This study aims to compare serum C-reactive protein (CRP), interleukin (IL-6), and tumor necrosis factor (TNF)-alpha in end-stage renal disease (ESRD) patients before versus after receiving renal transplantation (RT) and versus donors. Serum samples from 37 ESRD patients (24 male, age 34+/-13 years) were collected before and after RT; in addition, samples from 31 donors were obtained at transplantation. CRP concentrations were measured using nephelometry, and TNF-alpha and IL-6 were measured by enzyme-linked immunoadsorbent assay. Ninety-two percent of recipients had a living donor, 73% received cyclosporine A, 27% tacrolimus, and 70% induction with daclizumab. Thirteen percent had acute rejection and 16% chronic allograft nephropathy. All inflammation markers decreased 6 months after RT, but only CRP was below baseline values (baseline: 5.0+/-3.5; 6 months: 3.0+/-0; 12 months: 3.2+/-0.7; 18 months: 3.2+/-0.6; donors: 3.6+/-1.5 mg/L; P<0.05), whereas median TNF-alpha (baseline: 0.1 [0.03-0.2]; 6 months: 0 [0-0.1]; 12 months: 0.3 [0.1-2.6]; 18 months: 0.6 [0.1-1.9]; donors: 0 [0-0.1] pg/mL; P<0.05) and IL-6 (baseline: 1.9 [1.2-7.1]; 6 months: 1.2 [0.6-28.3]; 12 months: 2.6 [1.3-3.4]; 18 months: 2.7 [1.7-4.2]; donors: 1.1 [0.6-1.9] pg/mL; P<0.05) significantly increased up to the end of follow-up. Before RT, CRP correlated with age (r 0.45, P=0.006) and albumin (r -0.36, P=0.04). TNF-alpha and IL-6 were correlated before (r 0.34, P=0.04) and after (r 0.55, P=0.02) RT. Inflammation markers were not different in patients who had acute rejection episodes or chronic nephropathy. Compared with controls, patients displayed an inflammatory phenomenon before receiving RT. Serum CRP decreased significantly after RT, whereas TNFalpha and IL-6 increased.

To evaluate patient and technique survival, and to analyze mortality risk factors in a large Mexican single-center continuous ambulatory peritoneal dialysis (CAPD) program. Cohort study. Tertiary care, teaching hospital located in Mexico City. All patients from our CAPD program (1985 – 1997) were retrospectively studied. Clinical and biochemical variables at the start of dialysis were recorded and considered in the analysis of risk factors. End points were patient (alive, dead, or lost to follow-up) and technique status at the end of the study (December 1997). 627 patients, 37% with diabetes mellitus (DM), were included. Median patient survival (± SE) was 5.1 ± 0.6 years. In the univariate analysis, the following variables were associated (p < 0.05) with mortality: DM, old age, hypoalbuminemia, low serum creatinine, low serum phosphate, and lymphopenia. In the multivariate analysis, the only significant mortality risk factors were DM (RR 2.56, p < 0.0001), old age (RR 1.01, p = 0.01), hypoalbuminemia (RR 0.77, p = 0.04), and lymphopenia (RR 0.98, p = 0.05). Median technique survival was 4.0 ± 0.2 years. Peritonitis, hypoalbuminemia, lymphopenia, old age, and DM were all significantly associated (p < 0.05) with technique failure in the univariate analysis, while in the multivariate analysis, only DM (RR 1.78, p = 0.001), peritonitis (RR 1.13, p = 0.004), lymphopenia (0.98, p = 0.04), and hypoalbuminemia (RR 0.80, p = 0.06) were technique failure predictors. Patient survival in our setting is similar to that reported in other series. Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD. Our 12-year CAPD program is one of the largest single-centers reported in CAPD literature.

♦ Objective: To compare dietary intake of micronutrients by peritoneal dialysis (PD) patients according to their nutrition and inflammatory statuses.

No study has compared the bone histopathologic findings in renal transplant patients receiving cyclosporine A (CsA) monotherapy with those in patients receiving a non-CsA regimen. The aim of this study was to compare bone densitometry and histomorphometry findings in patients receiving CsA monotherapy versus those receiving azathioprine + prednisolone dual therapy. A bone biopsy and densitometry were performed in 13 patients receiving CsA monotherapy and 12 patients receiving azathioprine + prednisolone, who had been on these regimens since the time of transplantation. Fourteen men and 11 women, age 51+/-12 years, with 140+/-75 months since transplantation, were included. A low bone mineral density (BMD) was observed in patients on both immunosuppressive schemes-most notably at the distal radius and less significantly at the lumbar spine. No significant differences in BMD were observed between immunosuppressive groups. Histopathologic analysis of the group as a whole revealed mixed uremic bone disease in 42%, adynamic bone in 29%, hyperparathyroid disease in 17%, and normal bone in 12%. Patients showed a slight increase in osteoclast number and function, decreased osteoblast number and function, and retardation of dynamic parameters. No differences in histopathologic diagnosis or histomorphometric findings were observed between the immunosuppressive therapy groups. In addition to the immunosuppressive drugs, male gender and old age negatively affected bone mass. Both prednisolone and CsA were associated with slight osteoclast stimulation and osteoblast suppression and marked retardation of mineral apposition and bone formation rates. Both drugs were also associated with reduced BMD at the axial and appendicular skeleton, even though a nonsignificant trend to a better-preserved lumbar spine BMD was observed in the CsA group.