Search

Background: High aldosterone level may contribute to pathogenesis of hypertension, vessels damage and cardiovascular system deterioration in chronic kidney disease patients. Besides its classical action via mineralocorticoid receptor, aldosterone is also involved in cell growth, inflammation, oxidative stress, endothelial dysfunction and exerts fibroproliferative effects. The aim of the study was to assess whether aldosterone antagonist treatment may influence serum level of inflammatory, fibrosis, thrombosis and mineral-bone metabolism markers in peritoneal dialysis (PD) patients and blood pressure, aortic stiffness, echocardiographic indices after 12 months of treatment., Methods: Twenty-two patients on PD were assigned to spironolactone treatment in dose of 50 mg daily during 12 months. Fifteen PD patients were assigned to control group. Echocardiographic indices, PVW, SBP, DBP (mean values from ABPM) and biochemical parameters such as: aldosterone, osteopontin, IL-6, selectin-P, TGF-β, PTH, MMP-2 were performed at the beginning and after 12 months in spironolactone and control group., Results: There were no statistically significant differences in echocardiographic indices, PWV, BP (ABPM readings) and biochemical markers: MMP-2, serum aldosterone, TGF-β, IL-6, selectin-P, PTH level after 12 months of spironolactone treatment. There was statistically significant rise in osteopontin level after 12 months of spironolactone treatment. Episodes of life-threatening hyperkalemia were not reported., Conclusions: Aldosterone antagonists use in PD patients seems to be safe. Longer duration or higher dosage of spironolactone seems to be more effective in improving cardiovascular system status in PD patients. Further studies are required to determine relationship between mineralocorticoid receptor blockade and mineral-bone disturbances in PD patients.

The majority of hemodialyzed patients suffer from sleep disturbances. In the present study the prevalence of sleep apnea syndrome in hemodialyzed patients with end-stage renal disease (ESRD-patients) was investigated by the survey, Epworth Sleepiness Scale (ESS), and polysomnography (PSG). Sixty-one patients: 24 women and 37 men were involved in the study. All subjects participated in the first part of the study consisting of the survey and ESS. The second and third parts consisted of nighttime PSG, performed the night after hemodialysis (17 patients) and between hemodialyses (11 patients). Eleven out of the 61 patients had the symptoms of sleep apnea and heavy daily sleepiness. Eleven subjects were involved in the double PSG study: after and between hemodialyses. Obstructive sleep apnea was found in 7 of those patients during both nights analyzed. Our results confirm the occurrence of sleep disorders in ESRD-patients. Hemodialysis does not change the prevalence of obstructive sleep apnea in chronic renal disease.

Shift work is an important source of health disturbances. Night work has a negative influence on some spheres: biological, working, social, and medical. Disturbances of sleeping, one group of manifestations of medical problems, can be considered as a cause of health deterioration. This study focuses on the occurrence of breathing disturbances during sleep in shift workers. Twenty one shift worked police officers (40-60 years old) were compared with an age-matched control group operating in the some environment. All subjects underwent overnight polysomnography. The polysomnographic investigation by shift workers was conducted after a day shift and normal night sleep, after an adaptational night in the sleep laboratory. Obstructive sleep apnea was found in 8 shift workers (38%) with AHI of 5.72-45.45 and in 8 control volunteers (38% of the studied group) with AHI of 5.00-25.24. All breathing parameters, as measured by polysomnography, did not differ between the two groups. Our results do not confirm the hypothesis that chronic irregular work hours promote the occurrence of obstructive sleep apnea in subjects aged 40-60 years.

Several studies of sleep-breathing physiology have suggested that sleep deprivation may worsen obstructive sleep apnea. The aim of the study was to determine the direct effect of night work on breathing variables during sleep in fast-rotating shift workers. Twenty one men - police officers, fast-rotating shift workers, underwent polysomnography on 2 occasions: under a normal sleeping condition after day work and after sleep deprivations after night work. Both sleep studies were conducted within 2 to 3 weeks of each other. Approximately half of the group was tested under control conditions (day work) first, with the remaining subjects tested under sleep deprivation conditions (night work) first. After a night shift the subjects did not show a significantly different apnea-hypopnea-index (AHI). However, night work significantly increased several breathing variables recorded during sleep after it: total duration of obstructive apneas (OA) during REM sleep, mean duration of OA during arousal, total duration of OA during NREM sleep, apnea index during arousal, mean length of OA during sleep period time, total duration of OA during sleep period time, mean length of OA during total sleep time, mean length of hypopnea during REM sleep, total duration of hypopnea during sleep period time and during total sleep time, maximal length of central apnea and OA, and total sleep time. Night work does not favor obstructive sleep apnea episodes during sleep, but worsens many an obstructive sleep apnea variable, as measured by polysomnography.

The clinical case described below forces us to ask two basic questions: whether the patient is suffering from two separate, co-existing illnesses, i.e. primary nephritic syndrome or the nephritic syndrome in connection with Schoenlein-Henoch disease, with accompanies the HIV infection, or nephropathy, development of which has been triggered by HIV infection.