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Zhang H, Barralet JE. Mimicking oxygen delivery and waste removal functions of blood. Adv Drug Deliv Rev 2017; 122:84-104. [PMID: 28214553 DOI: 10.1016/j.addr.2017.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 12/20/2022]
Abstract
In addition to immunological and wound healing cell and platelet delivery, ion stasis and nutrient supply, blood delivers oxygen to cells and tissues and removes metabolic wastes. For decades researchers have been trying to develop approaches that mimic these two immediately vital functions of blood. Oxygen is crucial for the long-term survival of tissues and cells in vertebrates. Hypoxia (oxygen deficiency) and even at times anoxia (absence of oxygen) can occur during organ preservation, organ and cell transplantation, wound healing, in tumors and engineering of tissues. Different approaches have been developed to deliver oxygen to tissues and cells, including hyperbaric oxygen therapy (HBOT), normobaric hyperoxia therapy (NBOT), using biochemical reactions and electrolysis, employing liquids with high oxygen solubility, administering hemoglobin, myoglobin and red blood cells (RBCs), introducing oxygen-generating agents, using oxygen-carrying microparticles, persufflation, and peritoneal oxygenation. Metabolic waste accumulation is another issue in biological systems when blood flow is insufficient. Metabolic wastes change the microenvironment of cells and tissues, influence the metabolic activities of cells, and ultimately cause cell death. This review examines advances in blood mimicking systems in the field of biomedical engineering in terms of oxygen delivery and metabolic waste removal.
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Stockler-Pinto MB, Soulage CO, Borges NA, Cardozo LFMF, Dolenga CJ, Nakao LS, Pecoits-Filho R, Fouque D, Mafra D. From bench to the hemodialysis clinic: protein-bound uremic toxins modulate NF-κB/Nrf2 expression. Int Urol Nephrol 2017; 50:347-354. [PMID: 29151180 DOI: 10.1007/s11255-017-1748-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/11/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Uremic toxins produced by gut microbiota (indoxyl sulfate-IS, p-cresyl sulfate-p-CS, and indole-3-acetic acid-IAA) accumulate in hemodialysis (HD) patients and exhibit potent inflammatory effects. However, the impact of these toxins on nuclear E2-related factor 2 (Nrf2) and nuclear factor-kappa B (NF-κB) expression in HD patients remains poorly defined. The aim of this study was to evaluate the association between uremic toxins and Nrf2/NF-κB expression in vitro (RAW 264.7 macrophage-like cells) and in peripheral blood mononuclear cells from HD patients. METHODS Uremic toxins, C-reactive protein (CRP), interleukin-6 (IL-6) and malondialdehyde (MDA) levels were measured in fifteen HD patients and nine healthy individuals. RAW 264.7 macrophage-like cells were incubated with IS, as a prototype of protein-bound uremic toxin. Nrf2 and NF-κB expressions were analyzed by RT-qPCR. RESULTS HD patients presented high levels of inflammatory markers, MDA and uremic toxins. In addition, they presented high NF-κB and low Nrf2 expression. Uremic toxins were positively correlated with NF-κB expression (IS, ρ = 0.58, p < 0.003; p-CS, ρ = 0.71, p < 0.001; IAA, ρ = 0.62, p < 0.001) and negatively with Nrf2 (IS, ρ = - 0.48, p = 0.01; p-CS, ρ = - 0.46, p < 0.02). Uremic toxins also exhibited positive correlations with CRP and MDA levels. Multivariate analysis revealed that p-CS is a determinant factor of NF-κB expression. In RAW 264.7 culture, NF-κB mRNA expression was stimulated by IS, while Nrf2 was downregulated. CONCLUSIONS Thus, uremic toxins may stimulate NF-κB mRNA and decrease Nrf2 expression in HD patients and, consequently, trigger inflammation and oxidative stress.
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Affiliation(s)
- Milena B Stockler-Pinto
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
| | - Christophe O Soulage
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INSA Lyon, INRA U1397, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Natália A Borges
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Ludmila F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Carla J Dolenga
- Departamento de Patologia Básica, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Lia S Nakao
- Departamento de Patologia Básica, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | | | - Denis Fouque
- Department of Nephrology, Centre Hopitalier Lyon Sud, INSERM 1060, CENS, Université de Lyon, Lyon, France
| | - Denise Mafra
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
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53
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Kanemitsu Y, Asaji K, Matsumoto Y, Tsukamoto H, Saigusa D, Mukawa C, Tachikawa T, Abe T, Tomioka Y. Simultaneous quantitative analysis of uremic toxins by LC-MS/MS with a reversed-phase/cation-exchange/anion-exchange tri-modal mixed-mode column. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1068-1069:1-8. [PMID: 29024911 DOI: 10.1016/j.jchromb.2017.10.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 12/21/2022]
Abstract
Column choice is crucial to the development of liquid chromatography/tandem mass spectrometry (LC-MS/MS) methods because analyte selectivity is dependent on the nature of the stationary phase. Recently, mixed-mode chromatography, which employs a combination of two or more stationary phases and solvent systems, has emerged as an alternative to multiple, complementary, single-column systems. This report describes the development and validation of a novel analytical method based on LC-MS/MS employing a reversed-phase/cation-exchange/anion-exchange tri-modal column (Scherzo SS-C18; Imtakt) for the simultaneous quantification of various uremic toxins (UTx), including creatinine, 1-methyladenosine, trimethylamine-N-oxide, indoxyl sulfate, p-cresyl sulfate, phenyl sulfate and 4-ethylphenyl sulfate. Stable isotope-labeled compounds were prepared as internal standards (ISs) for each analyte. Mobile phase optimization and appropriate gradient conditions resulted in satisfactory retention and peak resolution that could not have been attained with a single stationary phase LC system. The essential validation parameters, including intra- and inter-assay precision and accuracy, were adequate. The validated method was applied to measure serum levels of the aforementioned compounds in 19 patients with chronic kidney disease. This is the first report detailing the simultaneous quantification of these analytes using stable isotopes as ISs. Our results suggest that Scherzo SS-C18 columns will be considered breakthrough tools in the development of analytical methods for compounds that are difficult to quantify simultaneously in traditional LC systems.
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Affiliation(s)
- Yoshitomi Kanemitsu
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Kei Asaji
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Yotaro Matsumoto
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Hiroki Tsukamoto
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Daisuke Saigusa
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Chikahisa Mukawa
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Tatsuki Tachikawa
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Takaaki Abe
- Department of Clinical Biology and Hormonal Regulation and Division of Nephrology, Endocrinology, and Vascular Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan; Department of Medical Science, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Yoshihisa Tomioka
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan.
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Deltombe O, de Loor H, Glorieux G, Dhondt A, Van Biesen W, Meijers B, Eloot S. Exploring binding characteristics and the related competition of different protein-bound uremic toxins. Biochimie 2017; 139:20-26. [DOI: 10.1016/j.biochi.2017.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
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Medium cut-off membranes - closer to the natural kidney removal function. Int J Artif Organs 2017; 40:328-334. [PMID: 28574113 PMCID: PMC6159847 DOI: 10.5301/ijao.5000603] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 01/31/2023]
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Abstract
The low water permeability feature of original cellulosic membranes was considered an advantage in the absence of dialysis equipment that are capable of controlling water removal. The advent of ultrafiltration control systems led to the development and use of high-flux (HF) membranes that allowed improved middle molecule removal including β-2 microglobulin. Further advances in technology allowed better control over the structure and permeability of membranes. Different polymers and improved spinning modalities led to significant advances in solute removal and hemocompatibility. Inner surface modification produced a reduction in membrane thrombogenicity and protein-membrane interaction with a less tendency to fouling and permeability decay. Further evolution in technology led to the development of a new class of membranes referred to as protein-leaking membranes or super-flux or high cutoff (HCO). These membranes are more permeable than conventional HF membranes and allow some passage of proteins, including albumin. The rationale for these membranes is the need for increased clearance of low molecular weight proteins and protein-bound solutes. However, albumin loss in protein-leaking HCO membranes represents a limitation whose effect in patients is still controversial. The last evolution in the field of membranes is the development of a new class defined as "high retention onset" (HRO) due to the peculiar high sieving value in the middle to high molecular weight range. The introduction of HRO membranes in the clinical routine has enabled the development of a new concept therapy called "expanded hemodialysis." Its simple set up and application offer the possibility to use it even in patients with suboptimal vascular access or even with an indwelling catheter. The system does not require particular hardware or unusual nursing skill. The quality of dialysis fluid is, however, mandatory to ensure a safe conduction of the dialysis session. This new therapy is likely to modify the outcome of end-stage kidney disease patients, thanks to the enhanced removal of molecules traditionally retained by current dialysis techniques.
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Affiliation(s)
- Claudio Ronco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
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Sandeman SR, Zheng Y, Ingavle GC, Howell CA, Mikhalovsky SV, Basnayake K, Boyd O, Davenport A, Beaton N, Davies N. A haemocompatible and scalable nanoporous adsorbent monolith synthesised using a novel lignin binder route to augment the adsorption of poorly removed uraemic toxins in haemodialysis. Biomed Mater 2017; 12:035001. [DOI: 10.1088/1748-605x/aa6546] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nagai K, Tsuchida K, Ishihara N, Minagawa N, Ichien G, Yamada S, Hirose D, Michiwaki H, Kanayama HO, Doi T, Minakuchi J. Implications of Albumin Leakage for Survival in Maintenance Hemodialysis Patients: A 7-year Observational Study. Ther Apher Dial 2017; 21:378-386. [PMID: 28452109 DOI: 10.1111/1744-9987.12526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/17/2016] [Accepted: 12/26/2016] [Indexed: 11/27/2022]
Abstract
Albumin leakage during hemodialysis (HD) presents a clinical dilemma. However, protein-binding uremic toxins are suggested to be responsible for increased mortality. No one has investigated the relationship between albumin leakage and mortality. Therefore, the purpose of this observational study was to analyze the association of albumin leakage with mortality in 690 HD patients who survived one year after enrollment. They were divided to three groups who received HD with large (3 g or more per HD session), middle (1 to 3 g) or small (less than 1 g) amount of albumin leakage, respectively. A propensity score analysis minimizing indication bias was performed. Consequently, in a 7-year observation period, 212 patients died. Albumin leakage 3 g or more per HD session provided better prognosis than albumin leakage less than 3 g per HD session. In conclusion, clinically acceptable large albumin leakage provides beneficial effects on mortality in maintenance HD patients.
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Affiliation(s)
- Kojiro Nagai
- Department of Nephrology, Tokushima University Graduate School, Tokushima, Japan
| | - Kenji Tsuchida
- Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima, Japan
| | - Noriyuki Ishihara
- Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima, Japan
| | | | | | - Satoshi Yamada
- Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima, Japan
| | - Daisuke Hirose
- Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima, Japan
| | - Hiroyuki Michiwaki
- Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima, Japan
| | - Hiro-Omi Kanayama
- Urology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toshio Doi
- Department of Nephrology, Tokushima University Graduate School, Tokushima, Japan
| | - Jun Minakuchi
- Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima, Japan
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Cernaro V, Lucisano S, Canale V, Bruzzese A, Caccamo D, Costantino G, Buemi M, Santoro D. Acetate-free biofiltration to remove fibroblast growth factor 23 in hemodialysis patients: a pilot study. J Nephrol 2017; 31:429-433. [PMID: 28401422 DOI: 10.1007/s40620-017-0393-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/23/2017] [Indexed: 12/17/2022]
Abstract
AIM Serum levels of 32 kDa-phosphaturic hormone fibroblast growth factor 23 (FGF23) rise early in renal failure in order to keep phosphatemia within the normal range; however, this compensatory mechanism itself contributes to chronic kidney disease-mineral bone disorder. High FGF23 is also associated to left ventricular hypertrophy, vascular calcifications and thus increased cardiovascular risk. The aim of this pilot pre-post study was to evaluate the effects of a single hemodiafiltration session with acetate-free biofiltration (AFB) on FGF23 serum levels. METHODS Nine hemodialysis patients were enrolled; sessions were performed using the Integra® monitor (Hospal, Bologna, Italy) and a polyacrylonitrile membrane. Peripheral venous blood samples were taken before (pre-HD), at mid- and after treatment (post-HD); dialysate samples were collected by the Quantiscan™ monitoring system. FGF23 was measured by a human FGF-23 ELISA kit. Mid- and post-HD values were corrected for hemoconcentration. RESULTS Pre-HD FGF23 levels positively correlated with dialysis vintage (r = 0.7192; p = 0.0443). They were significantly reduced by the hemodialysis session (from 2.38 ± 1.80 to 1.15 ± 1.21 ng/ml, p = 0.0171) with a reduction ratio of 52.55 ± 28.76%. FGF23 was detected in the dialysate samples. CONCLUSION FGF23 underwent a significant reduction during AFB. Such removal was greater than that induced by conventional hemodialysis as reported in the literature (19%-decrease using modified cellulosic membranes). This difference may be attributed to the ability of AFB hemodiafiltration to efficiently remove middle molecules by convection. Whether a better clearance of FGF23 during hemodialysis may result in improved cardiovascular outcomes in the long term needs to be confirmed by randomized controlled trials.
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Affiliation(s)
- Valeria Cernaro
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy
| | - Silvia Lucisano
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy
| | - Valeria Canale
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy
| | - Annamaria Bruzzese
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy
| | - Daniela Caccamo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Costantino
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy
| | - Michele Buemi
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
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Sabatino A, Regolisti G, Cosola C, Gesualdo L, Fiaccadori E. Intestinal Microbiota in Type 2 Diabetes and Chronic Kidney Disease. Curr Diab Rep 2017; 17:16. [PMID: 28271466 DOI: 10.1007/s11892-017-0841-z] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF THE REVIEW Diabetes mellitus is a major cause of kidney disease [chronic kidney disease (CKD) and end-stage renal disease (ESRD)] and are both characterized by an increased risk of cardiovascular events. Diabetes and kidney disease are also commonly associated with a chronic inflammatory state, which is now considered a non-traditional risk factor for atherosclerosis. In the case of type 2 diabetes mellitus (T2DM), inflammation is mainly a consequence of visceral obesity, while in the case of CKD or ESRD patients on dialysis, inflammation is caused by multiple factors, classically grouped as dialysis-related and non-dialysis-related. More recently, a key role has been credited to the intestinal microbiota in the pathogenesis of chronic inflammation present in both disease states. While many recent data on the intestinal microbiota and its relationship to chronic inflammation are available for CKD patients, very little is known regarding T2DM and patients with diabetic nephropathy. The aim of this review is to summarize and discuss the main pathophysiological issues of intestinal microbiota in patients with T2DM and CKD/ESRD. RECENT FINDINGS The presence of intestinal dysbiosis, along with increased intestinal permeability and high circulating levels of lipopolysaccharides, a condition known as "endotoxemia," characterize T2DM, CKD, and ESRD on dialysis. The hallmark of intestinal dysbiosis is a reduction of saccharolytic microbes mainly producing short-chain fatty acids (SCFA) and, in the case of CKD/ESRD, an increase in proteolytic microbes that produce different substances possibly related to uremic toxicity. Dysbiosis is associated with endotoxemia and chronic inflammation, with disruption of the intestinal barrier and depletion of beneficial bacteria producing SCFAs. T2DM and CKD/ESRD, whose coexistence is increasingly found in clinical practice, share similar negative effects on both intestinal microbiota and function. More studies are needed to characterize specific alterations of the intestinal microbiota in diabetic nephropathy and to assess possible effects of probiotic and prebiotic treatments in this setting.
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Affiliation(s)
- Alice Sabatino
- Unità di Fisiopatologia dell'Insufficienza Renale Acuta e Cronica, Università degli Studi di Parma, Parma, Italy
| | - Giuseppe Regolisti
- Unità di Fisiopatologia dell'Insufficienza Renale Acuta e Cronica, Università degli Studi di Parma, Parma, Italy
| | - Carmela Cosola
- Dipartimento dell'Emergenza e dei Trapianti di Organi-Sezione di Nefrologia, Dialisi e Trapianti, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Dipartimento dell'Emergenza e dei Trapianti di Organi-Sezione di Nefrologia, Dialisi e Trapianti, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Enrico Fiaccadori
- Unità di Fisiopatologia dell'Insufficienza Renale Acuta e Cronica, Università degli Studi di Parma, Parma, Italy.
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Boelaert J, Lynen F, Glorieux G, Schepers E, Neirynck N, Vanholder R. Metabolic profiling of human plasma and urine in chronic kidney disease by hydrophilic interaction liquid chromatography coupled with time-of-flight mass spectrometry: a pilot study. Anal Bioanal Chem 2017; 409:2201-2211. [DOI: 10.1007/s00216-016-0165-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/30/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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Tetali SD, Jankowski V, Luetzow K, Kratz K, Lendlein A, Jankowski J. Adsorption capacity of poly(ether imide) microparticles to uremic toxins. Clin Hemorheol Microcirc 2017; 61:657-65. [PMID: 26639769 DOI: 10.3233/ch-152026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uremia is a phenomenon caused by retention of uremic toxins in the plasma due to functional impairment of kidneys in the elimination of urinary waste products. Uremia is presently treated by dialysis techniques like hemofiltration, dialysis or hemodiafiltration. However, these techniques in use are more favorable towards removing hydrophilic than hydrophobic uremic toxins. Hydrophobic uremic toxins, such as hydroxy hipuric acid (OH-HPA), phenylacetic acid (PAA), indoxyl sulfate (IDS) and p-cresylsulfate (pCRS), contribute substantially to the progression of chronic kidney disease (CKD) and cardiovascular disease. Therefore, objective of the present study is to test adsorption capacity of highly porous microparticles prepared from poly(ether imide) (PEI) as an alternative technique for the removal of uremic toxins. Two types of nanoporous, spherically shaped microparticles were prepared from PEI by a spraying/coagulation process.PEI particles were packed into a preparative HPLC column to which a mixture of the four types of uremic toxins was injected and eluted with ethanol. Eluted toxins were quantified by analytical HPLC. PEI particles were able to adsorb all four toxins, with the highest affinity for PAA and pCR. IDS and OH-HPA showed a partially non-reversible binding. In summary, PEI particles are interesting candidates to be explored for future application in CKD.
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Affiliation(s)
- Sarada D Tetali
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Vera Jankowski
- RWTH Aachen University, University Hospital, Aachen, Germany
| | - Karola Luetzow
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Helmholtz Virtual Institute - Multifunctional Biomaterials for Medicine, Teltow and Berlin, Germany
| | - Karl Kratz
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Helmholtz Virtual Institute - Multifunctional Biomaterials for Medicine, Teltow and Berlin, Germany
| | - Andreas Lendlein
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Institute of Chemistry, University Potsdam, Potsdam, Germany.,Helmholtz Virtual Institute - Multifunctional Biomaterials for Medicine, Teltow and Berlin, Germany
| | - Joachim Jankowski
- RWTH Aachen University, University Hospital, Aachen, Germany.,Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, The Netherlands
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Underwood CF, Hildreth CM, Wyse BF, Boyd R, Goodchild AK, Phillips JK. Uraemia: an unrecognized driver of central neurohumoral dysfunction in chronic kidney disease? Acta Physiol (Oxf) 2017; 219:305-323. [PMID: 27247097 DOI: 10.1111/apha.12727] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/21/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
Chronic kidney disease (CKD) carries a large cardiovascular burden in part due to hypertension and neurohumoral dysfunction - manifesting as sympathetic overactivity, baroreflex dysfunction and chronically elevated circulating vasopressin. Alterations within the central nervous system (CNS) are necessary for the expression of neurohumoral dysfunction in CKD; however, the underlying mechanisms are poorly defined. Uraemic toxins are a diverse group of compounds that accumulate as a direct result of renal disease and drive dysfunction in multiple organs, including the brain. Intensive haemodialysis improves both sympathetic overactivity and cardiac baroreflex sensitivity in renal failure patients, indicating that uraemic toxins participate in the maintenance of autonomic dysfunction in CKD. In rodents exposed to uraemia, immediate early gene expression analysis suggests upregulated activity of not only pre-sympathetic but also vasopressin-secretory nuclei. We outline several potential mechanisms by which uraemia might drive neurohumoral dysfunction in CKD. These include superoxide-dependent effects on neural activity, depletion of nitric oxide and induction of low-grade systemic inflammation. Recent evidence has highlighted superoxide production as an intermediate for the depolarizing effect of some uraemic toxins on neuronal cells. We provide preliminary data indicating augmented superoxide production within the hypothalamic paraventricular nucleus in the Lewis polycystic kidney rat, which might be important for mediating the neurohumoral dysfunction exhibited in this CKD model. We speculate that the uraemic state might serve to sensitize the central actions of other sympathoexcitatory factors, including renal afferent nerve inputs to the CNS and angiotensin II, by way of recruiting convergent superoxide-dependent and pro-inflammatory pathways.
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Affiliation(s)
- C. F. Underwood
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - C. M. Hildreth
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - B. F. Wyse
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - R. Boyd
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - A. K. Goodchild
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - J. K. Phillips
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
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van den Brand JAJG, Mutsaers HAM, van Zuilen AD, Blankestijn PJ, van den Broek PH, Russel FGM, Masereeuw R, Wetzels JFM. Uremic Solutes in Chronic Kidney Disease and Their Role in Progression. PLoS One 2016; 11:e0168117. [PMID: 28033375 PMCID: PMC5199014 DOI: 10.1371/journal.pone.0168117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/27/2016] [Indexed: 11/18/2022] Open
Abstract
Background To date, over 150 possible uremic solutes have been listed, but their role in the progression of CKD is largely unknown. Here, the association between a selected panel of uremic solutes and progression in CKD patients was investigated. Methods Patients from the MASTERPLAN study, a randomized controlled trial in CKD patients with a creatinine clearance between 20 and 70 ml/min per 1.73m2, were selected based on their rate of eGFR decline during the first five years of follow-up. They were categorized as rapid (decline >5 ml/min per year) or slow progressors. Concentrations of eleven uremic solutes were obtained at baseline and after one year of follow-up. Logistic regression was used to compare the odds for rapid to slow progression by uremic solute concentrations at baseline. Variability in uremic solute levels was assessed using scatter plots, and limits of variability were calculated. Results In total, 40 rapidly and 40 slowly progressing patients were included. Uremic solutes were elevated in all patients compared to reference values for healthy persons. The serum levels of uremic solutes were not associated with rapid progression. Moreover, we observed substantial variability in solute levels over time. Conclusions Elevated concentrations of uremic solutes measured in this study did not explain differences in rate of eGFR decline in CKD patients, possibly due to lack of power as a result of the small sample size, substantial between patient variability, and variability in solute concentrations over time. The etiology of intra-individual variation in uremic solute levels remains to be elucidated.
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Affiliation(s)
- Jan A. J. G. van den Brand
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Henricus A. M. Mutsaers
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Arjan D. van Zuilen
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra H. van den Broek
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans G. M. Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosalinde Masereeuw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Jack F. M. Wetzels
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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65
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Lee J, Choi JY, Kwon YK, Lee D, Jung HY, Ryu HM, Cho JH, Ryu DH, Kim YL, Hwang GS. Changes in serum metabolites with the stage of chronic kidney disease: Comparison of diabetes and non-diabetes. Clin Chim Acta 2016; 459:123-131. [DOI: 10.1016/j.cca.2016.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/02/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
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Lekawanvijit S, Kompa AR, Krum H. Protein-bound uremic toxins: a long overlooked culprit in cardiorenal syndrome. Am J Physiol Renal Physiol 2016; 311:F52-62. [DOI: 10.1152/ajprenal.00348.2015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 05/01/2016] [Indexed: 11/22/2022] Open
Abstract
Protein-bound uremic toxins (PBUTs) accumulate once renal excretory function declines and are not cleared by dialysis. There is increasing evidence that PBUTs exert toxic effects on many vital organs, including the kidney, blood vessels, and heart. It has been suggested that PBUTs are likely to be a potential missing link in cardiorenal syndrome, based on the high incidence of cardiovascular events and mortality in the dialysis population, which are dramatically reduced in successful kidney transplant recipients. These data have led the call for more effective dialysis or additional adjunctive therapy to eradicate these toxins and their adverse biological effects. Indoxyl sulfate and p-cresyl sulfate are the two most problematic PBUTs, conferring renal and cardiovascular toxicity, and are derived from dietary amino acid metabolites by colonic microbial organisms. Therefore, targeting the colon where these toxins are initially produced appears to be a potential therapeutic alternative for patients with chronic kidney disease. This strategy, if approved, is likely to be applicable to predialysis patients, thereby potentially preventing progression of chronic kidney disease to end-stage renal disease as well as preventing the development of cardiorenal syndrome.
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Affiliation(s)
- Suree Lekawanvijit
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; and
| | - Andrew R. Kompa
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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67
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The microbiota and chronic kidney diseases: a double-edged sword. Clin Transl Immunology 2016; 5:e86. [PMID: 27757226 PMCID: PMC5067952 DOI: 10.1038/cti.2016.36] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 12/11/2022] Open
Abstract
Recent findings regarding the influence of the microbiota in many inflammatory processes have provided a new way to treat diseases. Now, one may hypothesize that the origin of a plethora of diseases is related to the health of the gut microbiota and its delicate, although complex, interface with the epithelial and immune systems. The ‘westernization' of diets, for example, is associated with alterations in the gut microbiota. Such alterations have been found to correlate directly with the increased incidence of diabetes and hypertension, the main causes of chronic kidney diseases (CKDs), which, in turn, have a high estimated prevalence. Indeed, data have arisen showing that the progression of kidney diseases is strictly related to the composition of the microbiota. Alterations in the gut microbiota diversity during CKDs do not only have the potential to exacerbate renal injury but may also contribute to the development of associated comorbidities, such as cardiovascular diseases and insulin resistance. In this review, we discuss how dysbiosis through alterations in the gut barrier and the consequent activation of immune system could intensify the progression of CKD and vice versa, how CKDs can modify the gut microbiota diversity and abundance.
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68
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Wyczalkowska-Tomasik A, Czarkowska-Paczek B, Giebultowicz J, Wroczynski P, Paczek L. Age-dependent increase in serum levels of indoxyl sulphate and p-cresol sulphate is not related to their precursors: Tryptophan and tyrosine. Geriatr Gerontol Int 2016; 17:1022-1026. [PMID: 27240996 DOI: 10.1111/ggi.12811] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 01/29/2023]
Abstract
AIM Retention of indoxyl sulphate and p-cresol sulphate is associated with many diseases. The aim of the present study was to examine serum levels of indoxyl sulphate and p-cresol sulphate, the dynamics of their changes according to age, and their precursors. METHODS The study included 180 healthy individuals aged 20-90 years (n = 180), divided into subgroups by decade (n = 30 in each subgroup) and into subgroups of ≥65 years (n = 42) or <65 years (n = 138). Serum indoxyl sulphate and p-cresol sulphate, tryptophan, and tyrosine were measured using high-performance liquid chromatography-mass spectrometry. RESULTS The 70-90 years age group had higher indoxyl sulphate than the 50-59 years age group (P = 0.033). The 70-90 years age group had higher p-cresol sulphate than the 20-29 years (P < 0.001), 30-39 years (P < 0.001), 40-49 years (P = 0.007) and 50-59 years (P = 0.001) age groups; the 60-69 years age group had higher p-cresol sulphate than the 20-29 years (P = 0.043) and 30-39 years (P = 0.011) age groups. Indoxyl sulphate and p-cresol sulphate serum levels were higher in those aged ≥65 years. Indoxyl sulphate and p-cresol sulphate serum levels correlated positively with age, but not with tryptophan and tyrosine, respectively. CONCLUSIONS Healthy aging is associated with indoxyl sulphate and p-cresol sulphate serum level increases, which are not linked to tryptophan and tyrosine serum levels. Geriatr Gerontol Int 2017; 17: 1022-1026.
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Affiliation(s)
| | | | - Joanna Giebultowicz
- Bioanalysis and Drugs Analysis Department, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Wroczynski
- Bioanalysis and Drugs Analysis Department, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Paczek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.,Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
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69
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Kromke M, Palomino-Schätzlein M, Mayer H, Pfeffer S, Pineda-Lucena A, Luy B, Hausberg M, Muhle-Goll C. Profiling human blood serum metabolites by nuclear magnetic resonance spectroscopy: a comprehensive tool for the evaluation of hemodialysis efficiency. Transl Res 2016; 171:71-82.e1-9. [PMID: 26924041 DOI: 10.1016/j.trsl.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
Hemodialysis remains the standard therapy to treat patients affected with end-stage renal disease by removing metabolites accumulated in blood plasma. The efficiency of hemodialysis is mainly monitored by urea clearance, which is routinely checked in clinical laboratory practice. However, there is mounting evidence that the clearance behavior of selected single metabolites is not sufficient to predict long-term outcome of treatment. To address this problem, we evaluated the potential of nuclear magnetic resonance spectroscopy for monitoring hemodialysis efficiency by comprehensive profiling of blood serum metabolites. We carried out a pilot study with a cohort of end-stage chronic kidney disease patients (n = 29), analyzing their serum prior and immediately after hemodialysis. To account for supposed variability in the accumulation of metabolites and efficiency of hemodialysis, patients' blood sera were repeatedly collected over a period of several months. Our results revealed that the metabolic profile in terms of concentrations varied considerably between patients but was comparably constant on the patient's level over the period of 4 months. Interestingly, also the individual clearance of the metabolites was characteristic for each patient. Thus, it is conceivable that the observed patient-dependent clearance patterns reflect to some extent the patients' long-term perspectives. We conclude that nuclear magnetic resonance spectroscopy is an optimal tool to complement traditional clinical methods based on a single variable, providing comprehensive and much more global information, which is crucial for patient evaluation and the development of improved treatments of kidney failure.
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Affiliation(s)
- Marika Kromke
- Karlsruhe Institute of Technology, Institute of Organic Chemistry, Karlsruhe, Germany
| | - Martina Palomino-Schätzlein
- Karlsruhe Institute of Technology, Institute of Organic Chemistry, Karlsruhe, Germany; Centro de Investigación Príncipe Felipe, Valencia, Spain
| | - Horst Mayer
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Antonio Pineda-Lucena
- Centro de Investigación Príncipe Felipe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Burkhard Luy
- Karlsruhe Institute of Technology, Institute of Organic Chemistry, Karlsruhe, Germany; Karlsruhe Institute of Technology, Institute for Biological Interfaces 4, Karlsruhe, Germany
| | | | - Claudia Muhle-Goll
- Karlsruhe Institute of Technology, Institute of Organic Chemistry, Karlsruhe, Germany; Karlsruhe Institute of Technology, Institute for Biological Interfaces 4, Karlsruhe, Germany.
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Nagai K, Tsuchida K, Hirose D, Michiwaki H, Hann M, Kanayama HO, Doi T, Minakuchi J. The effect of albumin leakage in hemodialysis patients on redox status of serum albumin. J Artif Organs 2016; 19:310-4. [PMID: 27086124 DOI: 10.1007/s10047-016-0900-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/30/2016] [Indexed: 11/26/2022]
Abstract
Human mercaptoalbumin (HMA) is a reduced form of albumin that is associated with cardiovascular disease in dialysis patients. Albumin-leaky hemodialysis (HD) is increasingly recognized as a gold standard therapy because it is correlated with better prognosis compared to conventional HD. However, albumin-leaky HD induces low serum albumin concentration because of albumin leakage, which is a classical risk factor for mortality. The aim of this study was to explain the preferable prognosis in patients undergoing albumin-leaky HD with low serum albumin concentration. Ten HD patients were enrolled. They were preconditioned with albumin-non-leaky HD (mean albumin leakage: 1.0 g) for 2 months. Subsequently, albumin-leaky HD (9.1 g) was performed for 6 months, followed by relatively non-leaky HD (within 3.0 g). The ratio and level of HMA were evaluated. The amount of albumin leakage was related to the ratio of HMA, and inversely correlated with serum albumin concentration. The level of HMA was maintained regardless of albumin leakage. Regarding HMA level, a moderate amount of albumin leakage was acceptable. A stably maintained HMA level in albumin-leaky HD patients can contribute to preferable prognosis even if they have low serum albumin concentration.
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Affiliation(s)
- Kojiro Nagai
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Kenji Tsuchida
- Department of Kidney Disease (Dialysis and Transplantation), Kawashima Hospital, 1-39, Kitasakoichiban-cho, Tokushima, 770-0011, Japan
| | - Daisuke Hirose
- Department of Kidney Disease (Dialysis and Transplantation), Kawashima Hospital, 1-39, Kitasakoichiban-cho, Tokushima, 770-0011, Japan
| | - Hiroyuki Michiwaki
- Department of Kidney Disease (Dialysis and Transplantation), Kawashima Hospital, 1-39, Kitasakoichiban-cho, Tokushima, 770-0011, Japan
| | - Michael Hann
- Department of Graduate Medical Education, Naval Medical Center San Diego, San Diego, CA, USA
| | - Hiro-Omi Kanayama
- Department of Urology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toshio Doi
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Jun Minakuchi
- Department of Kidney Disease (Dialysis and Transplantation), Kawashima Hospital, 1-39, Kitasakoichiban-cho, Tokushima, 770-0011, Japan
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71
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Neves DV, Lanchote VL, Moysés Neto M, Cardeal da Costa JA, Vieira CP, Coelho EB. Influence of chronic kidney disease and haemodialysis treatment on pharmacokinetics of nebivolol enantiomers. Br J Clin Pharmacol 2016; 82:83-91. [PMID: 26914703 DOI: 10.1111/bcp.12917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/19/2016] [Accepted: 02/18/2016] [Indexed: 11/29/2022] Open
Abstract
AIM The present study evaluated the pharmacodynamics and pharmacokinetics of nebivolol enantiomers in patients with chronic kidney disease (CKD) and in patients undergoing haemodialysis. METHODS Forty-three adult patients were distributed into three groups: healthy volunteers and hypertensive patients with normal kidney function (n = 22); patients with stage 3 and 4 CKD (n = 11); and patients with stage 5 CKD undergoing haemodialysis (n = 10). The subjects received a single oral dose of 10 mg racemic nebivolol. Serial blood samples were collected up to 48 h after administration of the drug and heart rate variation was measured over the same interval during the isometric handgrip test. The nebivolol enantiomers in plasma were analysed by liquid chromatography-tandem mass spectrometry. RESULTS The pharmacokinetics of nebivolol is enantioselective, with a greater plasma proportion of l-nebivolol. CKD increased the area under the concentration-time curve (AUC) of l-nebivolol (6.83 ng.h ml(-1) vs. 9.94 ng.h ml(-1) ) and d-nebivolol (4.15 ng.h ml(-1) vs. 7.30 ng.h ml(-1) ) when compared with the control group. However, the AUC values of l-nebivolol (6.41 ng.h ml(-1) ) and d-nebivolol (4.95 ng.h ml(-1) ) did not differ between the haemodialysis and control groups. The administration of a single dose of 10 mg nebivolol did not alter the heart rate variation induced by isometric exercise in the investigated patients. CONCLUSIONS Stage 3 and 4 CKD increases the plasma concentrations of both nebivolol enantiomers, while haemodialysis restores the pharmacokinetic parameters to values similar to those observed in the control group. No significant difference in heart rate variation induced by isometric exercise was observed between the investigated groups after the administration of a single oral dose of 10 mg nebivolol.
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Affiliation(s)
- Daniel V Neves
- Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Vera L Lanchote
- Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Miguel Moysés Neto
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - José A Cardeal da Costa
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carolina P Vieira
- Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Eduardo B Coelho
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Lu LF, Tang WH, Hsu CC, Tsai IT, Hung WC, Yu TH, Wu CC, Chung FM, Lu YC, Lee YJ, Wang CP. Associations among chronic kidney disease, high total p-cresylsulfate and left ventricular systolic dysfunction. Clin Chim Acta 2016; 457:63-8. [PMID: 27036086 DOI: 10.1016/j.cca.2016.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/01/2016] [Accepted: 03/17/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND A significant number of patients with chronic kidney disease (CKD) have cardiac abnormalities, and left ventricular systolic dysfunction (LVSD) is a common manifestation. p-Cresylsulfate (PCS), a protein-bound uraemic retention solute, is known to cause endothelial dysfunction and possibly plays a role in coronary atherosclerosis. Furthermore, the associations among serum total PCS, major adverse cardiovascular events, all-cause mortality, and QTc prolongation have also been found in previous studies. We thus investigated the association of total PCS and CKD with LVSD in the clinical setting. METHODS We included 403 consecutive patients with stable angina. To evaluate LV function, all patients underwent echocardiography. To measure the serum total PCS concentrations and estimated glomerular filtration rate (eGFR), blood samples were obtained. RESULTS Multiple regression analysis showed that left atrium diameter, left ventricular mass index, end diastolic interventricular septal thickness, left ventricular end-systolic diameter, left ventricular end-systolic volume, stroke volume, left ventricular end-systolic volume index, left ventricular ejection fraction (LVEF), and the interventricular septum/posterior wall of the left ventricle were independently associated with total PCS (all p<0.05). In addition, a significantly decreased LVEF was present in patients with lower and higher serum total PCS and with CKD, and with higher serum total PCS and without CKD than from those with lower serum total PCS concentrations and without CKD (p=0.004). In the multivariate logistic regression analysis, when patients without CKD and lower PCS were used as reference group, patients with the higher total PCS concentration and without CKD had an odds ratio of 3.59 for the risk of LVSD, the lower total PCS concentration and with CKD had an odds ratio of 3.89 for the risk of LVSD, and the higher total PCS concentration and with CKD had an odds ratio of 4.04 for the risk of LVSD (p=0.039, p=0.038, and p=0.020, respectively). CONCLUSIONS High serum concentrations of total PCS or CKD, or both, represent an increased risk of impaired LV systolic function in stable angina patients.
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Affiliation(s)
- Li-Fen Lu
- Division of Cardiac Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC
| | - Chia-Chang Hsu
- Division of Gastroenterology and Hepatology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - I-Ting Tsai
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Wei-Chin Hung
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Teng-Hung Yu
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Cheng-Ching Wu
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC; Institute of Biomedical Engineering, National Cheng Kung University, Tainan, 70101, Taiwan, ROC
| | - Fu-Mei Chung
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Yung-Chuan Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC; School of Medicine for International Students, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Yau-Jiunn Lee
- Lee's Endocrinologic Clinic, Pingtung 90000, Taiwan, ROC
| | - Chao-Ping Wang
- Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC; School of Medicine for International Students, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
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Challenges and opportunities for stem cell therapy in patients with chronic kidney disease. Kidney Int 2016; 89:767-78. [PMID: 26924058 DOI: 10.1016/j.kint.2015.11.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) is a global health care burden affecting billions of individuals worldwide. The kidney has limited regenerative capacity from chronic insults, and for the most common causes of CKD, no effective treatment exists to prevent progression to end-stage kidney failure. Therefore, novel interventions, such as regenerative cell-based therapies, need to be developed for CKD. Given the risk of allosensitization, autologous transplantation of cells to boost regenerative potential is preferred. Therefore, verification of cell function and vitality in CKD patients is imperative. Two cell types have been most commonly applied in regenerative medicine. Endothelial progenitor cells contribute to neovasculogenesis primarily through paracrine angiogenic activity and partly by differentiation into mature endothelial cells in situ. Mesenchymal stem cells also exert paracrine effects, including proangiogenic, anti-inflammatory, and antifibrotic activity. However, in CKD, multiple factors may contribute to reduced cell function, including older age, coexisting cardiovascular disease, diabetes, chronic inflammatory states, and uremia, which may limit the effectiveness of an autologous cell-based therapy approach. This Review highlights current knowledge on stem and progenitor cell function and vitality, aspects of the uremic milieu that may serve as a barrier to therapy, and novel methods to improve stem cell function for potential transplantation.
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74
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Jansen J, De Napoli IE, Fedecostante M, Schophuizen CMS, Chevtchik NV, Wilmer MJ, van Asbeck AH, Croes HJ, Pertijs JC, Wetzels JFM, Hilbrands LB, van den Heuvel LP, Hoenderop JG, Stamatialis D, Masereeuw R. Human proximal tubule epithelial cells cultured on hollow fibers: living membranes that actively transport organic cations. Sci Rep 2015; 5:16702. [PMID: 26567716 PMCID: PMC4644946 DOI: 10.1038/srep16702] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/05/2015] [Indexed: 11/11/2022] Open
Abstract
The bioartificial kidney (BAK) aims at improving dialysis by developing ‘living membranes’ for cells-aided removal of uremic metabolites. Here, unique human conditionally immortalized proximal tubule epithelial cell (ciPTEC) monolayers were cultured on biofunctionalized MicroPES (polyethersulfone) hollow fiber membranes (HFM) and functionally tested using microfluidics. Tight monolayer formation was demonstrated by abundant zonula occludens-1 (ZO-1) protein expression along the tight junctions of matured ciPTEC on HFM. A clear barrier function of the monolayer was confirmed by limited diffusion of FITC-inulin. The activity of the organic cation transporter 2 (OCT2) in ciPTEC was evaluated in real-time using a perfusion system by confocal microscopy using 4-(4-(dimethylamino)styryl)-N-methylpyridinium iodide (ASP+) as a fluorescent substrate. Initial ASP+ uptake was inhibited by a cationic uremic metabolites mixture and by the histamine H2-receptor antagonist, cimetidine. In conclusion, a ‘living membrane’ of renal epithelial cells on MicroPES HFM with demonstrated active organic cation transport was successfully established as a first step in BAK engineering.
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Affiliation(s)
- J Jansen
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Department of Physiology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - I E De Napoli
- Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, The Netherlands
| | - M Fedecostante
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Department of Physiology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - C M S Schophuizen
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Department of Physiology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - N V Chevtchik
- Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, The Netherlands
| | - M J Wilmer
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - A H van Asbeck
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - H J Croes
- Department of Cell Biology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - J C Pertijs
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - J F M Wetzels
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - L P van den Heuvel
- Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands.,Department of Pediatric Nephrology &Growth and Regeneration, Catholic University Leuven, Leuven, Belgium
| | - J G Hoenderop
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - D Stamatialis
- Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, The Netherlands
| | - R Masereeuw
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Div. Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, The Netherlands
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Asai H, Hirata J, Hirano A, Hirai K, Seki S, Watanabe-Akanuma M. Activation of aryl hydrocarbon receptor mediates suppression of hypoxia-inducible factor-dependent erythropoietin expression by indoxyl sulfate. Am J Physiol Cell Physiol 2015; 310:C142-50. [PMID: 26561638 DOI: 10.1152/ajpcell.00172.2015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/09/2015] [Indexed: 01/01/2023]
Abstract
Indoxyl sulfate (IS) is a representative uremic toxin that accumulates in the blood of patients with chronic kidney disease (CKD). In addition to the involvement in the progression of CKD, a recent report indicates that IS suppresses hypoxia-inducible factor (HIF)-dependent erythropoietin (EPO) production, suggesting that IS may also contribute to the progression of renal anemia. In this report, we provide evidence that aryl hydrocarbon receptor (AhR) mediates IS-induced suppression of HIF activation and subsequent EPO production. In HepG2 cells, IS at concentrations similar to the blood levels in CKD patients suppressed hypoxia- or cobalt chloride-induced EPO mRNA expression and transcriptional activation of HIF. IS also induced AhR activation, and AhR blockade resulted in abolishment of IS-induced suppression of HIF activation. The HIF transcription factor is a heterodimeric complex composed of HIF-α subunits (HIF-1α and HIF-2α) and AhR nuclear translocator (ARNT). IS suppressed nuclear accumulation of the HIF-α-ARNT complex accompanied by an increase of the AhR-ARNT complex in the nucleus, implying the involvement of interactions among AhR, HIF-α, and ARNT in the suppression mechanism. In rats, oral administration of indole, a metabolic precursor of IS, inhibited bleeding-induced elevation of renal EPO mRNA expression and plasma EPO concentration and strongly induced AhR activation in the liver and renal cortex tissues. Collectively, this study is the first to elucidate the detailed mechanism by which AhR plays an indispensable role in the suppression of HIF activation by IS. Hence, IS-induced activation of AhR may be a potential therapeutic target for treating renal anemia.
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Affiliation(s)
- Hirobumi Asai
- Safety Research Center, Kureha Corporation, Tokyo, Japan
| | - Junya Hirata
- Safety Research Center, Kureha Corporation, Tokyo, Japan
| | - Ayumi Hirano
- Safety Research Center, Kureha Corporation, Tokyo, Japan
| | - Kazuya Hirai
- Safety Research Center, Kureha Corporation, Tokyo, Japan
| | - Sayaka Seki
- Safety Research Center, Kureha Corporation, Tokyo, Japan
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Six I, Gross P, Rémond MC, Chillon JM, Poirot S, Drueke TB, Massy ZA. Deleterious vascular effects of indoxyl sulfate and reversal by oral adsorbent AST-120. Atherosclerosis 2015; 243:248-56. [PMID: 26408929 DOI: 10.1016/j.atherosclerosis.2015.09.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND In chronic kidney disease (CKD), blood vessels are permanently exposed to uremic toxins such as indoxyl sulfate (IS). We hypothesized that IS could alter vascular tone and that reducing its serum concentration could be beneficial. DESIGN We studied acute and longer-term effects of IS and AST-120, an oral charcoal adsorbent, on vascular reactivity, endothelium integrity and expression of adhesion molecules VCAM-1 and ICAM-1 in aortic rings of normal and uremic wild type (WT) mice in vitro, and the cardiovascular effects of AST-120 in both WT and apoE-/- mice with CKD in vivo. RESULTS In vitro, 1.0 mM IS acutely reduced vascular relaxation (64% for IS 1.0 mM vs. 80% for control, p < 0.05). The effect was more marked after 4 days exposure (39% for IS 1.0 mM 4 days; p < 0.001, prolonged vs. acute exposure), and was associated with endothelial cell loss and upregulation of ICAM-1/VCAM-1 expression. In vitro, AST-120 restored normal vascular function and prevented IS induced endothelial cell loss and ICAM-1/VCAM-1 upregulation. In vivo, AST-120 treatment of CKD mice (1) improved vascular relaxation (72% vs. 48% maximal relaxation in treated vs. untreated mice, p < 0.001), (2) reduced aortic VCAM-1 and ICAM-1 expression, (3) decreased aorta systolic expansion rate (9 ± 3% CKD vs. 14 ± 3% CKD + AST-120, p < 0.02), and (4) prevented the increase in pulse wave velocity (3.56 ± 0.17 m/s CKD vs. 3.10 ± 0.08 m/s CKD + AST-120, p < 0.006). Similar changes were observed in apoE-/- mice. CONCLUSION IS appears to be an important contributor to the vascular dysfunction associated with CKD. AST-120 treatment ameliorates this dysfunction, possibly via a decrease in serum IS concentration.
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Affiliation(s)
- Isabelle Six
- INSERM Unit 1088, Jules Verne University of Picardie, Amiens, France
| | - Priscilla Gross
- INSERM Unit 1088, Jules Verne University of Picardie, Amiens, France
| | - Mathieu C Rémond
- INSERM Unit 1088, Jules Verne University of Picardie, Amiens, France
| | - Jean Marc Chillon
- INSERM Unit 1088, Jules Verne University of Picardie, Amiens, France
| | - Sabrina Poirot
- INSERM Unit 1088, Jules Verne University of Picardie, Amiens, France
| | - Tilman B Drueke
- INSERM Unit 1088, Jules Verne University of Picardie, Amiens, France
| | - Ziad A Massy
- INSERM Unit 1088, Jules Verne University of Picardie, Amiens, France; Division of Nephrology, Ambroise Paré University Hospital, AP-HP, Paris-Ile-de-France-Ouest University (UVSQ), Boulogne-Billancourt, France.
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77
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Once upon a time in dialysis: the last days of Kt/V? Kidney Int 2015; 88:460-5. [DOI: 10.1038/ki.2015.155] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 11/09/2022]
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78
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Wong J, Vilar E, Davenport A, Farrington K. Incremental haemodialysis. Nephrol Dial Transplant 2015; 30:1639-48. [DOI: 10.1093/ndt/gfv231] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/21/2015] [Indexed: 12/15/2022] Open
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79
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Tang WH, Wang CP, Chung FM, Huang LLH, Yu TH, Hung WC, Lu LF, Chen PY, Luo CH, Lee KT, Lee YJ, Lai WT. Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients. PLoS One 2015; 10:e0119545. [PMID: 25893644 PMCID: PMC4403985 DOI: 10.1371/journal.pone.0119545] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD). In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS) is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc) prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK) was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD) and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.
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Affiliation(s)
- Wei-Hua Tang
- Graduate Institute of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Ping Wang
- Division of Cardiology, Department of Internal Medicine E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Lynn L. H. Huang
- Institute of Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Chin Hung
- Division of Cardiology, Department of Internal Medicine E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Li-Fen Lu
- Division of Cardiac Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Po-Yuan Chen
- Institute of Electric Engineering, National Cheng-Kung University, Tainan, Taiwan
| | - Ching-Hsing Luo
- Institute of Electric Engineering, National Cheng-Kung University, Tainan, Taiwan
| | - Kun-Tai Lee
- Graduate Institute of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Wen-Ter Lai
- Graduate Institute of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
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80
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Endothelial toxicity of unusual nucleotide metabolites. Pharmacol Rep 2015; 67:818-22. [PMID: 26321286 DOI: 10.1016/j.pharep.2015.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 11/20/2022]
Abstract
Endothelium plays a pivotal role in the vascular tone regulation, platelet aggregation, regulation of immune response, inflammation and angiogenesis and its dysfunction is an earliest event in the development of cardiovascular disease. All these processes are affected by endothelial dysfunction. Endothelial toxicity induced by metabolites present in blood is a common scenario in pathology. This involves physiological metabolites such as asymmetric dimethylarginine or homocysteine that are normally excreted by kidneys, but accumulate in pathological conditions, adversely affecting function of endothelium. Our group identified new molecule with potential endothelial toxicity: 4-pirydone-3-carboxamide-1-β-d-ribonucleoside (4PYR). This nucleoside is most likely produced by oxidation of nicotinamide containing precursor by aldehyde oxidase. 4PYR easy crosses cell membrane and become phosphorylated inside the cell giving rise to mono-, di- and triphospates (4PYMP, 4PYDP and 4PYTP). There is considerable evidence that 4PYR is toxic in endothelium and other cell types by disrupting cell energetics evident as ATP depletion. Endothelial dysfunction in the in vitro and in vivo experiments is, however, evident only after prolonged exposure to 4PYR while acute cardiovascular effects are minor. 4PYR endothelial toxicity could be particularly important in patients with chronic renal disease where accumulation of 4PYR and its metabolites is particularly prominent. 4PYR metabolism and toxicity could be blocked by application of nucleoside transport inhibitors and we have proven efficiency of such intervention. We believe that blocking metabolism of endothelial nucleoside toxins such as 4PYR could become important strategy for endothelial targeted therapy.
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81
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Lekawanvijit S, Krum H. Cardiorenal Syndrome: Role of Protein-Bound Uremic Toxins. J Ren Nutr 2015; 25:149-54. [DOI: 10.1053/j.jrn.2014.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/29/2014] [Indexed: 12/21/2022] Open
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82
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Ichimura Y, Takamatsu H, Ideuchi H, Oda M, Takeda K, Saitoh H. Plasma Concentrations of Anionic Uremic Toxins in Hemodialysis Patients and Their Effects on Protein Binding of Pravastatin. YAKUGAKU ZASSHI 2015; 135:821-8. [DOI: 10.1248/yakushi.14-00244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yuichi Ichimura
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido
| | - Hiroyuki Takamatsu
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido
| | - Hideki Ideuchi
- Department of Pharmacy, Sapporo Higashi Tokushukai Hospital
| | - Masako Oda
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido
| | | | - Hiroshi Saitoh
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido
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83
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Lekawanvijit S. Role of Gut-Derived Protein-Bound Uremic Toxins in Cardiorenal Syndrome and Potential Treatment Modalities. Circ J 2015; 79:2088-97. [DOI: 10.1253/circj.cj-15-0749] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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84
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Lisowska-Myjak B. Uremic toxins and their effects on multiple organ systems. Nephron Clin Pract 2014; 128:303-11. [PMID: 25531673 DOI: 10.1159/000369817] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nearly all body organs and systems are affected by the toxicity of uremic compounds retained in the course of renal dysfunction. Knowledge about the origin, chemical structure and composition of the retained endogenous substances responsible for these symptoms is far from complete. Organic retention solutes present a great variety of properties which makes their accurate classification extremely difficult. Their potential toxicity remains to be elucidated with meticulous observation of clearly formulated rules guiding the process. Toxicity assessment is a complex process because not just one but several retained compounds may be simultaneously involved in the same biological and metabolic processes. The search for new uremic compounds and combining them into panels of substances involved in the same pathophysiological processes seems to offer a novel approach to identifying and explaining any so far unexplored specific effects of endogenous compounds on the body organs and systems.
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Affiliation(s)
- Barbara Lisowska-Myjak
- Department of Biochemistry and Clinical Chemistry, Medical University of Warsaw, Warsaw, Poland
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85
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Abstract
Current views regarding hemodialysis adequacy reach beyond indices of small solute removal such as Kt/V. Nevertheless, new Kt/V-based constructs such as the standard Kt/V, which adjusts not only for dialysis frequency, but which also represents removal of sequestered solutes rather than easily removed urea, continue to be useful. The scaling of dialysis dose to measures of size other than body water results in higher recommended doses of dialysis for children, small patients, and women, compared with the current body water-based scaling approach. Aside from small solute removal, increasing weekly time on dialysis results in slower removal of fluid with better tolerance and with increased removal of phosphorus, although both salt and water and phosphorus control often respond to efforts to reduce intake. The intermediate term benefits of removing larger middle molecules such as beta-2-microglobulin appear to be modest, and the benefits of removal of protein-bound uremic toxins remain to be proved in controlled trials.
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86
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Tan X, He J, Cao X, Zou J, Liu H, Ding X. Effects of oral carbonic adsorbent (AST-120) on kidney of early-stage chronic kidney disease rats. Ren Fail 2014; 37:337-42. [DOI: 10.3109/0886022x.2014.986006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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87
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Classification of Five Uremic Solutes according to Their Effects on Renal Tubular Cells. Int J Nephrol 2014; 2014:512178. [PMID: 25431671 PMCID: PMC4241681 DOI: 10.1155/2014/512178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/19/2014] [Accepted: 10/06/2014] [Indexed: 11/18/2022] Open
Abstract
Background/Aims. Uremic solutes, which are known to be retained in patients with chronic kidney disease, are considered to have deleterious effects on disease progression. Among these uremic solutes, indoxyl sulfate (IS) has been extensively studied, while other solutes have been studied less to state. We conducted a comparative study to examine the similarities and differences between IS, p-cresyl sulfate (PCS), phenyl sulfate (PhS), hippuric acid (HA), and indoleacetic acid (IAA). Methods. We used LLC-PK1 cells to evaluate the effects of these solutes on viable cell number, cell cycle progression, and cell death. Results. All the solutes reduced viable cell number after 48-hour incubation. N-Acetyl-L-cysteine inhibited this effect induced by all solutes except HA. At the concentration that reduced the cell number to almost 50% of vehicle control, IAA induced apoptosis but not cell cycle delay, whereas other solutes induced delay in cell cycle progression with marginal impact on apoptosis. Phosphorylation of p53 and Chk1 and expression of ATF4 and CHOP genes were detected in IS-, PCS-, and PhS-treated cells, but not in IAA-treated cells. Conclusions. Taken together, the adverse effects of PCS and PhS on renal tubular cells are similar to those of IS, while those of HA and IAA differ.
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88
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Masuda M, Ishimura E, Ochi A, Tsujimoto Y, Tahahra H, Okuno S, Tabata T, Nishizawa Y, Inaba M. Serum β2-microglobulin correlates positively with left ventricular hypertrophy in long-term hemodialysis patients. Nephron Clin Pract 2014; 128:101-6. [PMID: 25376242 DOI: 10.1159/000365447] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS β2-Microglobulin (β2-MG) is a major protein component of dialysis-related amyloidosis. In long-term hemodialysis (HD) patients, β2-MG amyloid deposits not only in osteoarticular tissues, but also in systemic tissues, including the heart. The purpose of this study was to investigate the relationship between serum β2-MG concentrations and echocardiographic parameters in long-term HD patients in a cross-sectional study. METHODS Measurement of serum β2-MG concentrations and echocardiography were performed in 251 patients who had undergone HD therapy for more than 10 years. RESULTS The left ventricular mass index (LVMI) of the higher serum β2-MG (≥30 mg/l) group was significantly higher than that of the lower serum β2-MG (<30 mg/l) group (151.5 ± 45.7 vs. 137.0 ± 44.5 g/m(2), p = 0.020). In simple regression analyses, serum β2-MG concentrations correlated significantly and positively with interventricular septum thickness (IVST) (r = 0.215, p < 0.001), posterior left ventricular wall thickness (PWT) (r = 0.249, p < 0.001), left ventricular wall thickness (LVWT) (r = 0.252, p < 0.001), relative wall thickness (RWT) (r = 0.153, p = 0.015) and LVMI (r = 0.171, p = 0.007). Multiple regression analyses revealed that serum β2-MG concentrations correlated significantly and positively with IVST, PWT, LVWT and RWT. CONCLUSION Serum β2-MG concentrations correlated significantly and positively with the echocardiographic parameters of left ventricular hypertrophy (LVH) in long-term HD patients. Thus, deposition of β2-MG amyloid in the heart may be associated with LVH progression.
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Affiliation(s)
- Mio Masuda
- Department of Metabolism, Endocrinology, Molecular Medicine, and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Sabatino A, Regolisti G, Brusasco I, Cabassi A, Morabito S, Fiaccadori E. Alterations of intestinal barrier and microbiota in chronic kidney disease. Nephrol Dial Transplant 2014; 30:924-33. [PMID: 25190600 DOI: 10.1093/ndt/gfu287] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/04/2014] [Indexed: 12/27/2022] Open
Abstract
Recent studies have highlighted the close relationship between the kidney and the gastrointestinal (GI) tract--frequently referred to as the kidney--gut axis--in patients with chronic kidney disease (CKD). In this regard, two important pathophysiological concepts have evolved: (i) production and accumulation of toxic end-products derived from increased bacterial fermentation of protein and other nitrogen-containing substances in the GI tract, (ii) translocation of endotoxins and live bacteria from gut lumen into the bloodstream, due to damage of the intestinal epithelial barrier and quantitative/qualitative alterations of the intestinal microbiota associated with the uraemic milieu. In both cases, these gut-centred alterations may have relevant systemic consequences in CKD patients, since they are able to trigger chronic inflammation, increase cardiovascular risk and worsen uraemic toxicity. The present review is thus focused on the kidney-gut axis in CKD, with special attention to the alterations of the intestinal barrier and the local microbiota (i.e. the collection of microorganisms living in a symbiotic coexistence with their host in the intestinal lumen) and their relationships to inflammation and uraemic toxicity in CKD. Moreover, we will summarize the most important clinical data suggesting the potential for nutritional modulation of gut-related inflammation and intestinal production of noxious by-products contributing to uraemic toxicity in CKD patients.
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Affiliation(s)
- Alice Sabatino
- Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Hospital, Parma, Italy
| | - Giuseppe Regolisti
- Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Hospital, Parma, Italy
| | - Irene Brusasco
- Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Hospital, Parma, Italy
| | - Aderville Cabassi
- Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Hospital, Parma, Italy
| | - Santo Morabito
- Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Hospital, Parma, Italy
| | - Enrico Fiaccadori
- Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Hospital, Parma, Italy
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Saigo C, Nomura Y, Yamamoto Y, Sagata M, Matsunaga R, Jono H, Nishi K, Saito H. Meclofenamate elicits a nephropreventing effect in a rat model of ischemic acute kidney injury by suppressing indoxyl sulfate production and restoring renal organic anion transporters. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:1073-82. [PMID: 25143712 PMCID: PMC4137993 DOI: 10.2147/dddt.s67456] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Indoxyl sulfate (IS), a putative low-molecular weight uremic toxin, is excreted in the urine under normal kidney function, but is retained in the circulation and tissues during renal dysfunction in acute kidney injury and chronic kidney disease. IS, which is one of the most potent inducers of oxidative stress in the kidney and cardiovascular system, is enzymatically produced in the liver from indole by cytochrome P450-mediated hydroxylation to indoxyl, followed by sulfotransferase-mediated sulfate conjugation. We used rat liver S9 fraction to identify inhibitors of IS production. After testing several compounds, including phytochemical polyphenols, we identified meclofenamate as a potent inhibitor of IS production with an apparent IC50 value of 1.34 μM. Ischemia/reperfusion (I/R) of rat kidney caused a marked elevation in the serum IS concentration 48 hours after surgery. However, intravenous administration of meclofenamate (10 mg/kg) significantly suppressed this increase in the serum level of IS. Moreover, IS concentrations in both kidney and liver were dramatically elevated by renal I/R treatment, but this increase was blocked by meclofenamate. Serum creatinine and blood urea nitrogen were markedly elevated in rats after renal I/R treatment, but these increases were significantly restored by administration of meclofenamate. Renal expression of both basolateral membrane-localized organic anion transporters rOAT1 and rOAT3 was downregulated by I/R treatment. However, expression of rOAT1 and rOAT3 recovered after administration of meclofenamate, which is associated with the inhibition of I/R-evoked elevation of prostaglandin E2. Our results suggest that meclofenamate inhibits hepatic sulfotransferase-mediated production of IS, thereby suppressing serum and renal accumulation of IS. Meclofenamate also prevents the prostaglandin E2-dependent downregulation of rOAT1 and rOAT3 expression. In conclusion, meclofenamate was found to elicit a nephropreventive effect in ischemic acute kidney injury.
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Affiliation(s)
- Chika Saigo
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yui Nomura
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuko Yamamoto
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masataka Sagata
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Rika Matsunaga
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Jono
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan ; Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
| | - Kazuhiko Nishi
- Department of Hemo-Dialysis, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideyuki Saito
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan ; Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
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91
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Velenosi TJ, Urquhart BL. Pharmacokinetic considerations in chronic kidney disease and patients requiring dialysis. Expert Opin Drug Metab Toxicol 2014; 10:1131-43. [PMID: 24961255 DOI: 10.1517/17425255.2014.931371] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is the progressive decline in renal function over time. Patients with end-stage renal disease require renal replacement therapy such as hemodialysis to support life. Hemodialysis patients require several medications to treat a variety of comorbid conditions. Polypharmacy accompanied by alterations in the pharmacokinetics of medications places hemodialysis patients at increased risk of drug accumulation and adverse events. AREAS COVERED We review alterations in the pharmacokinetics of drugs in hemodialysis patients. The major areas of pharmacokinetics, absorption, distribution, metabolism and excretion, are covered and, where appropriate, differences between dialysis patients and non-dialysis CKD patients are compared. In addition, we review the importance of drug dialyzability and its potential impact on drug efficacy. Finally, we describe important clinical examples demonstrating nonrenal drug clearance is significantly altered in CKD. EXPERT OPINION Decreases in renal drug excretion experienced by hemodialysis patients have been known for years. Recent animal and human clinical pharmacokinetic studies have highlighted that nonrenal clearance of drugs is also substantially decreased in CKD. Clinical pharmacokinetic studies are required to determine the optimal dosage of drugs in CKD and hemodialysis patients in order to decrease the incidence of adverse medication events in these patient populations.
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Affiliation(s)
- Thomas J Velenosi
- Western University, Schulich School of Medicine and Dentistry, Department of Physiology and Pharmacology , London, Ontario , Canada
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92
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Saito H, Yoshimura M, Saigo C, Komori M, Nomura Y, Yamamoto Y, Sagata M, Wakida A, Chuman E, Nishi K, Jono H. Hepatic sulfotransferase as a nephropreventing target by suppression of the uremic toxin indoxyl sulfate accumulation in ischemic acute kidney injury. Toxicol Sci 2014; 141:206-17. [PMID: 24958931 DOI: 10.1093/toxsci/kfu119] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ischemia/reperfusion (I/R)-induced acute kidney injury (AKI) is evoked by diverse pathophysiological conditions and/or surgical procedures. Here, we evaluated the nephropreventive effect of sulfotransferase (SULT) inhibitors, quercetin, and resveratrol, which hamper hepatic indoxyl sulfate (IS) production. I/R of the kidney caused severe renal injury with marked accumulation of serum and renal IS and urinary excretion of kidney injury molecule-1. Oral administration of AST-120 resulted in a significant restoration of kidney injury, suggesting that uremic toxins, which can be suppressed or adsorbed by AST-120 in the intestine, contribute to the progression or development of I/R-induced AKI. Oral administration of resveratrol or quercetin, SULT inhibitors, suppressed IS accumulation, accompanied by significant amelioration of renal dysfunction. The expression of nuclear factor E2-related factor 2 (Nrf2) in the renal nuclear fractions was markedly elevated by renal I/R, but suppressed by treatment with SULT inhibitors. IS is primarily taken up by HK-2 cells derived from human proximal tubular cells via organic anion transporters, which then evokes activation of Nrf2, most likely due to intracellular oxidative stress. Renal basolateral organic anion transporters OAT1 and OAT3, which mediate renal tubular uptake of IS in basolateral membrane, were markedly downregulated by renal I/R, but restored by SULT inhibitors. Our results suggest that renal accumulation of IS in ischemic AKI induces oxidative stress and downregulation of organic anion transporters resulting in kidney damage, which could be restored to some extent by inhibiting hepatic SULT activity as a nephropreventive target.
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Affiliation(s)
- Hideyuki Saito
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Misato Yoshimura
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Chika Saigo
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Megumi Komori
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Yui Nomura
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Yuko Yamamoto
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Masataka Sagata
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Ayaka Wakida
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Erina Chuman
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Kazuhiko Nishi
- Department of Hemo-Dialysis, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hirofumi Jono
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
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93
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Lekawanvijit S, Krum H. Cardiorenal syndrome: acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins. J Physiol 2014; 592:3969-83. [PMID: 24907309 DOI: 10.1113/jphysiol.2014.273078] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) and kidney disease are closely interrelated. Disease of one organ can induce dysfunction of the other, ultimately leading to failure of both. Clinical awareness of synergistic adverse clinical outcomes in patients with coexisting CVD and kidney disease or 'cardiorenal syndrome (CRS)' has existed. Renal dysfunction, even mild, is a strong independent predictor for poor prognosis in CVD patients. Developing therapeutic interventions targeting acute kidney injury (AKI) has been limited due mainly to lack of effective tools to accurately detect AKI in a timely manner. Neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 have been recently demonstrated to be potential candidate biomarkers in patients undergoing cardiac surgery. However, further validation of AKI biomarkers is needed in other CVD settings, especially acute decompensated heart failure and acute myocardial infarction where AKI commonly occurs. The other concern with regard to understanding the pathogenesis of renal complications in CVD is that mechanistically oriented studies have been relatively rare. Pre-clininal studies have shown that activation of renal inflammation-fibrosis processes, probably triggered by haemodynamic derangement, underlies CVD-associated renal dysfunction. On the other hand, it is postulated that there still are missing links in the heart-kidney connection in CRS patients who have significant renal dysfunction. At present, non-dialysable protein-bound uraemic toxins (PBUTs) appear to be the main focus in this regard. Evidence of the causal role of PBUTs in CRS has been increasingly demonstrated, mainly focusing on indoxyl sulfate (IS) and p-cresyl sulfate (pCS). Both IS and pCS are derived from colonic microbiotic metabolism of dietary amino acids, and hence the colon has become a target of treatment in addition to efforts to improve dialysis techniques for better removal of PBUTs. Novel therapy targeting the site of toxin production has led to new prospects in early intervention for predialysis patients with chronic kidney disease.
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Affiliation(s)
- Suree Lekawanvijit
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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94
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Vanholder R, Schepers E, Pletinck A, Nagler EV, Glorieux G. The uremic toxicity of indoxyl sulfate and p-cresyl sulfate: a systematic review. J Am Soc Nephrol 2014; 25:1897-907. [PMID: 24812165 DOI: 10.1681/asn.2013101062] [Citation(s) in RCA: 469] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A growing number of publications supports a biologic effect of the protein-bound uremic retention solutes indoxyl sulfate and p-cresyl sulfate. However, the use of unrealistically high free concentrations of these compounds and/or inappropriately low albumin concentrations may blur the interpretation of these results. Here, we performed a systematic review, selecting only studies in which, depending on the albumin concentration, real or extrapolated free concentrations of indoxyl sulfate and p-cresyl sulfate remained in the uremic range. The 27 studies retrieved comprised in vitro and animal studies. A quality score was developed, giving 1 point for each of the following criteria: six or more experiments, confirmation by more than one experimental approach, neutralization of the biologic effect by counteractive reagents or antibodies, use of a real-life model, and use of dose-response analyses in vitro and/or animal studies. The overall average score was 3 of 5 points, with five studies scoring 5 of 5 points and six studies scoring 4 of 5 points, highlighting the superior quality of a substantial number of the retrieved studies. In the 11 highest scoring studies, most functional deteriorations were related to uremic cardiovascular disease and kidney damage. We conclude that our systematic approach allowed the retrieval of methodologically correct studies unbiased by erroneous conditions related to albumin binding. Our data seem to confirm the toxicity of indoxyl sulfate and p-cresyl sulfate and support their roles in vascular and renal disease progression.
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Affiliation(s)
| | - Eva Schepers
- Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | - Evi V Nagler
- Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Nephrology Section, Ghent University Hospital, Ghent, Belgium
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95
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Eloot S, Vanholder R, Dequidt C, Van Biesen W. Removal of Different Classes of Uremic Toxins in APD vs CAPD: A Randomized Cross-Over Study. Perit Dial Int 2014; 35:436-42. [PMID: 24584609 DOI: 10.3747/pdi.2013.00202] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/13/2013] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ AIM In this study, we investigated, and this for the different classes of uremic toxins, whether increasing dialysate volume by shifting from continuous ambulatory peritoneal dialysis (CAPD) to higher volume automated peritoneal dialysis (APD) increases total solute clearance. ♦ METHODS Patients on peritoneal dialysis were randomized in a cross-over design to one 24-hour session of first a CAPD regimen (3*2 L of Physioneal 1.36% and 1*2 L of icodextrin) or APD (consisting of 5 cycles of 2 L Physioneal 1.36 and 1 cycle of 2 L Extraneal), and the other week the alternate regime, each patient serving as his/her own control. Dialysate, blood and urine samples were collected and frozen for later batch analysis of concentrations of urea, creatinine, phosphorus, uric acid, hippuric acid, 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, indoxyl sulfate, indole acetic acid, and p-cresyl sulfate. For the protein-bound solutes, total and free fractions were determined. Total, peritoneal and renal clearance (K) and mass removal (MR) of each solute were calculated, using validated models. ♦ RESULTS In 15 patients (11 male, 3 diabetics, 56 ± 16 years, 8 on CAPD, time on peritoneal dialysis 12 ± 14 months, and residual renal function of 9.9 ± 5.4 mL/min) dialysate over plasma ratio for creatinine (D/Pcrea) was 0.62 ± 0.10. Drained volume and obtained ultrafiltration were higher with APD vs CAPD (13.3 ± 0.5 L vs 8.5 ± 0.7 L and 1.3 ± 0.5 L vs 0.5 ± 0.7 L), whereas urine output was lower (1.0 ± 0.5 L vs 1.4 ± 0.6 L). Total clearance and MR tended to be higher for CAPD vs APD for all small and water soluble solutes, but mainly because of higher renal contribution, with no difference in the peritoneal contribution. For the protein-bound solutes, no differences in clearance or mass removal were observed. ♦ CONCLUSION Although the drained dialysate volume nearly doubled, APD did not result in better peritoneal clearance or solute removal vs classic CAPD. APD resulted in better ultrafiltration, but at the expense of residual urinary output and clearance.
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Affiliation(s)
- Sunny Eloot
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| | - Raymond Vanholder
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| | - Clement Dequidt
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| | - Wim Van Biesen
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
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96
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Abstract
Cardiorenal syndrome (CRS) includes a broad spectrum of diseases within which both the heart and kidneys are involved, acutely or chronically. An effective classification of CRS in 2008 essentially divides CRS in two main groups, cardiorenal and renocardiac CRS, based on primum movens of disease (cardiac or renal); both cardiorenal and renocardiac CRS are then divided into acute and chronic, according to onset of disease. The fifth type of CRS integrates all cardiorenal involvement induced by systemic disease. This article addresses the pathophysiology, diagnosis, treatment, and outcomes of the 5 distinct types of CRS.
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Affiliation(s)
- Claudio Ronco
- International Renal Research Institute, S. Bortolo Hospital, Viale F. Ridolfi 37, Vicenza 36100, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi-Delfino Hospital, Piazza A. Moro, Colleferro, Roma 1-00034, Italy.
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97
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Poveda J, Sanchez-Niño MD, Glorieux G, Sanz AB, Egido J, Vanholder R, Ortiz A. p-Cresyl sulphate has pro-inflammatory and cytotoxic actions on human proximal tubular epithelial cells. Nephrol Dial Transplant 2014; 29:56-64. [DOI: 10.1093/ndt/gft367] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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98
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How to explain and exploit the beneficial effects of high-volume hemofiltration on hemodynamics and strong ion gap. Intensive Care Med 2013; 39:1140-2. [PMID: 23361626 DOI: 10.1007/s00134-013-2820-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 01/06/2013] [Indexed: 01/20/2023]
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99
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Piroddi M, Bartolini D, Ciffolilli S, Galli F. Nondialyzable Uremic Toxins. Blood Purif 2013; 35 Suppl 2:30-41. [DOI: 10.1159/000350846] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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