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  • Author: Căldăraru Carmen Denise x
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Open access

Carmen Denise Caldararu, Dorin Tarta, Raluca Pop, Mirela Gliga, Emilian Carasca and Grigore Dogaru

Abstract

Obesity and chronic kidney disease are epidemic size. Chronic kidney disease (CKD) appears to be more common in obese, although interrelation is not supported by all authors.

Aim: The aim of the study was to investigate the effects of overweight and obesity on glomerular filtration rate (GFR) and the relationship between body mass index (BMI) and other risk factors for CKD.

Methods: This is a cross-sectional study on 627 patients admitted in a Nephrology Department between January 2007 - December 2011. Patients were divided according to eGFR in a CKD group and a non-CKD group. Patients were divided based on BMI in: normal (<25 kg/m2), overweight (≥ 25 kg/m2 and ≤30 kg/m2) and obese (>30 kg/m2). Demographical, clinical and laboratory data (serum creatinine, lipid parameters, etc) were used for the statistical analysis. The relationship between BMI (as a marker of obesity and overweight), glomerular filtration rate and other possible risk factors for chronic kidney disease was studied.

Results: 43.70% patients were obese and 33.17% overweight. CKD prevalence was 58.69%. Logistic regression analysis showed that systolic blood pressure was the main determinant of CKD in our patients.

Conclusion: Lack of association between BMI and CKD was demonstrated in our study.

Open access

I.D. Tarța, Carmen Denise Căldăraru, Mirela Gliga, Adina Huțanu, Z. Bajko, E. Carașca and G.A. Dogaru

Abstract

Introduction: Chronic inflammation has a proven role in atherogenesis, lipid profile parameters being related to cytokine production. In kidney transplant recipients, interleukin 6 (IL-6) is significantly associated with graft-related outcomes and also alterations of cholesterol and triglyceride metabolism. The aim of this study was to investigate the relationship between chronic inflammation and glucidic-lipidic metabolism disorders in a group of patients with kidney transplantation as renal replacement therapy. Methods: A prospective observational study which enrolled thirtysix non-diabetic kidney transplant recipients was conducted in the Nephrology and Peritoneal Dialysis Department, County Clinic Hospital of Tirgu Mures. The study group was divided as following: recipients with serum IL-6 concentration higher than 3.8 pg/ml (group A) and IL-6 within the normal range (group B). Results: Allograft recipients with higher serum IL-6 had significant higher erytrocyte sedimentation rate(ESR, p=0.0067). Patients with over-the-range levels of IL-6 had significant higher levels of serum cholesterol and LDL-cholesterol respectively (p=0.0242 and p=0.0081). Serum Apo-B was also significant higher in Group A than Group B. Protein excretion was significant higher in patients from group A (p=0.0013). No statistical significant relationship could be proven between elevated levels of IL-6 and hbA1c, insulin and glycosuria disturbances in the two groups. Also, we found no statistical significant association between resistivity and pulsatility indices (both hilum and intragraft) or carotid intima media thickness. Conclusion: Serum interleukin 6 is related to lipid profile disorders and less to glucidic metabolism anomalies in non-diabetic kidney transplant recipients.

Open access

DI Tarta, Căldăraru Carmen Denise, Tarta Cristina, A Frigy, E Caraşca, Carlan Otilia and AG Dogaru

Abstract

How reliable is office assessed blood pressure (BP) in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, although the diagnosis of arterial hypertension has been based on these measurements. The aim of this study was to investigate the potential differences between office assessed BP and ambulatory blood pressure monitoring (ABPM) in CKD patients and KTx recipients. We conducted a prospective study which enrolled 45 patients. Morning and evening seated office BPs were assessed using a sphygmomanometer at 5 consecutive outpatient visits. A mean systolic BP (SBP) and diastolic BP (DBP) was calculated. Ambulatory blood pressure was measured over 24 hours using a Meditech ABPM-05 device. Office SBP was statistically significant higher in CKD patients than KTx recipients both in the morning and evening (p=0.0433 and p=0.0066 respectively). ABPM showed higher night-time SBPs (p=0.0445) and higher overall, day-time and night-time DBPs in KTX recipients (p=0.0001, p=0.0006, p<0.0001 respectively). In CKD patients, office SBPs and DBPs are significantly higher than overall SBPs and DBPs as assessed by 24hr ABPM. Office BP monitoring as assessed by clinician is acceptable but tends to overestimate BP in both CKD and KTx study groups.

Open access

Stoica Ciprian Mihai, Căldăraru Carmen Denise, Vari Camil Eugen, Tarţa Dorin Ionuţ, Dogaru Maria Titica, Caraşca Emilian and Dogaru Grigore Aloiziu

Abstract

Background: Therapeutic drug monitoring (TDM) in patients with Chronic Kidney Disease (CKD) with kidney transplant, represents a major post transplant concern due to the characteristics of this special category of patients, particularities which can generate changes of the pharmacokinetic profile of the administered medication.

Material and methods: The current study is a retrospective pharmacokinetic study, over a period of 50 months, including a group of 36 kidney transplanted patients with CKD. Tacrolimus blood concentration was determined by a validated high-performance liquid chromatography method (HPLC), at a 12 hour time interval from the last administration of the immunosuppressive medication and before the following dose (Residual concentration, Cmin(trough)).

Results: During the monitoring of therapy, based on the pharmacokinetic criteria, 252 measurements of blood concentration were determined, 58 of these being outside the therapeutic window.

Conclusions: The results obtained show that it is mandatory to continue to monitor closely medical therapy based on the pharmacokinetic criteria in view of improving drug administration. The other ways of monitoring therapy: the clinical and biochemical criteria should not be overlooked. In addition, the interindividual variability of patients should be considered, as well as drug interaction which can alter the pharmacokinetics of tacrolimus.

Open access

Carmen Denise Căldăraru, Dorin Ionuţ Tarta, Mirela Liana Gliga, Cristina Tarta, Emilian Caraşca, Sorin Albu, Adina Huţanu, Maria Dogaru and Grigore Dogaru

Abstract

Introduction: Hepcidin is a regulatory protein in iron metabolism; we do not know the role in chronic kidney disease anemia. Methods: 22 patients with CKD anemia and 15 patients with CKD without anemia were investigated. CKD anemia-inclusion criteria: over 18 years, hemoglobin ≤12 g/dl for women and ≤13 g/dl for men, no treatment for anemia 6 months before enrollment, glomerular filtration rate (eGFR) <60 ml/min/1.73m2 and stable creatinine three months before enrollment. Exclusion criteria: infection, bleeding, malignancy, systemic or liver disease, immunosuppression, renal replacement therapy. CKD without anemia-inclusion criteria: over 18 years, no anemia or treatment for anemia, CKD with stable creatinine values three months before enrollment. Exclusion criteria: medical conditions known to have a role in the development of polycythemia. Hepcidin-25 and ferritin were measured by ELISA method. Erythropoietin (EPO), tumor necrosis factor (TNF)-α, interleukin (IL)-6 were evaluated using chemiluminescent enzyme immunometric assays. Unpaired T test, Pearson correlation and multiple regression were used for statistical analysis. Results: Hemoglobin values were significantly lower in anemia group. There were no differences in terms of eGFR, age, body mass index, serum hepcidin, erythropoietin, fibrinogen, IL-6, and TNF-α between CKD patients with and without anemia. Serum hepcidin correlated positively with ferritin (r=0.45 p<0.05), TNF-α (r=0.54, p<0.05) and negatively with erythropoietin (r=-0.51, p<0.05). Multiple linear regression analysis demonstrated that TNF-α is an independent predictor of serum hepcidin in our patients (p=0.003, R=0.71). Conclusion: We found no differences in serum hepcidin, erythropoietin and inflammatory markers in non-dialysis CKD patients with and without anemia.