BACKGROUND: Renal changes may have long-term sequalae and prevention is a main goal of management of primary vesicoureteral reflux (VUR). AIM: This study aims to reveal how much 99mTc-DMSA scintigraphy findings are reflected in the adopted surgical or non-surgical treatment in children with diagnosed primary VUR and to give the clinicians information regarding their final therapeutic decision. PATIENTS AND METHODS: A total 207 children with primary VUR who underwent non-acute 99mTc-DMSA scan were retrospectively evaluated. The presence of renal changes, their grading, differential function asymmetry (<45%) and grade of VUR were compared with subsequent choice of therapy. RESULTS: Altogether 92 (44%) children had asymmetric differential function, 122 (59%) showed presence of renal changes, 79 (38%) had high-grade VUR (IV-V). Patients with renal changes had lower differential function (41%vs.48%) and higher grade of VUR. The incidence of high-grade changes (G3+G4B) afflicting more than one third of the kidney was significantly different between grade I-II, III and IV-V VUR (9%, 27%, 48%, respectively). Renal changes were detected in 76% of surgically and 48% of non-surgically treated patients, high-grade 99mTc-DMSA changes in 69% and 31%, respectively. In children with no scars/dysplasia (G0+G4A), non-surgical treatment prevailed in 77%. The independent predictors for surgical intervention were presence of renal changes and higher grade of VUR, but not functional asymmetry. DISCUSSION: Over the last 20 years, there has been a shift toward more non-surgical management of VUR. The long-term outcome of this approach should be thoroughly studied. This is the first study analysing renal status in VUR patients using 99mTc-DMSA scan and its grading regarding the adopted treatment. Renal changes in almost half of non-surgically treated children with VUR should be an indicator for earlier diagnosis and effective treatment of acute pyelonephritis and VUR. We recommend distinguishing grade III VUR, as a moderate-grade VUR, because it is linked to higher incidence of high-grade 99mTc-DMSA changes (G3+G4B); our findings of 65% of grade III VURs treated non-surgically should be cautionary. Grade III VUR does not mean a low-risk condition and should alert the clinician to evaluate the extent of renal changes and unmask high-risk cases. CONCLUSIONS: Our data strengthens the need to investigate the extent of renal changes in VUR patients regarding treatment decision. Performing 99mTc-DMSA scan individualizes the treatment of VUR patients; its grading can distinguish grade III-VUR as a separate risk entity because it differs significantly in terms of incidence of high-grade renal changes and chosen therapy.

• MeSH
• Child MeSH
• Urinary Tract Infections * diagnostic imaging   MeSH
• Infant MeSH
• Kidney diagnostic imaging   MeSH
• Humans MeSH
• Radiopharmaceuticals MeSH
• Radionuclide Imaging MeSH
• Retrospective Studies MeSH
• Technetium Tc 99m Dimercaptosuccinic Acid MeSH
• Vesico-Ureteral Reflux * diagnostic imaging   therapy   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Introduction: Symmetrical and Asymmetric dimethyl-L-arginine were previously discovered in urine, the present study explored the link between acute kidney injury (AKI) and modulation in the level of these biomarkers.Methods: Ninety volunteers were recruited in the current study, sixty of them were dialysis-dependent AKI patients, their ages ranged between 29-70 years, 13 were diabetic and 47 were non-diabetics patients. Thirty healthy subjects were recruited as a control group. Blood urea, serum creatinine, uric acid, glucose, lipid profile, albumin, hemoglobin, levels were measured using an automated analyzer (SK3002b). Asymmetric dimethyl-L-arginine (ADMA) and symmetric dimethyl-L-arginine (SDMA) serum concentrations were measured using ELISA.Results: The findings of the current study demonstrated a significant decrease in hemoglobin and serum albumin levels alongside an increase in the serum creatinine, uric acid, and serum triglyceride (TG) in the patients when compared to the apparently healthy controls. Serum concentrations of ADMA and SDMA were significantly lower in healthy controls compared to the patients. Conclusion: These data confirm the assumption which assumes that both, ADMA and SDMA serum levels are sensitive markers of reduced renal function and serum SDMA is more sensitive than ADMA in dialysis-dependent AKI patients.

• MeSH
• Acute Kidney Injury * diagnosis   MeSH
• Arginine * analysis   MeSH
• Biomarkers MeSH
• Renal Dialysis MeSH
• Clinical Studies as Topic MeSH
• Humans MeSH
• Check Tag
• Humans MeSH

BACKGROUND: There is little mechanistic information on factors predisposing atrial fibrillation (AF) patients to thromboembolism or bleeding, but generation of nitric oxide (NO) might theoretically contribute to both. OBJECTIVES: The authors tested the hypothesis that plasma levels of the methylated arginine derivatives asymmetric and symmetric dimethylarginine (ADMA/SDMA), which inhibit NO generation, might be associated with outcomes in AF. METHODS: Plasma samples were obtained from 5,004 patients with AF at randomization to warfarin or apixaban in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. ADMA and SDMA concentrations were measured by high-performance liquid chromatography. Relationships to clinical characteristics were evaluated by multivariable analyses. Associations with major outcomes, during a median of 1.9 years follow-up, were evaluated by adjusted Cox proportional hazards models. RESULTS: Both ADMA and SDMA plasma concentrations at study entry increased significantly with patients' age, female sex, renal impairment, permanent AF, or congestive heart failure. ADMA and SDMA increased (p < 0.001) with both increased CHA2DS2-VASc and HAS-BLED scores, but decreased in the presence of diabetes. On multivariable analysis adjusting for established risk factors and treatment, tertile groups of ADMA concentrations were significantly associated with stroke/systemic embolism (p = 0.034), and death (p < 0.0001), whereas tertile groups of SDMA were associated with major bleeding and death (p < 0.001 for both). Incorporating ADMA and SDMA into CHA2DS2-VASc or HAS-BLED predictive models improved C-indices for those outcomes. Neither ADMA nor SDMA predicted differential responses to warfarin or apixaban. CONCLUSIONS: In anticoagulated patients with AF, elevated ADMA levels are weakly associated with thromboembolic events, elevated SDMA levels with bleeding events and both are strongly associated with increased mortality. These findings suggest that disturbances of NO function modulate both thrombotic and hemorrhagic risk in anticoagulated patients with AF. (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE]; NCT00412984).

• MeSH
• Anticoagulants therapeutic use   MeSH
• Arginine analogs & derivatives   blood   MeSH
• Biomarkers blood   MeSH
• Double-Blind Method MeSH
• Atrial Fibrillation blood   diagnosis   drug therapy   MeSH
• Factor Xa Inhibitors therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Predictive Value of Tests MeSH
• Pyrazoles therapeutic use   MeSH
• Pyridones therapeutic use   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Warfarin therapeutic use   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

Předním úkolem současné podiatrie je zvýšení povědomí o správné diagnostice i terapii syndromu diabetické nohy a o zásadách jeho prevence mezi lékaři nejrůznějších oborů. Spoluprací ošetřujících lékařů s podiatrickými ambulancemi pro diabetiky je postupně možné docílit snížení výskytu invalidizujících následků syndromu diabetické nohy – amputací. Předpokladem snížení výskytu ulcerací i jejich recidiv jsou podiatrická edukace pacientů a jejich dispenzarizace podle stupně rizika tohoto onemocnění. Včasná léčba, spojená podle potřeby i s urgentní hospitalizací, je účinná nejen u ulcerací na nohou způsobených diabetem a jeho komplikacemi, které jsou nejčastějším projevem syndromu diabetické nohy, ale i u hlubokých infekcí typu flegmóny nebo osteomyelitidy a také u postižení kostí nohy při neuropatické Charcotově osteoartropatii. Pro zkvalitnění podiatrické péče je nutné zvýšit kapacitu podiatrických ambulancí v regionech a zajistit podmínky pro jejich funkci.

The challenge of the current podiatry is to raise awareness of the correct diagnosis and therapy of diabetic foot syndrome and of its prevention among doctors of various specialties. It is possible to reduce gradually the disabling diabetic foot amputation by cooperation of physicians with foot clinics. The reduction in the incidence of ulceration and their recurrence may be provided by patient's education in foot care and by regular long‑term follow up of patients according to degree of risk. Early treatment, as necessary and urgent hospitalisation are effective in not only in the ulceration caused by diabetes and its complications, but also in cellulitis or osteomyelitis and in neuropathic Charcot osteoartrhopathy. It is necessary to increase capacity of the foot clinics in the regions and to ensure the conditions for their function for improving podiatric care.

• MeSH
• Amputation, Surgical trends   MeSH
• Diabetic Foot * complications   prevention & control   therapy   MeSH
• Diabetic Neuropathies diagnosis   complications   prevention & control   MeSH
• Diagnosis, Differential MeSH
• Diabetes Complications diagnosis   complications   prevention & control   MeSH
• Skin Diseases diagnosis   etiology   MeSH
• Humans MeSH
• Hospitals, Special organization & administration   trends   MeSH
• Arthropathy, Neurogenic diagnosis   etiology   MeSH
• Orthopedic Procedures methods   utilization   MeSH
• Podiatry * methods   organization & administration   trends   MeSH
• Preventive Medicine * methods   organization & administration   trends   MeSH
• Renal Insufficiency diagnosis   etiology   MeSH
• Statistics as Topic MeSH
• Patient Education as Topic methods   trends   MeSH
• Venous Thrombosis diagnosis   etiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Pohybová aktivita je v léčbě diabetu neprávem často podceňována a málo využívána. Jedním z důvodů, proč není v praxi často využívána, je obava z poškození, zvláště u pacientů s komplikacemi diabetu. Pohybová aktivita hraje důležitou roli v prevenci progrese periferní neuropatie a vliv má především na rozvoj svalové síly a schopností nahradit funkci poškozenou postižením nervových vláken. Prokazatelný efekt na neuropatii je zaznamenáván již po několika týdnech pravidelného cvičení, dlouhodobé programy pak prokazují bezpečnost z hlediska výskytů ulcerací při dodržování základní péči o dolní končetiny. Při přítomné autonomní neuropatii nelze předvídat reakci srdeční resp. tepové frekvence ani krevního tlaku. Vzhledem k dalším rizikům (němé ischemie apod) je vhodné provést před plánovanou preskripcí pohybové aktivity zátěžový test. Monitorování krevního tlaku, srdeční frekvence a glykemie v průběhu prvních hodin pohybové aktivity je samozřejmostí. U pacientů s autonomní neuropatií gastrointestinálního traktu může významně ovlivnit složení stravy nejen schopnost pohybové aktivity, ale může ovlivnit i vznik hypoglykemií vzhledem ke zpomalenému vstřebávání sacharidů u těchto pacientů. Dalším rizikem u pacientů s autonomní neuropatií je ortostatická hypotenze, která může být potencována antihypertenzivy při hypertenzi bílého pláště. Preskripce u pacientů s retinopatií záleží na formě a stupni retinopatie. Pouze proliferativní retinopatie může významně omezit preskripci pohybové aktivity a vždy je třeba konzultovat s očním lékařem. U pacientů s nefropatií je pro preskripci rozhodující stadium renální insuficience. Preskripce je pak ovlivněna kromě stupně renální insuficience přítomností dalších komorbidit. Pohybová aktivita je zásadní i u pacientů v dialyzačním programu resp. po transplantaci ledvin, protože zachování periferních svalů a jejích funkcí nejen, že zlepšuje prognózu, ale především zlepšuje kvalitu života a udržuje soběstačnost.

Physical activity is often underestimated and little used in the treatment of diabetes. The fear of damage, especially in patients with diabetes complications is one of the reasons why it occurs. Physical activity plays an important role in prevention of the progression of peripheral neuropathy and its impact is primarily on the development of muscle strength and the ability to replace the function of nerve fibers damaged disabilities. Demonstrable effect on neuropathy is already recorded a few weeks of regular exercise, long-term programs then demonstrate the safety of occurrence of ulcers in compliance with basic foot care. Present autonomic neuropathy cannot predict response to cardiac respectively, heart rate and blood pressure. Due to other risks (silent ischemia, arrhythmia etc.), it is appropriate to stress test before a prescription of exercise programs. Monitoring of blood pressure, heart rate and blood glucose during the first hours of physical activity is necessary. In patients with autonomic neuropathy of the gastrointestinal tract may significantly affect the composition of the diet not only the ability of physical activity, but can also affect hypoglycaemia due to a slow carbohydrate absorption in these patients. Another risk in patients with autonomic neuropathy is orthostatic hypotension, which may potentiate antihypertensive drugs in „white coat“ hypertension. Prescription of patients with retinopathy depends on the form and degree of retinopathy. Only proliferative retinopathy can significantly reduce exercise prescription, and it is always necessary to consult with ophthalmologist. In patients with nephropathy is an important stage of renal insufficiency for prescription of physical activity. Prescription is then influenced by the degree of renal insufficiency in addition to the presence of other associated diseases (anemia, hypertension, osteopathy etc.). Physical activity is essential in patients on dialysis respectively. After renal transplantation as maintaining peripheral muscle and its functions not only improves the prognosis, but also improves the quality of life and self-sufficiency is maintained.

• MeSH
• Exercise * MeSH
• Diabetic Retinopathy MeSH
• Diabetic Nephropathies MeSH
• Diabetic Neuropathies MeSH
• Renal Dialysis MeSH
• Diabetes Complications * prevention & control   MeSH
• Humans MeSH
• Resistance Training MeSH
• Motor Activity * MeSH
• Exercise Test MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Levels of the endogenous nitric oxide synthase inhibitor asymmetrical dimethylarginine (ADMA) are elevated and endothelial progenitor cells (EPCs) decreased in patients undergoing renal transplantation (Tx) and may contribute to cardiovascular complications. In this study, we tested the hypothesis that elevated ADMA and decreased EPC can be positively influenced with regular physical exercise early after Tx. Blood samples for analysis of ADMA and EPC were obtained from randomly selected 64 patients after Tx who agreed to participate in a supervised aerobic exercise program for 6 months (group I). Samples were collected before the training began, 1 month after surgery (with stabilized renal function), and at 6 months after initiation. Sixty-two age, sex, human leukocyte antigens (HLA) typing, duration of previous dialysis, history of cardiovascular disease, and immunosupression regimen-matched transplant patients who did not exercise regularly were examined as controls (group II). There were no differences in ADMA levels and EPC count between both groups before the training program began. After 6 months of exercise, ADMA concentration in the group I decreased (3.50 ± 0.45 vs. 2.11 ± 0.35 μmol/L; P < .01) and was also lower comparing with group II (2.11 ± 0.23 vs. 3.25 ± 0.35 μmol/L; P < .01). In the same period, EPC cells increased from 2.085 ± 650 cells/mL versus 3.991 ± 560 cells/mL, P < .01 in group I; but in group II, changes were nonsignificant (P = .11). Blood lipids, HbA1c, insulin, and systolic blood pressure were also affected by the training program. Elevated ADMA level and decreased EPC count were significantly influenced by early regular exercise in patients after Tx.

• MeSH
• Arginine analogs & derivatives   blood   MeSH
• Adult MeSH
• Endothelial Progenitor Cells * MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Postoperative Complications prevention & control   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Exercise Therapy * MeSH
• Kidney Transplantation * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

Z literatúry je zrejmé, že počas návalu extrémnych horúčav stúpa aj chorobnosť, aj úmrtnosť a uvedené sa týka vo významne väčšej miere diabetikov. Najčastejšou príčinou býva dehydratácia, náhla príhoda z horúčavy a celkové vyčerpanie z horúčavy. Nateraz však nie je jasné, do akej miery diabetes mellitus znižuje schopnosť znášať teplo. V našej práci prezentujeme dva prípady úmrtia na hypertermiu, ktorú nebolo možné zvládnuť bežnou antipyretickou terapiou u pacientov s diabetes mellitus 2. typu. U prvého pacienta síce bola dokázaná infekcia, bola ale patológmi posúdená iba ako spolupodieľajúca sa na úmrtí pacienta. Je veľmi pravdepodobné, že išlo aj o následok náhlej príhody z horúčavy (tzv. heat stroke), čomu zodpovedá nielen dysfunkcia CNS (porucha vedomia spôsobená edémom mozgu), ale aj porucha renálnych a hepatálnych (steatóza pečene) funkcií, teda multiorgánová dysfunkcia. U druhého pacienta žiadne jednoznačné známky akútne prebiehajúcej infekcie neboli zistené, či už počas života, alebo posmrtnou sekciou. Išlo pravdepodobne o kombináciu dvoch faktorov pri vzniku hypertermie: extrémne vysoká teplota okolitého prostredia, spojená s veľkým hematómom v teréne chronickej diabetickej neuropatie. Hematóm vznikol tiež na podklade veľkého tepla, ktoré viedlo k dehydratácii, hyponatriémii a hypoosmolalite séra pravdepodobne pri nedodržaní pitného režimu u diabetika s následnou extrémnou telesnou slabosťou a pádmi. Oba prípady nezvládnuteľnej telesnej teploty u diabetikov naznačujú, že je veľmi dôležité poučiť pacientov ako sa chovať pri extrémnych teplotách, radšej nevychádzať počas najväčšej horúčavy z domu, vyhýbať sa slnečným lúčom, venovať pozornosť dostatočnej hydratácii organizmu. Je predpoklad totiž, že pri globálnom otepľovaní zemegule budeme aj v budúcnosti častejšie vystavení podobných extrémnym teplám vonkajšieho prostredia.

It is known from literature that there is an increase in both morbidity and mortality in extreme heat and this is in significantly greater extent present in diabetic patients. Dehydration, heat stroke and heat exhaustion are usually the most common cause. It is not clear up to now, to what extent diabetes mellitus reduces the ability to tolerate heat. In our paper we present two fatal cases caused by hyperthermia in patients with the type 2 diabetes mellitus that were unmanageable by common antipyretic treatment. Although the infection was proved in the first patient, pathologist considered it only a contributing factor to death. It is very likely that it was also a consequence of the heat stroke with corresponding dysfunction of the central nervous system (impaired consciousness caused by the brain edema) and the impairment of renal and hepatic (liver steatosis) functions, thus the multiorgan dysfunction. There were no clear signs of an acute infection detected neither in life nor by autopsy in the second patient. It was probably a combination of two factors that caused hyperthermia: extreme heat in the environment accompanied by a large hematoma in concomitant chronic diabetic neuropathy. The hematoma was also caused by the extreme heat leading to the dehydration, hyponatermia and hypoosmolality of blood plasma probably due to a failure to follow drinking regimen in the diabetic patient with subsequent extreme asthenia and falls. Both case reports of unmanageable body temperature in the diabetic patients suggest that it is very important to educate patients how to cope with the extreme heat, that it is better to avoid going outside during the highest daily temperature, to avoid direct sunshine and to pay attention to an adequate hydration. It can be anticipated that in global warming we will be more frequently exposed to suchextreme heat in the environment.

• MeSH
• Diabetes Mellitus, Type 2 * MeSH
• Diabetic Neuropathies complications   MeSH
• Fatal Outcome MeSH
• Fever * etiology   complications   MeSH
• Hyponatremia MeSH
• Middle Aged MeSH
• Humans MeSH
• Multiple Organ Failure MeSH
• Emergencies MeSH
• Treatment Failure MeSH
• Heat Stress Disorders * diagnosis   etiology   therapy   MeSH
• Aged MeSH
• Body Temperature Regulation physiology   MeSH
• Hot Temperature * adverse effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

BACKGROUND/AIMS: Asymmetric dimethylarginine (ADMA) is a prognostic factor in patients with chronic kidney disease (CKD). However, the relationships among factors influencing the metabolism of ADMA and the CKD progression are not fully understood. METHODS: Serum ADMA, and variables related to the metabolism of ADMA were measured in 181 non-dialysis patients (CKD stages 3-5) and in 46 controls. Patients were assessed at baseline, and 6 and 12 months after the initiation of the study. RESULTS: Patients had increased baseline ADMA, advanced glycation end products (AGE), and advanced oxidation protein products (AOPP) compared with controls (P<0.001). In a total of 164 patients who completed a one-year study, the estimated GFR (eGFR) declined from 23.5 (17.7-36) mL/min/1.73m(2) to 21 (14.7-31.5) (P=0.018), AGE rose from 1.58 (1.38-1.90) μmol/L to 1.76 (1.52-2.21) (P<0.001), while ADMA, AOPP, tubular function, and proteinuria remained stable. In a multiple regression model (adjusted R(2) = 0.49, P<0.0001), the interaction of relatively higher baseline eGFR, i.e. > 25 mL/min/1.73m(2), with higher ADMA (P=0.02) and higher AOPP (P=0.04) predicted the severest decrease in eGFR per year. Other predictors of progression were higher baseline AGE (P<0.001), proteinuria (P=0.003), hypertension (P=0.01), and higher baseline eGFR (P=0.03). CONCLUSION: Elevated ADMA and markers of oxidative stress were strong predictors of progression in patients with eGFR between 25-40 mL/min/1.73m(2) , i.e. at the borderline of CKD stages 3-4.

• MeSH
• Arginine analogs & derivatives   blood   MeSH
• Biomarkers blood   MeSH
• Renal Insufficiency, Chronic blood   diagnosis   physiopathology   MeSH
• Glomerular Filtration Rate physiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Follow-Up Studies MeSH
• Oxidative Stress physiology   MeSH
• Glycation End Products, Advanced blood   MeSH
• Advanced Oxidation Protein Products blood   MeSH
• Prognosis MeSH
• Disease Progression * MeSH
• Prospective Studies MeSH
• Aged MeSH
• Case-Control Studies MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Úvod a cíl studie: Hladiny endogenního inhibitoru NO syntázy asymetrického dimetylargininu jsou zvýšeny u pacientů po transplantaci ledvin a mohou významně přispět k cévním komplikacím. V této studii jsme testovali hypotézu, zda pravidelné fyzické cvičení započaté po transplantaci ledviny může snížit zvýšené hladiny asymetrického dimetylargininu. Současně jsme vyšetřili vybrané cytokiny a metabolické parametry. Metody: Plazmatické vzorky pro analýzu asymetrického dimetylargininu, adiponektinu, leptinu, rozpustného receptoru pro leptin, rezistinu, visfatinu, CRP, TNFα a další vybrané parametry lipidového a sacharidového metabolizmu byly vyšetřeny v prospektivní randomizované studii u 68 pacientů po 1. kadaverózní transplantaci ledviny, kteří souhlasili s účastí v kontrolovaném aerobním cvičebním programu po dobu 6 měsíců (skupina I). Vzorky byly odebrány před zahájením cvičení v 1. měsíci po transplantaci při již stabilní funkci transplantované ledviny a kontrolní odběry za 6 měsíců od zahájení. Kontrolní skupinu tvořilo 60 transplantovaných pacientů srovnatelných dle věku, pohlaví, HLA typizace, délky předchozí dialýzy, anamnézy kardiovaskulárních onemocnění a imunosupresivního režimu, kteří nepodstoupili pravidelný cvičební režim (skupina II). Výsledky: Na začátku sledovaného údobí nebyly mezi oběma skupinami zjištěny signifikantní rozdíly v hladinách asymetrického dimetylargininu. Po 6měsíčním pravidelném cvičebním programu hladiny asymetrického dimetylargininu ve skupině I významně poklesly (z 3,5 ? 0,45 na 2,11 ? 0,35 ?mol/l, p < 0,01) a byly také signifikantně nižší ve srovnání s kontrolní skupinou II (2,11 ? 0,23 vs 3,25 ? 0,34 ?mol/l,p < 0,01). Byly zjištěny i další signifikantní změny ve skupině I v následujících sledovaných parametrech: adiponektin (z 14,6 ? 6,6 na 22,3 ? 6,2 mg/ml, p < 0,01), leptin (z 51,3 ? 11,2 na 20,3 ? ? 9,2 ng/l, p < 0,01), rozpustný/solubilní receptor pro leptin (z 24,6 ? 8,4 na 46,1 ? 11,4 U/ml, p < 0,01), rezistin (z 20,8 ? 10,1 na 14,6 ? ? 6,4 mg/ml, p < 0,025) a visfatin (z 1,8 ? 0,2 na 1,2 ? 0,01 ng/ml, p < 0,05). Současně byly ovlivněny i parametry lipidového a sacharidového metabolizmu (celkový a LDL-cholesterol, triacylglyceroly, HbA1c, hladina inzulinu), jakož i hladiny prozánětlivých cytokinů (CRP a TNFα). Závěr: Zvýšená hladina asymetrického dimetylargininu a vybrané adipocytokiny byly u pacientů po transplantaci ledviny signifikantně ovlivněny časným pravidelným pohybovým režimem. Cvičební režim může významně snížit i riziko kardiovaskulárních onemocnění po transplantaci ledviny.

Background: Levels of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine are elevated in patients undergoing kidney transplantation and may contribute to vascular complications. In this study we tested the hypothesis that elevated asymmetric dimethylarginine can be reduced in patients after kidney transplantation by early regular physical exercise. Selected cytokines and metabolic parameters were also analysed. Methods: Plasma samples for analysis of asymmetric dimethylarginine, adiponectin, leptin, soluble leptin receptor, resistin, visfatin, CRP, TNFα and selected metabolic parameters were obtained from randomly selected sixty eight patients after kidney transplantation who agreed to participate in a supervised aerobic exercise program for six months. Samples were collected before the training began (one month after surgery with stabilized graft function) and at six months after initiation. Sixty transplant patients matched for age, sex, HLA typing, duration of previous dialysis, history of cardiovascular disease and immunosupression regimen who did not exercise regularly and did not participate in the training program were examined as controls. Results: There were no differences in elevated asymmetric dimethylarginine levels between both groups before the training program began. After six months of exercise, asymmetric dimethylarginine concentration in the exercising group I significantly decreased (3.5 ? 0.45 vs 2.11 ? 0.35 ?mol/L, P < 0.01) and was also significantly lower comparing to non-exercising group II (2.11 ? 0.23 vs 3.25 ? 0.34 ?mol/L, P < 0.01). We found significant changes in exercising group I: adiponectin (15.4 ? 6.6 vs 22.3 ? 6.2 mg/mL, P < 0.01), leptin (51.3 ? 11.2 vs 20.3 ? 9.2 ng/L, P < 0.01), soluble leptin receptor (24.6 ? 8.4 vs 46.1 ? 11.4 U/mL, P < 0.01), resistin (20.8 ? 10.1 vs 14.6 ? 6.4 mg/mL, P < 0.025) and visfatin (1.8 ? 0.2 vs 1.2 ? 0.01 ng/mL, P < 0.05). Blood lipids, HbA1c, CRP and TNFα were also affected by the training program. Conclusions: Elevated asymmetric dimethylarginine level, selected adipocytokines and proinflammatory cytokines in patients after kidney transplantation were significantly influenced by early regular exercise. This regimen may decrease cardiovascular risk in patients after kidney transplantation.

• Keywords
• tělesné cvičení, ADMA, rezistin, visfatin,
• MeSH
• Adiponectin MeSH
• Arginine * analogs & derivatives   blood   metabolism   MeSH
• Biomarkers blood   metabolism   MeSH
• Endothelium, Vascular enzymology   physiopathology   MeSH
• Adult MeSH
• Cardiovascular Diseases prevention & control   MeSH
• Clinical Laboratory Techniques methods   utilization   MeSH
• Leptin MeSH
• Middle Aged MeSH
• Humans MeSH
• Metabolic Diseases blood   metabolism   MeSH
• Postoperative Period * MeSH
• Risk Factors MeSH
• Nitric Oxide Synthase * antagonists & inhibitors   MeSH
• Exercise Therapy * methods   MeSH
• Kidney Transplantation * utilization   MeSH
• Kidney Function Tests methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

Asymmetric dimethylarginine (ADMA) is a mediator of endothelial dysfunction. Production and elimination of ADMA may be affected by the type of renal replacement therapy used and oxidative stress. Plasma ADMA, advanced glycation end products (AGE), and homocysteine were assessed in 59 subjects: 20 hemodialysis (HD) patients, 19 patients undergoing peritoneal dialysis (PD), and 20 controls. Results were compared between the groups. The effect of 8 weeks of HD and high-volume predilution hemodiafiltration (HDF) was compared in a randomized study. HD patients showed higher ADMA (1.20 [0.90-1.39 micromol/L]) compared to controls (0.89 [0.77-0.98], P < 0.01), while ADMA in PD did not differ from controls (0.96 [0.88-1.28]). AGE and homocysteine were highest in HD, lower in PD (P < 0.01 vs. HD), and lowest in controls (P < 0.001 vs. HD and PD). PD patients had higher residual renal function than HD (P < 0.01). The decrease in ADMA at the end of HD (from 1.25 [0.97-1.33] to 0.66 [0.57-0.73], P < 0.001) was comparable to that of HDF. Switching from HD to HDF led to a decrease in predialysis homocysteine level in 8 weeks (P < 0.05), while ADMA and AGE did not change. Increased ADMA levels in patients undergoing HD, as compared to PD, may be caused by higher oxidative stress and lower residual renal function in HD. Other factors, such as diabetes and statin therapy, may also be at play. The decrease in ADMA at the end of HD and HDF is comparable. Switching from HD to HDF decreases in 8 weeks the predialysis levels of homocysteine without affecting ADMA.

• MeSH
• Arginine analogs & derivatives   blood   MeSH
• Renal Dialysis MeSH
• Homocysteine blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Oxidative Stress MeSH
• Peritoneal Dialysis MeSH
• Glycation End Products, Advanced blood   MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH