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Nifedipine is a Ca-antagonist drug that reduces contractility of vascular smooth muscle, and is used in the treatment of arterial hypertension and of stable and vasospastic angina. Aim of this study is to evaluate long-term effect of nifedipine on distribution of body fluid compartment, assessed by BIA (Bio-Impedance Analysis), and on cardiac function, in hypertensive patients on dialysis. Two groups of hypertensive patients were compared: a) a first group of nine patients (5 Male, 4 Female; age 62.67 +/- 10.39) treated with nifedipine (30 mg/day) for one year; b) a control group of sixteen dialysis patients (9 Male, 7 Female; age 56.31 +/- 14.44), previously hypertensive, with normal blood pressure without anti-hypertensive drugs for three months or more. By BIA, extracellular water percentage (ECW%) is higher in nifedipine-treated patients (p0.001) in comparison with the control group before dialysis; no other difference is present. The intradialytical variations (before dialysis vs. the end of dialysis) of body fluid compartments are a significant decrease of total body water % (52.33 +/- 2.89 vs. 48.72 +/- 3.35, p0.001), ECW% (40.97 +/- 2.2 vs. 37.56 +/- 3.47, p0.005), Left Ventricular End-Diastolic Volume (81.1 +/- 14.6 vs. 63.4 +/- 21.66 ml/m2, p0.003), Cardiac Output (3.35 +/- 0.71 vs. 2.51 +/- 0.76 l/min/m2, p0.04) and Stroke Volume (45.76 +/- 10.21 vs. 34.34 +/- 9.98 ml/m2, p0.02) in nifedipine-treated patients. Our findings suggest that nifedipine induces intermittent and prolonged expansion of extra-cellular volume. This condition, in patients otherwise without clinical and echocardiographic signs of heart failure, can be potentially detrimental for cardiac function on long-term nifedipine treatment.

Hyperparathyroidism of hemodialysis patients is associated with osteo-dystrophy, impairment of cardiac function, of peripheral nerve conduction, of response to r-HuEPO and with decrease of lean body mass. Primary hyperparathyroidism of post-menopausal women is associated with increased fat mass (FM). The study investigated if gender varies relationship between i-PTH, and body composition, assessed by multifrequency bio-electrical impedance analysis (BIA), cardiac function, assessed by echocardiography, and anemia, in long-term hemodialysis patients. Seventy patients on long-term bicarbonate dialysis, 34 male and 36 post-menopausal female, were studied. i-PTH RIA, multifrequency BIA and Kt/V were assessed at three months intervals. i-PTH (345.88 +/- 199.58 vs. 224.26 +/- 161.62 pg/ml, p0.01) and FM% (39.13 +/- 10.42 vs. 30.95 +/- 5.88, p0.001) were both significantly higher in women vs men; BMI was not significantly different. In the total group of patients (r = 0.572, p0.001) and in women (r = 0.68, p0.001) a positive correlation was found between i-PTH and FM%, and reciprocally an inverse negative correlation with free fat mass (FFM) was observed. No significant relationship was observed in men. Decrease of blood pressure measurements and increase of left ventricular Ejection Fraction, in the comparison of beginning and end of three dialysis sessions, were significantly greater in women. Reduced FFM of women on dialysis could have also some relationship with a more close long-term adherence to dietary protein restriction. Hyperparathyroidism in chronic renal failure patients could share liability of bone structural abnormalities, cardiac function impairment, excitable tissue disease, and anemia. However, malnutrition, and its consequent relative decrease of lean mass, resulting from kidney disease and, possibly, from nutritional behavioral modifications, could be responsible of the multi-organ involvement of hyperparathyroidism in end-stage renal disease.

Circulatory adaptation to hemodialysis (HD) depends on several inter-related factors, due to the particular patient and to technical procedures. The cardiac effects of nutritional status and the improvement that erythropoietin (r-HuEPO) treatment, through the reduction of anemia, can determine, were reported; r-HuEPO requirements are quite different, in different patients, while achieving similar haemoglobin end-point. Thirty-four patients on r-HuEPO and 11 patients not treated, all in hemodialysis, were studied by echocardiography at beginning and at the end of 3 consecutive dialysis sessions. Ejection fraction increased with hemodialysis in all patients of the control group. A slight and not significant decrease of ejection fraction was observed, as average, in the r-HuEPO treated patients. But, more in detail, 20 patients on r-HuEPO showed a worsening of systolic function with hemodialysis; in the other 14 patients on r-HuEPO, as in not treated control patients, systolic function improved. A significant difference between the two sub-groups on r-HuEPO was the higher drug dose requirement, associated with a slightly lower haemoglobin concentration, both observed in patients with decreased ejection fraction after hemodialysis. Moreover, a close relationship between higher r-HuEPO requirements and worsening of systolic function was observed. This trend is not associated with adequacy of dialysis and malnutrition. Patients with higher r-HuEPO requirement share a worse cardiac adaptation to hemodialysis and slightly lower haemoglobin levels.

116 patients (53 women and 63 men) with congestive heart failure, secondary to chronic ischemic heart disease and/or hypertensive heart disease, were studied with the aim of assessing effects of moderate alcohol use on the clinical features of the disease. Two subgroups were considered: a) 57 moderate drinkers (11 women and 46 men); b) 59 non-drinkers or ex-drinkers (42 women, 17 men). Left ventricular mass/m2 (LVM/m2) is higher among moderate drinkers in comparison with non-drinkers (p0.001); this difference is present both in men (p0.05) and in women (p0.001). These results suggest that higher LVM/m2 of drinkers does not depend on sex and cigarette smoking; i.e., in males, a subgroup with the same prevalence of cigarette smokers among drinkers and non drinkers, congestive heart failure of drinkers is associated with a greater left ventricular enlargement. Our results suggest that moderate alcohol use can represent an additional pathogenetic factor for more severe clinical and laboratory features of congestive heart failure.

To evaluate the effect of long-term levocarnitine supplementation on nutritional state of patients in maintenance dialysis.We studied by multifrequency-BIA (bioelectric impedance analysis) two groups of patients in maintenance bicarbonate hemodialysis for at least 4 years, comparable with respect to gender and age, and without liver disease, diabetes and malignancy. One group (25 patients) was treated with levocarnitine (1g/die) for three years or more; the control group (35 patients) never received this agent.Long-term levocarnitine supplementation was associated with higher serum levels of total protein and albumin in comparison to the control group. These effects were not associated with an increase in body fat mass and/or in total body water content, which are potentially detrimental conditions, especially considering the reported frequent association with circulatory and blood pressure alterations.Levocarnitine is able to improve the nutritional state, and this is associated with higher protein catabolism rate, i.e. with a higher protein intake, without detrimental effects on dialysis efficacy and adequacy.

Hemodialysis has a major influence on the quality of life of chronic renal failure patients. Great attention is currently paid to the development of supporting programmes for this patient group. Aim of this study was to evaluate the quality of life in maintenance dialysis and to research the influence of various factors related to treatment and ESRD on quality of life, taking into account also the level of school instruction.Reduced functional abilities, as measured by the Sickness Impact Profile (SIP), and Functional Living Test (FLT), derived by Karnofsky Activity Scale were assessed; Hospital Anxiety and Depression Scale (HAD) and semistructured interviews, including a clinical grading of symptoms were considered vs. age, duration of dialysis, level of school instruction. The study was performed with 40 hemodialysis patients, aged 57.4 +/- 14.9 years (range 22-79), treated since at least three years.Significant (P0.05) independent correlates with higher SIP scores (greater disability) and Functional Living Test were lower educational level, and the score of Hospital Anxiety and Depression Scale (HAD). No correlation was found for any of the three scales vs. age and vs. dialytic age; no gender difference was observed.A greater care in considering Quality of Life questionnaires is warranted, especially for the severe interference of instruction level of patients on results. QALY (Quality Adjusted Life Years), used as a tool for decision-making in clinical and political subsets, can include critical bias that invalidate conclusion.

Hepatic encephalopathy in liver cirrhosis is due to several factors, including amino acid imbalance and hyperammonemia. Lactitol [correction of lactilol], a non adsorbable disaccharide, improves hepatic encephalopathy increasing bowel movements, modifying colonic bacteria and pH, and reducing blood ammonium. Ten patients with liver cirrhosis and longstanding stable hepatic encephalopathy were treated, after a period of drugs wash-out, with lactitol. A significant improvement of hepatic encephalopathy was observed, with a significant decrease of blood ammonium, related with the increase of stool frequency/day. Atrial natriuretic peptide decreased as well. Moreover, an increase of the ratio of plasma aliphatic amino acids (valine, leucine and isoleucine)/aromatic amino acid (tyrosine and phenylalanine) was observed. Lactitol is an effective drug in the treatment of chronic hepatic encephalopathy; its mechanism of action involves not only a decrease of blood ammonium but also modifications of the degree of plasma amino acid imbalance, and fluid and circulatory adjustments.