients were treated with L-carnitine supplements in three different dosages, and the effects on plasma and RBC carnitine were measured. Before supplementation began, the subjects had abnormally low levels of carnitine in plasma and high levels in RBCs. HD lowered plasma carnitine, but did not affect RBC carnitine. The lowest dose of carnitine (1 milligram per kilogram of body weight) brought both types of carnitine back to normal; this dose is recommended for HD patients. Higher doses of carnitine (5 and 15 mg/kg) caused dramatic and persistent increases in plasma and RBC levels. This finding suggests that patients who receive supplemental carnitine be monitored for overdose. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Carnitine, Chronic kidney failure

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Elevated plasma lipoprotein(a) in patients with the nephrotic syndrome

Article Abstract:

Blood levels of lipoprotein(a) may be elevated in most patients with nephrotic syndrome. Nephrotic syndrome is a condition characterized by fluid collection, elevated levels of protein in the urine and increased susceptibility to recurrent infections. A study compared blood levels of lipoprotein(a) in 62 patients with nephrotic syndrome to those in 91 healthy individuals (control group). Forty-seven patients with nephrotic syndrome had primary kidney disease, and 15 had diabetic kidney disease. Blood levels of lipoprotein(a) were significantly higher in the nephrotic syndrome patients than in the healthy individuals. Sixty percent of the nephrotic syndrome patients had more than 30 milligrams of lipoprotein(a) per deciliter of blood, compared with 18% of the control group.

Lipoprotein A, Nephrotic syndrome

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