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Objective: Ventricular repolarization (VR) markers may predict ventricular arrhythmias and cardiac arrest. The aim of this study was to investigate the acute effects of a hemodialysis (HD) session and HD adequacy on VR markers in HD patients., Methods: This cross-sectional study was conducted at 2 university hospitals with 83 patients and VR markers were measured before and after an HD session: QT, QTc, QT minimum, QT maximum, dispersion of QT (QTd), T-peak to T-end (Tp-e) interval, and Tp-e/QT. Kt/V measurements calculated using the second generation Daugirdas formula were used to indicate dialysis adequacy. The patients were divided into 2 groups according to the Kt/V value. Group 1 patients had a Kt/V of ≤1.6 with a standard dialysis dose, and Group 2 comprised those with a measurement of >1.6 with a high dialysis dose., Results: There were 36 patients in Group 1 and 47 patients in Group 2. There were statistically significantly more female patients in Group 2 (p=0.016). After an HD session, heart rate increased, blood pressure decreased, and the QT, QTc, QT maximum, QTd, Tp-e interval, and Tp-e/QT were prolonged (p<0.05). The VR markers measured were similar in the 2 groups. VR markers were not significantly different in diabetic patients., Conclusion: HD may be a risk factor for cardiac arrest because of prolonged VR parameters, independent of HD adequacy. A high dialysis dose may not always be best for the heart.

Metformin is a biguanide group oral antidiabetic drug used for the treatment of type 2 diabetes mellitus. Nausea, vomiting, diarrhea, abdominal pain, and anorexia are the most common adverse effects encountered during treatment. Lactic acidosis is a serious side effect seen with metformin use, and while the incidence of lactic acidosis is similar to other oral antidiabetics, metformin is not recommended to patients with certain risk factors, such as cardiovascular, pulmonary, and renal and liver failure. We describe a chronic hemodialysis patient treated with metformin, presenting to the nephrology department with altered mental status., (© 2013 International Society for Hemodialysis.)

Arteriosclerosis is characterized by stiffening of arteries. The incremental elastic modulus (Einc) measurement is a good marker of arterial wall stiffness. Metabolic, inflammatory and hemodynamic alterations cause structural changes and vascular complications in end stage renal disease. The aim of the present study was to evaluate the factors that may affect the development of arteriosclerosis by measurement of Einc in hemodialysis (HD) patients. Thirty-two patients (16 men; 16 female) on chronic HD with a mean age of 42.2 +/- 19.3 (range: 15-80) were included in the study. The carotid Einc was measured to determine arteriosclerosis by high-resolution echo-tracking system (Acuson Aspen, Acuson Corp., Mountain View, California, USA). Einc measurement was calculated from transcutaneous measurements of common carotid arterial (CCA) internal diameter and wall thickness and carotid pulse pressure. Common carotid compliance and distensibility were determined from changes in carotid artery diameter during systole and simultaneously measured carotid pulse pressure. Common carotid artery stuffiness (Einc) was influenced by age, systolic blood pressure (SBP), pulse pressure (PP), calcium (Ca) and alkaline phosphatase (ALP). The distensibility of CCA was correlated with age, SBP, diastolic blood pressure (DBP), PP, Ca, ALP, and parathormone (PTH). The inflammatory parameter, hs-CRP, was increased with Einc. The mean Einc measurement was found significantly increased in patient receiving vitamin D. In conclusion, the stiffening of carotid artery in HD patients is related not only to hemodynamic changes (increased SBP, PP) but also to metabolic (increased Ca) and to inflammation (increased hs-CRP). Carotid Einc is accepted independent risk factor for cardiovascular mortality. Because of the positive correlation between Einc and serum Ca, vitamin D and Ca containing phosphorus (P) binders should be used carefully.

Tumor necrosis factor alpha (TNF-alpha) levels were measured by immunoradiometric assay in chronically hemodialyzed patients consisting of 9 males and 3 females aged between 14 and 60 years. TNF-alpha levels were 5.47-15.1 pg/ml (mean 9.76 +/- 6.63) before hemodialysis (HD), and 5.75-58.55 pg/ml (mean 22.15 +/- 15.14) after HD. According to these results TNF-alpha levels in chronically hemodialyzed patients were within normal limits, but after 4 h of HD, higher levels of TNF-alpha were found.