101
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Velenosi TJ, Thomson BKA, Tonial NC, RaoPeters AAE, Mio MA, Lajoie GA, Garg AX, House AA, Urquhart BL. Untargeted metabolomics reveals N, N, N-trimethyl-L-alanyl-L-proline betaine (TMAP) as a novel biomarker of kidney function. Sci Rep 2019; 9:6831. [PMID: 31048706 PMCID: PMC6497643 DOI: 10.1038/s41598-019-42992-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/08/2019] [Indexed: 01/19/2023] Open
Abstract
The diagnosis and prognosis of chronic kidney disease (CKD) currently relies on very few circulating small molecules, which can vary by factors unrelated to kidney function. In end-stage renal disease (ESRD), these same small molecules are used to determine dialysis dose and dialytic clearance. Therefore, we aimed to identify novel plasma biomarkers to estimate kidney function in CKD and dialytic clearance in ESRD. Untargeted metabolomics was performed on plasma samples from patients with a single kidney, non-dialysis CKD, ESRD and healthy controls. For ESRD patients, pre- and post-dialysis plasma samples were obtained from several dialysis modalities. Metabolomics analysis revealed over 400 significantly different features in non-dialysis CKD and ESRD plasma compared to controls while less than 35 features were significantly altered in patients with a single kidney. N,N,N-trimethyl-L-alanyl-L-proline betaine (TMAP, AUROC = 0.815) and pyrocatechol sulfate (AUROC = 0.888) outperformed creatinine (AUROC = 0.745) in accurately identifying patients with a single kidney. Several metabolites accurately predicted ESRD; however, when comparing pre-and post-hemodialysis, TMAP was the most robust biomarker of dialytic clearance for all modalities (AUROC = 0.993). This study describes TMAP as a novel potential biomarker of kidney function and dialytic clearance across several hemodialysis modalities.
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Affiliation(s)
- Thomas J Velenosi
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
| | - Benjamin K A Thomson
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
| | - Nicholas C Tonial
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
| | - Adrien A E RaoPeters
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
| | - Megan A Mio
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
| | - Gilles A Lajoie
- Department of Biochemistry, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada.,Lawson Health Research Institute, London, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada.,Lawson Health Research Institute, London, Canada
| | - Bradley L Urquhart
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada. .,Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada. .,Lawson Health Research Institute, London, Canada.
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102
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Tao S, Tao S, Cheng Y, Liu J, Ma L, Fu P. Effects of probiotic supplements on the progression of chronic kidney disease: A meta-analysis. Nephrology (Carlton) 2019; 24:1122-1130. [PMID: 30561114 DOI: 10.1111/nep.13549] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a worldwide public health problem. Although accumulated data suggested that probiotic supplements played roles in CKD, the results remained controversial. Here, we performed a meta-analysis to assess the effects of probiotic supplements on the CKD progression. METHODS A systematic search was conducted through the PubMed, Embase and Cochrane databases until September 2018. Randomized controlled trials with control receiving placebo, evaluating the effects of probiotic supplements on CKD were included. RESULTS A total of 10 randomized controlled trials in 8 countries were selected. In the meta-analysis, urea level was significantly reduced in probiotics-administrated non-dialysis patients (mean differences (MD) = -30.01; 95% confidence interval (CI) = [-56.78, -3.25]; P = 0.03) while no significant change was found in the dialysis patients receiving probiotics (MD = 0.1; 95% CI = [-9.28, 9.48]; P = 0.98). Probiotic supplements also exhibited no effect on uric acid (MD = -0.43; 95% CI = [-1.19, 0.33]; P = 0.27), C-reactive protein (MD = -0.48; 95% CI = [-1.29, 0.33]; P = 0.24), creatinine (MD = -0.18; 95% CI = [-0.82, 0.47]; P = 0.59), and estimated glomerular filtration rate (MD = 2.10; 95% CI = [-1.31, 5.52]; P = 0.23) of CKD patients. CONCLUSION Our results highlighted that probiotic supplements exerted a statistically significant effect on urea levels in non-dialysis CKD population, while no evidence suggested that probiotics possessed meaningful impacts on the reduction of uric acid, C-reactive protein, creatinine and estimated glomerular filtration rate preservation of CKD population.
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Affiliation(s)
- Sibei Tao
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Siying Tao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cardiology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yiming Cheng
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Liu
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Liang Ma
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
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103
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Toxines urémiques de moyen poids moléculaire : un véritable regain d’intérêt. Nephrol Ther 2019; 15:82-90. [DOI: 10.1016/j.nephro.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/02/2018] [Indexed: 01/20/2023]
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104
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Gu YH, Yang XH, Pan LH, Zhan XL, Guo LL, Jin HM. Additional hemoperfusion is associated with improved overall survival and self-reported sleep disturbance in patients on hemodialysis. Int J Artif Organs 2019; 42:347-353. [PMID: 30917741 DOI: 10.1177/0391398819837546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Patients with maintenance hemodialysis have experienced long-standing sleep disturbance. In this study, we attempted to explore whether long-term hemoperfusion could improve sleep and increase the overall survival in hemodialysis patients. Methods: A total of 158 patients, who underwent routine hemodialysis, were assessed in this study. These patients were computer-matched into two groups, with one group including 80 patients with absolute hemodialysis and the other consisting of 78 cases with hemodialysis in combination with hemoperfusion. Hemoperfusion was performed 1–2 times biweekly, with each session lasting 2 h. Self-reported sleep disturbance was evaluated before and after the observational time (2-year period); sleep quality was measured using the Pittsburgh Sleep Quality Index. Findings: Using multivariate regression analyses, we found sleep duration was associated with age, diabetes, low income, pruritus, hyperphosphatemia, hypercalcemia, high parathyroid hormone, and hemoglobin ( P < 0.001). The overall survival rate of the hemodialysis in combination with hemoperfusion group was significantly higher than that of the absolute hemodialysis group ( P < 0.05) after adjusting for sex, age, and diabetes. A 2-year hemoperfusion therapy was associated with improved sleep disturbance and sleep efficiency; this was accompanied by an increase in nocturnal melatonin levels. Furthermore, there was a significant difference in the first hospitalization between the hemodialysis and hemodialysis in combination with hemoperfusion groups ( P < 0.01). Discussion: Our results indicated that hemoperfusion in combination with hemodialysis is associated with an increase in the overall survival and improved sleep disorders in hemodialysis patients.
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Affiliation(s)
- Yan Hong Gu
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiu Hong Yang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Li Hua Pan
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiao Li Zhan
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Li Li Guo
- Hemodialysis Center, Bao Shan Branch of No.1 People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Min Jin
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
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105
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Wang W, Hao G, Pan Y, Ma S, Yang T, Shi P, Zhu Q, Xie Y, Ma S, Zhang Q, Ruan H, Ding F. Serum indoxyl sulfate is associated with mortality in hospital-acquired acute kidney injury: a prospective cohort study. BMC Nephrol 2019; 20:57. [PMID: 30764800 PMCID: PMC6376694 DOI: 10.1186/s12882-019-1238-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/29/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Protein-bound uremic toxins are associated with poor outcomes in patients with chronic kidney disease. The aim of this study is to investigate the relationship between indoxyl sulfate (IS), a protein-bound solute, and 90-day mortality in patients with acute kidney injury. METHODS Adults with hospital-acquired AKI (HA-AKI) were enrolled in this prospective cohort study between 2014 and 2015, according to the KDIGO creatinine criteria. The primary end point was all-cause death during follow-up. RESULTS The mean serum IS level in patients with HA-AKI was 2.74 ± 0.75 μg/ml, which was higher than that in healthy subjects (1.73 ± 0.11 μg/ml, P < 0.001) and critically ill patients (2.46 ± 0.35 μg/ml, P = 0.016) but was lower than that in patients with chronic kidney disease (3.07 ± 0.31 μg/ml, P < 0.001). Furthermore, serum IS levels (2.83 ± 0.55 μg/ml) remained elevated in patients with HA-AKI on the seventh day after AKI diagnosis. Patients with HA-AKI were divided into the following two groups according to the median serum IS level: the low-IS group and the high-IS group. A total of 94 (35.9%) patient deaths occurred within 90 days, including 76 (29.0%) in the low-IS group and 112 (42.7%) in the high-IS group (P = 0.019). Kaplan-Meier analysis revealed that the two groups differed significantly with respect to 90-day survival (log-rank P = 0.007), and Cox regression analysis showed that an IS level ≥ 2.74 μg/ml was significantly associated with a 2.0-fold increased risk of death (adjusted hazard ratio [HR], 2.92; 95% confidence interval [CI], 1.76 to 4.86; P < 0.001) compared with an IS level < 2.74 μg/ml. CONCLUSIONS Serum IS levels were significantly elevated in patients with HA-AKI compared to those in healthy subjects and critically ill patients and were associated with a worse prognosis of HA-AKI. TRIAL REGISTRATION www.clinicaltrials.gov NCT 00953992. Registered 6 August 2009.
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Affiliation(s)
- Wenji Wang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Guihua Hao
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yu Pan
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Shuai Ma
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Tianye Yang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Peng Shi
- Department of Medical Statistics, Children's Hospital; Center for Evidence-based Medicine, Fudan University, Shanghai, 200433, China
| | - Qiuyu Zhu
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yingxin Xie
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Shaojun Ma
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qi Zhang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Hong Ruan
- Department of Nursing, Clinical Medical School, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Feng Ding
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China.
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106
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Hamed SA. Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:61-90. [PMID: 30501441 DOI: 10.1080/17512433.2019.1555468] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sherifa A. Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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107
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Wu Y, Jin S, Zhang L, Cheng J, Hu X, Chen H, Zhang Y. Minimum Alveolar Concentration-Awake of Sevoflurane Is Decreased in Patients With End-Stage Renal Disease. Anesth Analg 2019; 128:77-82. [DOI: 10.1213/ane.0000000000003676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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108
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Syed-Ahmed M, Narayanan M. Immune Dysfunction and Risk of Infection in Chronic Kidney Disease. Adv Chronic Kidney Dis 2019; 26:8-15. [PMID: 30876622 DOI: 10.1053/j.ackd.2019.01.004] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/16/2019] [Indexed: 02/08/2023]
Abstract
Cardiovascular disease and infections are directly or indirectly associated with an altered immune response, which leads to a high incidence of morbidity and mortality, and together, they account for up to 70% of all deaths among patients with chronic kidney dysfunction. Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response. On the other hand, an abnormal, exaggerated reaction of the immune systems can also occur in this group of patients, resulting in increased production and decreased clearance of proinflammatory cytokines, which can lead to inflammation and its sequelae (eg, atherosclerotic cardiovascular disease). Epigenetically, modifications in hematopoietic stem cells involving a shift from lymphoid to myeloid cell lineage may underlie uremia-associated immunological senescence, which is not reversed by renal replacement therapy, including kidney transplantation. Measures aimed at attenuating the immune abnormalities in chronic kidney disease/end-stage renal disease should be an area of focused research as this could potentially lead to a better understanding and, thus, development of therapies that could reduce the disastrously high death rate in this patient population. The aim of the present article is to review the characteristics, causes, and mechanisms of the immune dysfunction related to chronic kidney disease.
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109
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Chen YZ, Sun DQ, Zheng Y, Zheng GK, Chen RQ, Lin M, Huang LF, Huang C, Song D, Wu BQ. WISP1 silencing confers protection against epithelial-mesenchymal transition of renal tubular epithelial cells in rats via inactivation of the wnt/β-catenin signaling pathway in uremia. J Cell Physiol 2018; 234:9673-9686. [PMID: 30556898 DOI: 10.1002/jcp.27654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 12/30/2022]
Abstract
Uremia can affect hepatic metabolism of drugs by regulating the clearance of drugs, but it has not been clarified whether gene silencing could modulate the epithelial-mesenchymal transition (EMT) process in uremia. Hence, we investigated the effect of WISP1 gene silencing on the renal tubular EMT in uremia through the wnt/β-catenin signaling pathway. Initially, microarray-based gene expression profiling of uremia was used to identify differentially expressed genes. Following the establishment of uremia rat model, serum creatinine, and urea nitrogen of rats were detected. Renal tubular epithelial cells (TECs) were transfected with shRNA-WISP1 lentivirus interference vectors and LiCI (the wnt/β-catenin signaling pathway activator) to explore the regulatory mechanism of WISP1 in uremia in relation to the wnt/β-catenin signaling pathway. Then, expression of WISP1, wnt2b, E-cadherin, α-SMA, c-myc, Cyclin D1, MMP-2, and MMP-9 was determined. Furthermore, TEC migration and invasion were evaluated. Results suggested that WISP1 and the wnt/β-catenin signaling pathway were associated with uremia. Uremic rats exhibited increased serum creatinine and urea nitrogen levels, upregulated WISPl, and activated wnt/β-catenin signaling pathway. Subsequently, WISP1 silencing decreased wnt2b, c-myc, Cyclin D1, α-SMA, MMP-2, and MMP-9 expression but increased E-cadherin expression, whereas LiCI treatment exhibited the opposite trends. In addition, WISP1 silencing suppressed TEC migration and invasion, whereas LiCI treatment promoted TEC migration and invasion. The findings indicate that WISP1 gene silencing suppresses the activation of the wnt/β-catenin signaling pathway, thus reducing EMT of renal TECs in uremic rats.
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Affiliation(s)
- Yuan-Zhen Chen
- Department of Nephrology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Dan-Qin Sun
- Department of Nephrology, Wuxi No. 2 People's Hospital, Nanjing Medical University, Wuxi, China
| | - Yi Zheng
- Central Laboratory, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China.,Central Laboratory, Huadu District People's Hospital, Southern Medical University, Guangzhou, China
| | - Guang-Kuai Zheng
- Department of Nephrology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Rong-Quan Chen
- Department of Nephrology, Wuxi No. 2 People's Hospital, Nanjing Medical University, Wuxi, China
| | - Mei Lin
- Department of Nephrology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Lian-Fang Huang
- Department of Nephrology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Cong Huang
- Department of Nephrology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Dan Song
- Department of Nephrology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Ben-Qing Wu
- Children's Medical Center, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
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110
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Llopis‐Lorente A, Villalonga R, Marcos MD, Martínez‐Máñez R, Sancenón F. A Versatile New Paradigm for the Design of Optical Nanosensors Based on Enzyme‐Mediated Detachment of Labeled Reporters: The Example of Urea Detection. Chemistry 2018; 25:3575-3581. [DOI: 10.1002/chem.201804706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Antoni Llopis‐Lorente
- Instituto de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)Universitat Politècnica de València, Universitat de València Spain
- Departamento de QuímicaUniversitat Politècnica de València Camino de Vera s/n 46022 Valencia Spain
- CIBER de BioingenieríaBiomateriales y Nanomedicina, (CIBER-BBN) Spain
| | - Reynaldo Villalonga
- Department of Analytical Chemistry, Faculty of ChemistryComplutense University of Madrid 28040 Madrid Spain
| | - M. Dolores Marcos
- Instituto de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)Universitat Politècnica de València, Universitat de València Spain
- Departamento de QuímicaUniversitat Politècnica de València Camino de Vera s/n 46022 Valencia Spain
- CIBER de BioingenieríaBiomateriales y Nanomedicina, (CIBER-BBN) Spain
- Unidad Mixta de Investigación en Nanomedicina y SensoresUniversitat Politècnica de València, Instituto de Investigación Sanitaria La Fe Valencia Spain
- Unidad Mixta UPV-CIPF de Investigación en Mecanismos de, Enfermedades y NanomedicinaUniversitat Politècnica de València, Centro de Investigación Príncipe Felipe Valencia Spain
| | - Ramón Martínez‐Máñez
- Instituto de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)Universitat Politècnica de València, Universitat de València Spain
- Departamento de QuímicaUniversitat Politècnica de València Camino de Vera s/n 46022 Valencia Spain
- CIBER de BioingenieríaBiomateriales y Nanomedicina, (CIBER-BBN) Spain
- Unidad Mixta de Investigación en Nanomedicina y SensoresUniversitat Politècnica de València, Instituto de Investigación Sanitaria La Fe Valencia Spain
- Unidad Mixta UPV-CIPF de Investigación en Mecanismos de, Enfermedades y NanomedicinaUniversitat Politècnica de València, Centro de Investigación Príncipe Felipe Valencia Spain
| | - Félix Sancenón
- Instituto de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)Universitat Politècnica de València, Universitat de València Spain
- Departamento de QuímicaUniversitat Politècnica de València Camino de Vera s/n 46022 Valencia Spain
- CIBER de BioingenieríaBiomateriales y Nanomedicina, (CIBER-BBN) Spain
- Unidad Mixta de Investigación en Nanomedicina y SensoresUniversitat Politècnica de València, Instituto de Investigación Sanitaria La Fe Valencia Spain
- Unidad Mixta UPV-CIPF de Investigación en Mecanismos de, Enfermedades y NanomedicinaUniversitat Politècnica de València, Centro de Investigación Príncipe Felipe Valencia Spain
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111
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Tandukar S, Palevsky PM. Continuous Renal Replacement Therapy: Who, When, Why, and How. Chest 2018; 155:626-638. [PMID: 30266628 DOI: 10.1016/j.chest.2018.09.004] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/29/2018] [Accepted: 09/12/2018] [Indexed: 01/31/2023] Open
Abstract
Continuous renal replacement therapy (CRRT) is commonly used to provide renal support for critically ill patients with acute kidney injury, particularly patients who are hemodynamically unstable. A variety of techniques that differ in their mode of solute clearance may be used, including continuous venovenous hemofiltration with predominantly convective solute clearance, continuous venovenous hemodialysis with predominantly diffusive solute clearance, and continuous venovenous hemodiafiltration, which combines both dialysis and hemofiltration. The present article compares CRRT with other modalities of renal support and reviews indications for initiation of renal replacement therapy, as well as dosing and technical aspects in the management of CRRT.
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Affiliation(s)
- Srijan Tandukar
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Paul M Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Renal Section, Medical Service, VA Pittsburgh Healthcare System, Pittsburgh, PA.
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112
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Hu DY, Luo Y, Li CB, Zhou CY, Li XH, Peng A, Liu JY. Oxylipin profiling of human plasma reflects the renal dysfunction in uremic patients. Metabolomics 2018; 14:104. [PMID: 30830362 DOI: 10.1007/s11306-018-1402-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/26/2018] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Nearly all the enzymes that mediate the metabolism of polyunsaturated fatty acids (PUFAs) are present in the kidney. However, the correlation of renal dysfunction with PUFAs metabolism in uremic patients remains unknown. OBJECTIVES To test whether the alterations in the metabolism of PUFAs reflect the renal dysfunction in uremic patients. METHODS LC-MS/MS-based oxylipin profiling was conducted for the plasma samples from the uremic patients and controls. The data were analyzed by principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA). The receiver operating characteristic (ROC) curves and the correlation of the estimated glomerular filtration rate (eGFR) with the key markers were evaluated. Furthermore, qPCR analysis of the whole blood cells was conducted to investigate the possible mechanisms. In addition, a 2nd cohort was used to validate the findings from the 1st cohort. RESULTS The plasma oxylipin profile distinguished the uremic patients from the controls successfully by using both PCA and OPLS-DA models. 5,6-Dihydroxyeicosatrienoic acid (5,6-DHET), 5-hydroxyeicosatetraenoic acid (5-HETE), 9(10)-epoxyoctadecamonoenoic acid [9(10)-EpOME] and 12(13)-EpOME were identified as the key markers to discriminate the patients from controls. The excellent predictive performance of these four markers was validated by ROC analysis. The eGFR significantly correlated with plasma levels of 5,6-DHET and 5-HETE positively but with plasma 9(10)-EpOME and 12(13)-EpOME negatively. The changes of these markers may account for the inactivation of cytochrome P450 2C18, 2C19, microsome epoxide hydrolase (EPHX1), and 5-lipoxygenase in the patients. CONCLUSION The alterations in plasma metabolic profile reflect the renal dysfunction in the uremic patients.
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Affiliation(s)
- Da-Yong Hu
- Division of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Center for Nephrology and Metabolomics, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ying Luo
- Division of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Center for Nephrology and Metabolomics, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chang-Bin Li
- Division of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Center for Nephrology and Metabolomics, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chun-Yu Zhou
- Division of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Center for Nephrology and Metabolomics, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xin-Hua Li
- Division of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Center for Nephrology and Metabolomics, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ai Peng
- Division of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Center for Nephrology and Metabolomics, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jun-Yan Liu
- Division of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Center for Nephrology and Metabolomics, Tongji University School of Medicine, Shanghai, People's Republic of China.
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González-Mateo GT, Pascual-Antón L, Sandoval P, Aguilera Peralta A, López-Cabrera M. Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis. J Vis Exp 2018. [PMID: 30080204 DOI: 10.3791/56746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Peritoneal dialysis (PD) is a renal replacement therapy consistent on the administration and posterior recovery of a hyperosmotic fluid in the peritoneal cavity to drain water and toxic metabolites that functionally-insufficient kidneys are not able to eliminate. Unfortunately, this procedure deteriorates the peritoneum. Tissue damage triggers the onset of inflammation to heal the injury. If the injury persists and inflammation becomes chronic, it may lead to fibrosis, which is a common occurrence in many diseases. In PD, chronic inflammation and fibrosis, along with other specific processes related to these ones, lead to ultrafiltration capacity deterioration, which means the failure and subsequent cessation of the technique. Working with human samples provides information about this deterioration but presents technical and ethical limitations to obtain biopsies. Animal models are essential to study this deterioration since they overcome these shortcomings. A chronic mouse infusion model was developed in 2008, which benefits from the wide range of genetically modified mice, opening up the possibility of studying the mechanisms involved. This model employs a customized device designed for mice, consisting of a catheter attached to an access port that is placed subcutaneously at the back of the animal. This procedure avoids continuous puncture of the peritoneum during long-term experiments, reducing infections and inflammation due to injections. Thanks to this model, peritoneal damage induced by chronic PD fluid exposure has been characterized and modulated. This technique allows the infusion of large volumes of fluids and could be used for the study of other diseases in which inoculation of drugs or other substances over extended periods of time is necessary. This article shows the method for the surgical placement of the catheter in mice. Moreover, it explains the procedure for a 5/6 nephrectomy to mimic the state of renal insufficiency present in PD patients.
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Affiliation(s)
- Guadalupe Tirma González-Mateo
- Molecular Biology Research Centre Severo Ochoa, Spanish National Research Council; IdiPAZ Research Institute, La Paz University Hospital;
| | - Lucía Pascual-Antón
- Molecular Biology Research Centre Severo Ochoa, Spanish National Research Council
| | - Pilar Sandoval
- Molecular Biology Research Centre Severo Ochoa, Spanish National Research Council
| | | | - Manuel López-Cabrera
- Molecular Biology Research Centre Severo Ochoa, Spanish National Research Council
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Intestinal Barrier Function in Chronic Kidney Disease. Toxins (Basel) 2018; 10:toxins10070298. [PMID: 30029474 PMCID: PMC6071212 DOI: 10.3390/toxins10070298] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022] Open
Abstract
The kidneys are key contributors to body homeostasis, by virtue of controlled excretion of excessive fluid, electrolytes, and toxic waste products. The syndrome of uremia equals the altered physiology due to irreversible loss of kidney function that is left uncorrected for, despite therapeutic intervention(s). The intestines and its microbial content are prime contributors to this syndrome. The intestinal barrier separates the self (or the so-called “milieu intérior”) from the environment. In the large intestine, the intestinal barrier keeps apart human physiology and the microbiota. The enterocytes and the extracellular mucin layer functions form a complex multilayered structure, facilitating complex bidirectional metabolic and immunological crosstalk. The current review focuses on the intestinal barrier in chronic kidney disease (CKD). Loss of kidney function results in structural and functional alterations of the intestinal barrier, contribution to the syndrome of uremia.
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Velasquez MT, Centron P, Barrows I, Dwivedi R, Raj DS. Gut Microbiota and Cardiovascular Uremic Toxicities. Toxins (Basel) 2018; 10:E287. [PMID: 29997362 PMCID: PMC6071268 DOI: 10.3390/toxins10070287] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) remains a major cause of high morbidity and mortality in patients with chronic kidney disease (CKD). Numerous CVD risk factors in CKD patients have been described, but these do not fully explain the high pervasiveness of CVD or increased mortality rates in CKD patients. In CKD the loss of urinary excretory function results in the retention of various substances referred to as "uremic retention solutes". Many of these molecules have been found to exert toxicity on virtually all organ systems of the human body, leading to the clinical syndrome of uremia. In recent years, an increasing body of evidence has been accumulated that suggests that uremic toxins may contribute to an increased cardiovascular disease (CVD) burden associated with CKD. This review examined the evidence from several clinical and experimental studies showing an association between uremic toxins and CVD. Special emphasis is addressed on emerging data linking gut microbiota with the production of uremic toxins and the development of CKD and CVD. The biological toxicity of some uremic toxins on the myocardium and the vasculature and their possible contribution to cardiovascular injury in uremia are also discussed. Finally, various therapeutic interventions that have been applied to effectively reduce uremic toxins in patients with CKD, including dietary modifications, use of prebiotics and/or probiotics, an oral intestinal sorbent that adsorbs uremic toxins and precursors, and innovative dialysis therapies targeting the protein-bound uremic toxins are also highlighted. Future studies are needed to determine whether these novel therapies to reduce or remove uremic toxins will reduce CVD and related cardiovascular events in the long-term in patients with chronic renal failure.
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Affiliation(s)
- Manuel T Velasquez
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC 20037, USA.
| | - Patricia Centron
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC 20037, USA.
| | - Ian Barrows
- Department of Medicine, Georgetown University, Washington, DC 20007, USA.
| | - Rama Dwivedi
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC 20037, USA.
- United States Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Dominic S Raj
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC 20037, USA.
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Ribeiro HS, Oliveira MC, Anastácio LR, Generoso SV, Lima AS, Correia MI. PREVALENCE AND RISK FACTORS OF HYPERKALEMIA AFTER LIVER TRANSPLANTATION. ACTA ACUST UNITED AC 2018; 31:e1357. [PMID: 29947691 PMCID: PMC6050000 DOI: 10.1590/0102-672020180001e1357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is a lack of data regarding hyperkalemia after liver transplantation. AIM To evaluate the prevalence of hyperkalemia after liver transplantation and its associated factors. METHODS This retrospective cohort study evaluated 147 consecutive post-transplant patients who had at least one year of outpatient medical follow up. The data collection included gender, age, potassium values, urea, creatinine, sodium and medication use at 1, 6 and 12 months after. Hyperkalemia was defined as serum potassium concentrations higher than 5.5 mEq/l. RESULTS Hiperkalemia was observed in 18.4%, 17.0% and 6.1% of patients 1, 6 and 12 months after tranplantation, respectively. Older age (p=0.021), low creatinine clearance (p=0.007), increased urea (p=0.010) and hypernatremia (p=0.014) were factors associated with hyperkalemia, as well as the dose of prednisone at six months (p=0.014). CONCLUSION Hyperkalemia was prevalent in less than 20% of patients in the 1st month after liver transplantation and decreased over time. Considering that hyperkalemia does not affect all patients, attention should be paid to the routine potassium intake recommendations, and treatment should be individualized.
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Affiliation(s)
- Helem Sena Ribeiro
- Postgraduate Program in Applied Sciences for Surgery, Faculty of Medicine
| | | | | | | | - Agnaldo Soares Lima
- Hospital das Clínicas, Alpha Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Isabel Correia
- Hospital das Clínicas, Alpha Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Vanholder R, Van Laecke S, Glorieux G, Verbeke F, Castillo-Rodriguez E, Ortiz A. Deleting Death and Dialysis: Conservative Care of Cardio-Vascular Risk and Kidney Function Loss in Chronic Kidney Disease (CKD). Toxins (Basel) 2018; 10:E237. [PMID: 29895722 PMCID: PMC6024824 DOI: 10.3390/toxins10060237] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023] Open
Abstract
The uremic syndrome, which is the clinical expression of chronic kidney disease (CKD), is a complex amalgam of accelerated aging and organ dysfunctions, whereby cardio-vascular disease plays a capital role. In this narrative review, we offer a summary of the current conservative (medical) treatment options for cardio-vascular and overall morbidity and mortality risk in CKD. Since the progression of CKD is also associated with a higher cardio-vascular risk, we summarize the interventions that may prevent the progression of CKD as well. We pay attention to established therapies, as well as to novel promising options. Approaches that have been considered are not limited to pharmacological approaches but take into account lifestyle measures and diet as well. We took as many randomized controlled hard endpoint outcome trials as possible into account, although observational studies and post hoc analyses were included where appropriate. We also considered health economic aspects. Based on this information, we constructed comprehensive tables summarizing the available therapeutic options and the number and kind of studies (controlled or not, contradictory outcomes or not) with regard to each approach. Our review underscores the scarcity of well-designed large controlled trials in CKD. Nevertheless, based on the controlled and observational data, a therapeutic algorithm can be developed for this complex and multifactorial condition. It is likely that interventions should be aimed at targeting several modifiable factors simultaneously.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Steven Van Laecke
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Francis Verbeke
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | | | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain.
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Schubert CR, Paulsen AJ, Nondahl DM, Dalton DS, Fischer ME, Klein BEK, Klein R, Tweed TS, Cruickshanks KJ. Association Between Cystatin C and 20-Year Cumulative Incidence of Hearing Impairment in the Epidemiology of Hearing Loss Study. JAMA Otolaryngol Head Neck Surg 2018; 144:469-474. [PMID: 29710267 PMCID: PMC6014887 DOI: 10.1001/jamaoto.2018.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/24/2018] [Indexed: 01/07/2023]
Abstract
Importance Hearing impairment (HI) is one of the most common conditions affecting older adults. Identification of factors associated with the development of HI may lead to ways to reduce the incidence of this condition. Objective To investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of HI. Design, Setting, and Participants Data were obtained from the Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study in Beaver Dam, Wisconsin. Baseline examinations began in 1993 and continued through 1995, and participants were examined approximately every 5 years, with the most recent examination phase completed in 2015. The EHLS participants with serum cystatin C concentration data and without HI at the baseline examination were included in this study. Main Outcomes and Measures Participants without HI were followed up for incident HI (pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz >25 dB hearing level in either ear) for 20 years. Cystatin C was analyzed as a biomarker (concentration) and used to determine estimated glomerular filtration rate (eGFRCysC). Discrete-time Cox proportional hazards regression models were used to analyze the association between cystatin C concentration and eGFRCysC and the 20-year cumulative incidence of HI. Results There were 863 participants aged 48 to 86 years with cystatin C data and without HI at baseline. Of these, 599 (69.4%) were women. In models adjusted for age and sex, cystatin C was associated with an increased risk of developing HI (hazard ratio [HR], 1.20; 95% CI, 1.07-1.34 per 0.2-mg/L increase in cystatin C concentration), but the estimate was attenuated after further adjusting for educational level, current smoking, waist circumference, and glycated hemoglobin (HR, 1.11; 95% CI, 0.98-1.27 per 0.2-mg/L increase in cystatin C concentration). Low eGFRCysC was significantly associated with the 20-year cumulative incidence of HI in both the age- and sex-adjusted model (HR, 1.70; 95% CI, 1.16-2.48; <60 vs ≥60 mL/min/1.73 m2) and the multivariable-adjusted model (HR, 1.50; 95% CI, 1.02-2.22; <60 vs ≥60 mL/min/1.73 m2). Conclusions and Relevance Reduced kidney function as estimated using cystatin C, but not cystatin C alone, was associated with the 20-year cumulative incidence of HI, suggesting that some age-related HI may occur in conjunction with or as the result of reduced kidney function.
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Affiliation(s)
- Carla R. Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Adam J. Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - David M. Nondahl
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Dayna S. Dalton
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Mary E. Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Barbara E. K. Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Ted S. Tweed
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Karen J. Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
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A patient-centred approach to measuring quality in kidney care: patient-reported outcome measures and patient-reported experience measures. Curr Opin Nephrol Hypertens 2018; 26:442-449. [PMID: 28806191 DOI: 10.1097/mnh.0000000000000357] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is associated with symptoms that can significantly reduce the health-related quality of life (HRQOL) of patients. Patient-reported outcome and experience measures (PROMs and PREMs) may assist with the evaluation of HRQOL and quality of care from the patient perspective. This review focuses on evidence from recent studies exploring the role of PROMs and PREMs in the measurement of quality in CKD care. RECENT FINDINGS PROMs are increasingly used in CKD research as measures of clinical effectiveness, whereas the current use of PROMs in routine clinical settings and PREMs in all settings is more limited. Electronic PROMs may be sensitive enough to detect clinically relevant patient-reported outcomes changes. Patients on frequent shorter-hours daily haemodialysis may experience better HRQOL compared with those on conventional haemodialysis. PROM data may correlate significantly with clinical parameters. PREMs are being utilized by healthcare professionals to inform service improvements. SUMMARY PROMs and PREMs may facilitate the measurement of quality in renal care and aid the tailoring of care to individual patients. PROMs may have a potential role as prognostic markers.
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Ellis RJ, Small DM, Ng KL, Vesey DA, Vitetta L, Francis RS, Gobe GC, Morais C. Indoxyl Sulfate Induces Apoptosis and Hypertrophy in Human Kidney Proximal Tubular Cells. Toxicol Pathol 2018; 46:449-459. [PMID: 29683083 DOI: 10.1177/0192623318768171] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Indoxyl sulfate (IS) is a protein-bound uremic toxin that accumulates in patients with declining kidney function. Although generally thought of as a consequence of declining kidney function, emerging evidence demonstrates direct cytotoxic role of IS on endothelial cells and cardiomyocytes, largely through the expression of pro-inflammatory and pro-fibrotic factors. The direct toxicity of IS on human kidney proximal tubular epithelial cells (PTECs) remains a matter of debate. The current study explored the effect of IS on primary cultures of human PTECs and HK-2, an immortalized human PTEC line. Pathologically relevant concentrations of IS induced apoptosis and increased the expression of the proapoptotic molecule Bax in both cell types. IS impaired mitochondrial metabolic activity and induced cellular hypertrophy. Furthermore, statistically significant upregulation of pro-fibrotic (transforming growth factor-β, fibronectin) and pro-inflammatory molecules (interleukin-6, interleukin-8, and tumor necrosis factor-α) in response to IS was observed. Albumin had no influence on the toxicity of IS. The results of this study suggest that IS directly induced a pro-inflammatory and pro-fibrotic phenotype in proximal tubular cells. In light of the associated apoptosis, hypertrophy, and metabolic dysfunction, this study demonstrates that IS may play a role in the progression of chronic kidney disease.
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Affiliation(s)
- Robert J Ellis
- 1 Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia.,2 Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - David M Small
- 1 Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia.,3 Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Keng Lim Ng
- 1 Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia.,2 Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - David A Vesey
- 1 Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia.,4 Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Luis Vitetta
- 5 Sydney Medical School, University of Sydney, Sydney, Australia.,6 Medlab Clinical, Sydney, Australia
| | - Ross S Francis
- 1 Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia.,4 Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Glenda C Gobe
- 1 Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Christudas Morais
- 1 Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
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Abstract
Chronic pruritus (>6 week's duration) in the geriatric population (≥65 years old), is an increasing health care problem. The pathophysiologic predisposing factors are abnormalities of the epidermal barrier, immune system, and nervous system. Causes can be dichotomized into histaminergic and nonhistaminergic pruritus. Topical treatments are generally safe. Systemic treatments are chosen depending on the condition, comorbid diseases, and drug interactions. Treatment options are limited. Progress has been made in identifying itch-selective mediators over the last decade. Numerous new medications are currently undergoing clinical trials and they are anticipated to enter the clinics in the near future.
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123
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Cazaña-Pérez V, Cidad P, Donate-Correa J, Martín-Núñez E, López-López JR, Pérez-García MT, Giraldez T, Navarro-González JF, Alvarez de la Rosa D. Phenotypic Modulation of Cultured Primary Human Aortic Vascular Smooth Muscle Cells by Uremic Serum. Front Physiol 2018; 9:89. [PMID: 29483881 PMCID: PMC5816230 DOI: 10.3389/fphys.2018.00089] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/26/2018] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic kidney disease (CKD) have a markedly increased incidence of cardiovascular disease (CVD). The high concentration of circulating uremic toxins and alterations in mineral metabolism and hormone levels produce vascular wall remodeling and significant vascular damage. Medial calcification is an early vascular event in CKD patients and is associated to apoptosis or necrosis and trans-differentiation of vascular smooth muscle cells (VSMC) to an osteogenic phenotype. VSMC obtained from bovine or rat aorta and cultured in the presence of increased inorganic phosphate (Pi) have been extensively used to study these processes. In this study we used human aortic VSMC primary cultures to compare the effects of increased Pi to treatment with serum obtained from uremic patients. Uremic serum induced calcification, trans-differentiation and phenotypic remodeling even with normal Pi levels. In spite of similar calcification kinetics, there were fundamental differences in osteochondrogenic marker expression and alkaline phosphatase induction between Pi and uremic serum-treated cells. Moreover, high Pi induced a dramatic decrease in cell viability, while uremic serum preserved it. In summary, our data suggests that primary cultures of human VSMC treated with serum from uremic patients provides a more informative model for the study of vascular calcification secondary to CKD.
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Affiliation(s)
- Violeta Cazaña-Pérez
- Departamento de Ciencias Médicas Básicas (Fisiología), Instituto de Tecnologías Biomédicas and Centro de Investigaciones Biomédicas de Canarias, Universidad de La Laguna, Tenerife, Spain.,Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Pilar Cidad
- Departamento de Bioquímica y Biología Molecular y Fisiología e Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid y Consejo Superior de Investigaciones Científicas (CSIC), Valladolid, Spain
| | - Javier Donate-Correa
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Ernesto Martín-Núñez
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - José R López-López
- Departamento de Bioquímica y Biología Molecular y Fisiología e Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid y Consejo Superior de Investigaciones Científicas (CSIC), Valladolid, Spain
| | - M Teresa Pérez-García
- Departamento de Bioquímica y Biología Molecular y Fisiología e Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid y Consejo Superior de Investigaciones Científicas (CSIC), Valladolid, Spain
| | - Teresa Giraldez
- Departamento de Ciencias Médicas Básicas (Fisiología), Instituto de Tecnologías Biomédicas and Centro de Investigaciones Biomédicas de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Juan F Navarro-González
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Diego Alvarez de la Rosa
- Departamento de Ciencias Médicas Básicas (Fisiología), Instituto de Tecnologías Biomédicas and Centro de Investigaciones Biomédicas de Canarias, Universidad de La Laguna, Tenerife, Spain
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Liu Y, Li J, Yu J, Wang Y, Lu J, Shang EX, Zhu Z, Guo J, Duan J. Disorder of gut amino acids metabolism during CKD progression is related with gut microbiota dysbiosis and metagenome change. J Pharm Biomed Anal 2018; 149:425-435. [DOI: 10.1016/j.jpba.2017.11.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 12/29/2022]
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Sircana A, De Michieli F, Parente R, Framarin L, Leone N, Berrutti M, Paschetta E, Bongiovanni D, Musso G. Gut microbiota, hypertension and chronic kidney disease: Recent advances. Pharmacol Res 2018; 144:390-408. [PMID: 29378252 DOI: 10.1016/j.phrs.2018.01.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/29/2017] [Accepted: 01/22/2018] [Indexed: 02/07/2023]
Abstract
A large number of different microbial species populates intestine. Extensive research has studied the entire microbial population and their genes (microbiome) by using metagenomics, metatranscriptomics and metabolomic analysis. Studies suggest that the imbalances of the microbial community causes alterations in the intestinal homeostasis, leading to repercussions on other systems: metabolic, nervous, cardiovascular, immune. These studies have also shown that alterations in the structure and function of the gut microbiota play a key role in the pathogenesis and complications of Hypertension (HTN) and Chronic Kidney Disease (CKD). Increased blood pressure (BP) and CKD are two leading risk factors for cardiovascular disease and their treatment represents a challenge for the clinicians. In this Review, we discuss mechanisms whereby gut microbiota (GM) and its metabolites act on downstream cellular targets to contribute to the pathogenesis of HTN and CKD, and potential therapeutic implications.
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Affiliation(s)
- Antonio Sircana
- Unità Operativa di Cardiologia, Azienda Ospedaliero Universitaria, Sassari, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Franco De Michieli
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Renato Parente
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Luciana Framarin
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Nicola Leone
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Mara Berrutti
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Elena Paschetta
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Daria Bongiovanni
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy
| | - Giovanni Musso
- HUMANITAS Gradenigo, University of Turin, Turin, Italy; Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy.
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Cherng YG, Lin CS, Shih CC, Hsu YH, Yeh CC, Hu CJ, Chen TL, Liao CC. Stroke risk and outcomes in patients with chronic kidney disease or end-stage renal disease: Two nationwide studies. PLoS One 2018; 13:e0191155. [PMID: 29329323 PMCID: PMC5766135 DOI: 10.1371/journal.pone.0191155] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022] Open
Abstract
Background and aims Because the risk and outcomes of stroke in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) were unclear, we evaluated these risks using a retrospective cohort study and a nested cohort study. Methods We used Taiwan’s National Health Insurance Research Database to identify 1378 patients aged ≥20 years who had ESRD in 2000–2004. An age- and sex-matched CKD cohort (n = 5512) and a control cohort (n = 11,024) were selected for comparison. Events of incident stroke were considered as outcome during the follow-up period in 2000–2013, and we calculated adjusted hazard ratios (HR) and 95% CIs of stroke associated with CKD or ESRD. We further used matching procedure with propensity score to estimate the risk of stroke for control group, CKD patients, and EDRD patients. A nested cohort study of 318,638 hospitalized stroke patients between 2000 and 2010 also was conducted to analyze the impact of CKD and ESRD on post-stroke mortality. Results Before propensity-score matching, the incidences of stroke for controls, CKD patients and ESRD patients were 6.57, 13.3, and 21.7 per 1000 person-years, respectively. Compared with control group, the adjusted HRs of stroke were 1.49 (95% CI, 1.32–1.68) and 2.39 (95% CI, 1.39–2.87) for people with CKD or ESRD respectively, and were significantly higher in both sexes and every age group. After propensity-score matching, the HRs of stroke for patients with CKD and ESRD were 1.51 (95% CI 1.24–1.85) and 2.08 (95% CI 1.32–3.26), respectively, during the follow-up period. Among hospitalized stroke patients, adjusted rate ratio (RR) of post-stroke mortality in CKD and ESRD cohorts were 1.44 (95% CI, 1.33–1.56) and 2.62 (95% CI, 2.43–2.82) respectively compared with control. Conclusions CKD and ESRD patient groups thus faced significantly higher risk of stroke and post-stroke mortality. Risk factor identification and preventive strategies are needed to minimize stroke risk and post-stroke mortality in these vulnerable patient groups.
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Affiliation(s)
- Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Program for the Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan
| | - Yung-Ho Hsu
- Department of Nephrology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Nephrology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, United States of America
| | - Chaur-Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- * E-mail: ,
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Martinez Cantarin MP, Whitaker-Menezes D, Lin Z, Falkner B. Uremia induces adipose tissue inflammation and muscle mitochondrial dysfunction. Nephrol Dial Transplant 2018; 32:943-951. [PMID: 28605780 DOI: 10.1093/ndt/gfx050] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/02/2017] [Indexed: 11/14/2022] Open
Abstract
Background. End-stage renal disease (ESRD) is associated with inflammation and increased reactive oxygen species (ROS). Inflammation and oxidative stress are associated with several complications of ESRD. The aim of this study was to determine histological characteristics of adipose tissue and muscle mitochondrial function in uremia and its relationship with inflammation. Methods. ESRD patients ( n = 18) and controls ( n = 6) were enrolled for studies of adipose and muscle tissue by immunohistochemistry and western blot. In a uremic muscle cell model, C2C12 cells were exposed to uremic serum and inflammatory cytokines. Mitochondrial function was studied by MitoTracker Orange, translocase of the mitochondrial outer membrane 20 (TOMM20) and mitochondrial oxidative phosphorylation complex subunit expression. Results. ESRD patients had increased macrophage infiltration in subcutaneous and visceral adipose tissue compared with controls, even in nonobese ESRD patients (P < 0.05). Compared with controls, TOMM20 expression in muscle tissue was lower in ESRD, consistent with reduced mitochondrial function (P < 0.05). C2C12 exposed to uremia had decreased mitotracker intensity (P < 0.05) and the reduced mitochondrial function was rescued by N-acetyl cysteine (P < 0.01). Similarly, C2C12 cells exposed to tumor necrosis factor α (TNF-α)/interleukin-6 (IL-6) have decreased mitotracker intensity (P < 0.01) that was rescued with adiponectin (P < 0.05). C2C12 exposed to TNF-α, IL-6 and buthionine sulfoximine had decreased TOMM20 expression and cells exposed to TNF-α showed a decrease in subunits of mitochondrial complexes I and III. Conclusion. Our data indicate that uremia is associated with increased adipose tissue macrophage infiltration and concurrent muscle tissue mitochondrial dysfunction induced by inflammation/ROS. Adipose tissue is a potential source of inflammation in ESRD that is not due to increased adiposity and may contribute to mitochondrial dysfunction in uremia.
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Affiliation(s)
- Maria P Martinez Cantarin
- Department of Medicine, Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Zhao Lin
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bonita Falkner
- Department of Medicine, Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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128
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House AA, Ronco C. Cardiovascular Risk in Hemodialysis Patients: A Mechanistic Approach. Int J Artif Organs 2018; 30:1020-7. [DOI: 10.1177/039139880703001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A new formula is proposed to express the excess burden of cardiovascular risk faced by hemodialysis patients as a function of various inherent, acquired and potentially modifiable factors. The proposed equation CVRHD = CVRB X f(([CKD+HD]/[HDtech+Dr])+X) includes the terms: CVRHD (cardiovascular risk in hemodialysis patients); CVRB (baseline cardiovascular risk); CKD (risk associated with chronic kidney disease); HD (risks associated with the process of hemodialysis); HDtech (benefits of new hemodialysis technologies); Dr (benefits of drug therapies) and X (unknown or putative factors influencing cardiovascular morbidity). We review the various factors included in this proposed formula, touching upon the epidemiology, pathophysiology and therapeutic implications, including possible strategies to modify risk. As is apparent from the formula, CKD and HD in particular act as risk multipliers in augmenting or amplifying the baseline cardiovascular risk, while new hemodialysis technologies may provide an opportunity for “cardioprotective dialysis.” Drug treatment may serve to mitigate some of the risk unique to this population.
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Affiliation(s)
- A. A. House
- University of Western Ontario Division of Nephrology, University Hospital, London Health Sciences Centre, London, Ontario - Canada
| | - C. Ronco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital, Vicenza - Italy
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Péterle VB, Souza JDO, Busato FDO, Eutrópio FJ, da Costa GDAP, Olivieri DN, Tadokoro CE. Clinical and hematological data to group different chronic kidney disease patients: A practical approach to establish different groups of patients. J Clin Lab Anal 2018; 32:e22377. [PMID: 29314251 DOI: 10.1002/jcla.22377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is the convergent point of several pathological processes, and its evolution is insidious and characterized by a progressive and irreversible loss of kidney function. This impaired function induces the accumulation of uremic toxins and individuals with terminal CKD often have altered physiological responses, including a persistent state of immuno-suppression and development of diseases. A better characterization and stratification of these patients with CKD in different immuno-compromised groups would contribute to more effective and personalized treatments. The focus of this study was to use two parameters to stratify patients with CKD into four separate groups that are representative of different immunological status. METHODS Patients with CKD were chosen randomly and stratified into four separate groups according to the period of time receiving dialysis treatment and leukocyte blood counts. The amount of apoptotic CD4 T cells were measured in each group of patients, and clinical/hematological parameters were correlated by multivariate analysis with each group. RESULTS Observations reveal that one of the four groups of patients with CKD (group 3) had more apoptotic CD4 T cells than the other group; this group also had an increased malnutrition inflammation score (MIS), an elevated Kt/V, and a higher incidence of smoking. CONCLUSION A simple two-parameter-based stratification strategy could be used to design effective immunological therapies that differentiate the degrees of immuno-suppression across groups of patients with CKD.
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Affiliation(s)
- Vinícius B Péterle
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Vila Velha, Vila Velha, Brazil
| | - Jéssica de O Souza
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Vila Velha, Vila Velha, Brazil
| | | | | | - Gisele de A P da Costa
- Programa de Pós-Graduação em Ecologia de Ecossistemas, Universidade Vila Velha, Vila Velha, Brazil
| | - David N Olivieri
- Escuela Superior de Ingeniería Informatica, University of Vigo, Vigo, Spain
| | - Carlos E Tadokoro
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Vila Velha, Vila Velha, Brazil.,Laboratory of Immunobiology, Universidade Vila Velha, Vila Velha, Brazil.,Programa de Pós-Graduação em Ecologia de Ecossistemas, Universidade Vila Velha, Vila Velha, Brazil
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130
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Layal K, Perdhana IS, Louisa M, Estuningtyas A, Soetikno V. The effects of quercetin on oxidative stress and fibrosis markers in chronic kidney disease rat model. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i3.1462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Oxidative stress may play a role in the pathogenesis of (CKD), Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcription factor involved in cell defense mechanism against oxidative stress. In this study, we examined the effect of quercetin, a polyphenplic antioxidant anti fibrosis compund in fruits and vegetables, on the 5/6 nephrectomy-induced CKD progression model rats through modulation of Nrf2 expression.Methods: Male Sprague-Dawley rats were randomly divided into normal control group (C), untreated 5/6 nephrectomy (Nx), quercetin-treated 5/6 nephrectomy (100 mg/kgBW/day orally) (NxQ), and captopril-treated 5/6 nephrectomy (10 mg/kgBW/day orally) (NxK) for 8 weeks. At the end of study, all animals were sacrified. Urine, blood, and kidney tissues were taken for examination of proteinuria, plasma creatinine, urea, malondialdehyde (MDA), glutathione peroxidase (GPx) activity, Nrf2, Keap1, heme oxygenase-1 (HO-1) expressions, and renal fibrosis.Results: Quercetin administration did not affect the level of protein in urine, plasma creatinine, and urea. However, it tended to reduce the level of MDA, increase GPx activity, Nrf2, Keap1, and HO-1 expression as well as the degree of fibrosis.Conclusion: In 5/6 nephrectomized rats, quercetin tended to ameliorate the level of MDA, GPx activity, Nrf2, Keap1, and HO-1 expression. In addition, quercetin tended to decrease the degree of fibrosis in the remnant kidney.
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131
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Ku E, Kopple JD, McCulloch CE, Warady BA, Furth SL, Mak RH, Grimes BA, Mitsnefes M. Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. Am J Kidney Dis 2017; 71:648-656. [PMID: 29132947 DOI: 10.1053/j.ajkd.2017.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/03/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD). STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study. PREDICTORS Repeated measurements of estimated glomerular filtration rate (eGFR) by serum creatinine concentration in our trajectory analysis using mixed models; change in BMI z score (per year) after eGFR decreased to <35mL/min/1.73m2 in logistic regression models. OUTCOMES Repeated measurements of BMI z score (as a reflection of weight status) in our trajectory analysis; ESRD in logistic regression models. RESULTS During a mean longitudinal follow-up of 3.4 years, BMI z scores remained stable until eGFR decreased to <35mL/min/1.73m2. When eGFR decreased to <35mL/min/1.73m2, a mean decline in BMI z score of 0.13 (95% CI, 0.09-0.17) was noted with each 10-mL/min/1.73m2 further decline in eGFR. This was statistically significantly different from the weight trajectory when eGFR was ≥35mL/min/1.73 m2 (P<0.001). Among children and adolescents with significant weight loss (defined as decline in BMI z score > 0.2 per year) after eGFR decreased to <35mL/min/1.73m2, the odds of ESRD was 3.28 (95% CI, 1.53-7.05) times greater compared with participants with stable BMI z scores (BMI z score change per year of 0-0.1). LIMITATIONS Observational nature of our study, lack of longitudinal assessments of inflammatory markers. CONCLUSIONS In children and adolescents with CKD, weight loss mostly occurs when eGFR decreases to <35mL/min/1.73m2, and this weight loss was associated with higher risk for ESRD. Further studies are needed to define the reasons for the association between weight loss and more rapid progression to ESRD in children and adolescents.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
| | - Joel D Kopple
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Susan L Furth
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert H Mak
- Division of Pediatric Nephrology, Department of Pediatrics, Rady Children's Hospital, La Jolla, CA
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Mark Mitsnefes
- Division of Pediatric Nephrology, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH
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132
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Lowenstein J, Grantham JJ. Residual renal function: a paradigm shift. Kidney Int 2017; 91:561-565. [PMID: 28202171 DOI: 10.1016/j.kint.2016.09.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 11/17/2022]
Abstract
Residual renal function (RRF) in patients undergoing dialysis treatments is currently viewed as glomerular filtrate that has escaped tubular reabsorption. RRF has been quantified as a clearance of urea or creatinine, or urea + creatinine. A major paradigm shift has followed the recognition that a substantial number of organic anion retention solutes (possible "uremic toxins") are protein-bound and therefore are not readily filtered. These protein-bound aryl compounds are secreted by renal tubular organic anion transporters (OATs). This has led to the recognition that RRF in dialysis patients probably represents not only unreabsorbed glomerular filtrate but also a contribution of renal tubular transporters that secrete organic anions. Tubular secretion of hippurate, indoxyl sulfate, and p-cresol sulfate, protein-bound organic anions retained in the plasma of end-stage renal disease patients, can be quantified and used to evaluate the integrity of a function dependent on active solute transport. Here we propose a shift away from the exclusive "glomerulocentric" view of RRF as unreabsorbed glomerular filtrate and of the progression of renal disease as progressive glomerular loss. We expand the definition of RRF to include the combined renal and tubule functions remaining after a disease begins to destroy nephrons and proceeds to anuria. We propose renewed application of the first principles of renal physiology, articulated in the last century by Homer Smith, to the understanding and monitoring of RRF and progression of renal injury in patients during the sometimes long course of and at the end stage of chronic renal disease.
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Affiliation(s)
| | - Jared J Grantham
- Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
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Pereira-Rodríguez JE, Boada-Morales L, Niño-Serrato DR, Caballero-Chavarro M, Rincón-Gonzales G, Jaimes-Martín T, Melo-Ascanio J. Síndrome cardiorrenal. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Al-Zubaidi ES, Rabee AM. The risk of occupational exposure to mercury vapor in some public dental clinics of Baghdad city, Iraq. Inhal Toxicol 2017; 29:397-403. [PMID: 29043874 DOI: 10.1080/08958378.2017.1369601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dental workers are exposed to elevated levels of elemental mercury vapor substantially above the occupational exposure standards when placing or removing mercury/silver tooth restorations and disposing of mercury waste. This results in a significant increase in occupational exposure and risk of mercury intoxication. METHODS To evaluate the occupational exposure of dental workers to amalgam in four dental clinics in Baghdad city, the concentrations of mercury vapor were measured seasonally from February to November 2016. Samples of blood and urine were collected from 30 dental workers (exposed individuals) and five non-occupationally exposed individuals. Biochemical parameters such as cholesterol, liver enzymes (alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase), renal enzymes (urea and creatinine), total protein and reduced glutathione (GSH) were observed. RESULTS The results indicated that mercury vapor levels varied from 84.7 ± 18.67 to 609.3 ± 238.90 µg/m3 and most concentrations were above the occupational exposure standards. The results of the biochemical parameters showed a significant increase in levels of cholesterol, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and no significant increase in blood urea and creatinine in dental workers in comparison with unexposed persons (control). Although the results showed a significant reduction in the levels of glutathione and total protein, there was no significant decrease in the levels of alkaline phosphatase (ALP) in exposed dental workers when compared with non-occupationally exposed individuals. CONCLUSIONS It is concluded that mercury vapor concentrations in the indoor air of some dental clinics in Baghdad city are high and exceed the OSHA STEL(Occupational Safety and Health Administration Short Term Exposure Limit). The present data showed that altered biochemical parameters can be used as efficient bioindicators for mercury toxicity.
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Affiliation(s)
| | - Adel Mashaan Rabee
- b Department of Biology, College of Science , University of Baghdad , Baghdad , Iraq
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Bosteen MH, Madsen Svarrer EM, Bisgaard LS, Martinussen T, Madsen M, Nielsen LB, Christoffersen C, Pedersen TX. Effects of apolipoprotein M in uremic atherosclerosis. Atherosclerosis 2017; 265:93-101. [PMID: 28866363 DOI: 10.1016/j.atherosclerosis.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/08/2017] [Accepted: 08/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Chronic kidney disease is characterized by uremia and causes premature death, partly due to accelerated atherosclerosis. Apolipoprotein (apo) M is a plasma carrier protein for the lipid sphingosine-1-phosphate (S1P). The Apom-S1P complex associates with HDL, and may contribute to its anti-atherosclerotic effects. The role of Apom/S1P in atherosclerosis is presently controversial and has not been explored in a uremic setting. We aimed to explore whether plasma concentrations of Apom/S1P are altered by uremia and whether Apom overexpression or deficiency affects classical and uremic atherosclerosis. METHODS Mild to moderate uremia was induced by subtotal nephrectomy (NX) in 86-92 Apoe-deficient mice that were either Apom-wild type, Apom-deficient, or overexpressed Apom (∼10 fold). The effects of uremia on plasma Apom/S1P and atherosclerosis were evaluated and compared to non-nephrectomized controls. RESULTS Uremia increased plasma Apom by ∼25%, but not S1P. Plasma S1P was elevated by ∼300% in mice overexpressing Apom, and decreased by ∼25% in Apom-deficient mice. Apom overexpression augmented aortic root atherosclerosis and plasma cholesterol. In contrast, aortic arch atherosclerosis was unaffected by the Apom genotype. There was no effect of Apom-deficiency or Apom overexpression on uremic atherosclerosis. CONCLUSIONS This study highlights the complexity of Apom/S1P in atherosclerosis and challenges the notion that the Apom/S1P complex is anti-atherogenic, at least in Apoe-deficient mice.
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Affiliation(s)
- Markus Høybye Bosteen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark
| | | | - Line Stattau Bisgaard
- Department of Biomedical Sciences, University of Copenhagen, Denmark; Department of Diabetic Complications Biology, Novo Nordisk A/S, Måløv, Denmark
| | | | - Marie Madsen
- Department of Biomedical Sciences, University of Copenhagen, Denmark
| | - Lars Bo Nielsen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark.
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Gortan Cappellari G, Semolic A, Ruozi G, Vinci P, Guarnieri G, Bortolotti F, Barbetta D, Zanetti M, Giacca M, Barazzoni R. Unacylated ghrelin normalizes skeletal muscle oxidative stress and prevents muscle catabolism by enhancing tissue mitophagy in experimental chronic kidney disease. FASEB J 2017; 31:5159-5171. [PMID: 28778977 DOI: 10.1096/fj.201700126r] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/17/2017] [Indexed: 12/18/2022]
Abstract
Unacylated ghrelin (UnAG) may lower skeletal muscle oxidative stress, inflammation, and insulin resistance in lean and obese rodents. UnAG-induced autophagy activation may contribute to these effects, likely involving removal of dysfunctional mitochondria (mitophagy) and redox state maintenance. In chronic kidney disease (CKD) oxidative stress, inflammation and insulin resistance may negatively influence patient outcome by worsening nutritional state through muscle mass loss. Here we show in a 5/6 nephrectomy (Nx) CKD rat model that 4 d s.c. UnAG administration (200 µg twice a day) normalizes CKD-induced loss of gastrocnemius muscle mass and a cluster of high tissue mitochondrial reactive oxygen species generation, high proinflammatory cytokines, and low insulin signaling activation. Consistent with these results, human uremic serum enhanced mitochondrial reactive oxygen species generation and lowered insulin signaling activation in C2C12 myotubes while concomitant UnAG incubation completely prevented these effects. Importantly, UnAG enhanced muscle mitophagy in vivo and silencing RNA-mediated autophagy protein 5 silencing blocked UnAG activities in myotubes. UnAG therefore normalizes CKD-induced skeletal muscle oxidative stress, inflammation, and low insulin signaling as well as muscle loss. UnAG effects are mediated by autophagy activation at the mitochondrial level. UnAG administration and mitophagy activation are novel potential therapeutic strategies for skeletal muscle metabolic abnormalities and their negative clinical impact in CKD.-Gortan Cappellari, G., Semolic, A., Ruozi, G., Vinci, P., Guarnieri, G., Bortolotti, F., Barbetta, D., Zanetti, M., Giacca, M., Barazzoni, R. Unacylated ghrelin normalizes skeletal muscle oxidative stress and prevents muscle catabolism by enhancing tissue mitophagy in experimental chronic kidney disease.
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Affiliation(s)
| | - Annamaria Semolic
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Ruozi
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Pierandrea Vinci
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianfranco Guarnieri
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesca Bortolotti
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | | | - Michela Zanetti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
| | - Mauro Giacca
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Rocco Barazzoni
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy;
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Abstract
Volume overload is common and associated with adverse outcomes in the hemodialysis population including systemic hypertension, pulmonary hypertension, left ventricular hypertrophy, and mortality. Since the beginning of the era of maintenance dialysis, prescribing and maintaining a dry weight remains the standard of care for managing volume overload on hemodialysis. Reducing dry weight even by relatively small amounts has been shown to improve blood pressure and has been associated with reductions in left ventricular hypertrophy. Maintaining an adequately low dry weight requires attention to sodium intake and adequate time on dialysis, as well as a high index of suspicion for volume overload. Reducing dry weight can provoke decreased cardiac chamber filling and is associated with risks including intradialytic hypotension. The ideal method to minimize intradialytic morbidity is unknown, but more frequent dialysis should be considered. Experimental methods of assessing volume status may allow identification of patients most likely both to tolerate and to benefit from dry weight reduction, but further study is needed.
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Affiliation(s)
- Arjun D Sinha
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
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Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Dutton M, Slade A, Marklew N, Price G, Verdi R, Waters J, Sharpe K, Calvert M. Using Patient-Reported Outcome Measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney disease (PRO-trACK project): a mixed-methods project protocol. BMJ Open 2017; 7:e016687. [PMID: 28667225 PMCID: PMC5726096 DOI: 10.1136/bmjopen-2017-016687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Advanced chronic kidney disease (CKD) has a major effect on the quality of life and health status of patients and requires accurate and responsive management. The use of electronic patient-reported outcome measures (ePROMs) could assist patients with advanced pre-dialysis CKD, and the clinicians responsible for their care, by identifying important changes in symptom burden in real time. We report the protocol for 'Using Patient-Reported Outcome measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney Disease' (PRO-trACK) project, which will explore the feasibility and validity of an ePROM system for use in patients with advanced CKD. METHODS AND ANALYSIS The project will use a mixed-methods approach in three studies: (1) usability testing of the ePROM system involving up to 30 patients and focusing on acceptability and technical performance/stability; (2) ascertaining the views of patient and clinician stakeholders on the optimal use and administration of the CKD ePROM system-this will involve qualitative face-to-face/telephone interviewing with up to 30 patients or until saturation is achieved, focus groups with up to 15 clinical staff, management and IT team members; (3) psychometric assessment of the system, within a cohort of at least 180 patients with advanced CKD, to establish the measurement properties of the ePROM. ETHICS AND DISSEMINATION This project was approved by the West Midlands Edgbaston Research Ethics Committee (Reference 17/WM/0010) and received Health Research Authority (HRA) approval on 24 February 2017.The findings from this project will be provided to clinicians at the Department of Renal Medicine, Queen Elizabeth Hospitals, Birmingham (QEHB), NHS England, presented at conferences and to the Kidney Patients' Association, British Kidney Patient Association and the British Renal Society. Articles based on the findings will be written and submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Tom Marshall
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mary Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neil Marklew
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Rav Verdi
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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139
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Orvalho JS, Cowgill LD. Cardiorenal Syndrome: Diagnosis and Management. Vet Clin North Am Small Anim Pract 2017; 47:1083-1102. [PMID: 28669432 DOI: 10.1016/j.cvsm.2017.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiorenal syndrome (CRS) has not been well characterized in veterinary medicine, yet an accurate appreciation of the kidney and the cardiovascular system and their interactions may have practical clinical implications. A consensus for cardiovascular-renal axis disorders of dogs and cats was recently attempted. The outcome of patients with CRS is likely to improve with the increasing awareness and ability to identify and understand the pathophysiologic characteristics of CRS. The utilization of existing and emerging organ-specific biomarkers with greater sensitivities than conventional diagnostics forecast new opportunities to diagnose and manage cardiac disease.
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Affiliation(s)
- João S Orvalho
- University of California Veterinary Medical Center - San Diego, 10435 Sorrento Valley Road, Suite 101, San Diego, CA 92121, USA.
| | - Larry D Cowgill
- University of California Veterinary Medical Center - San Diego, 10435 Sorrento Valley Road, Suite 101, San Diego, CA 92121, USA; Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, 2108 Tupper Hall, Davis, CA 95616, USA
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140
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Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Gheorghe A, Keeley T, Slade A, Calvert M. Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: A systematic review. PLoS One 2017. [PMID: 28636678 PMCID: PMC5479575 DOI: 10.1371/journal.pone.0179733] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) can provide valuable information which may assist with the care of patients with chronic kidney disease (CKD). However, given the large number of measures available, it is unclear which PROMs are suitable for use in research or clinical practice. To address this we comprehensively evaluated studies that assessed the measurement properties of PROMs in adults with CKD. Methods Four databases were searched; reference list and citation searching of included studies was also conducted. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to appraise the methodological quality of the included studies and to inform a best evidence synthesis for each PROM. Results The search strategy retrieved 3,702 titles/abstracts. After 288 duplicates were removed, 3,414 abstracts were screened and 71 full-text articles were retrieved for further review. Of these, 24 full-text articles were excluded as they did not meet the eligibility criteria. Following reference list and citation searching, 19 articles were retrieved bringing the total number of papers included in the final analysis to 66. There was strong evidence supporting internal consistency and moderate evidence supporting construct validity for the Kidney Disease Quality of Life-36 (KDQOL-36) in pre-dialysis patients. In the dialysis population, the KDQOL-Short Form (KDQOL-SF) had strong evidence for internal consistency and structural validity and moderate evidence for test-retest reliability and construct validity while the KDQOL-36 had moderate evidence of internal consistency, test-retest reliability and construct validity. The End Stage Renal Disease-Symptom Checklist Transplantation Module (ESRD-SCLTM) demonstrated strong evidence for internal consistency and moderate evidence for test-retest reliability, structural and construct validity in renal transplant recipients. Conclusions We suggest considering the KDQOL-36 for use in pre-dialysis patients; the KDQOL-SF or KDQOL-36 for dialysis patients and the ESRD-SCLTM for use in transplant recipients. However, further research is required to evaluate the measurement error, structural validity, responsiveness and patient acceptability of PROMs used in CKD.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Tom Marshall
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | | | - Anita Slade
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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141
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Kim KI, Jeong S, Han N, Oh JM, Oh KH, Kim IW. Identification of differentially expressed miRNAs associated with chronic kidney disease-mineral bone disorder. Front Med 2017. [PMID: 28623542 DOI: 10.1007/s11684-017-0541-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study is to characterize a meta-signature of differentially expressed mRNA in chronic kidney disease (CKD) to predict putative microRNA (miRNA) in CKD-mineral bone disorder (CKD-MBD) and confirm the changes in these genes and miRNA expression under uremic conditions by using a cell culture system. PubMed searches using MeSH terms and keywords related to CKD, uremia, and mRNA arrays were conducted. Through a computational analysis, a meta-signature that characterizes the significant intersection of differentially expressed mRNA and expected miRNAs associated with CKD-MBD was determined. Additionally, changes in gene and miRNA expressions under uremic conditions were confirmed with human Saos-2 osteoblast-like cells. A statistically significant mRNA meta-signature of upregulated and downregulated mRNA levels was identified. Furthermore, miRNA expression profiles were inferred, and computational analyses were performed with the imputed microRNA regulation based on weighted ranked expression and putative microRNA targets (IMRE) method to identify miRNAs associated with CKD occurrence. TLR4 and miR-146b levels were significantly associated with CKD-MBD. TLR4 levels were significantly downregulated, whereas primiR- 146b and miR-146b were upregulated in the presence of uremic toxins in human Saos-2 osteoblast-like cells. Differentially expressed miRNAs associated with CKD-MBD were identified through a computational analysis, and changes in gene and miRNA expressions were confirmed with an in vitro cell culture system.
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Affiliation(s)
- Kyung Im Kim
- College of Pharmacy, Korea University, Sejong, 30019, Republic of Korea
| | - Sohyun Jeong
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Nayoung Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - In-Wha Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea.
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Perl J, Dember LM, Bargman JM, Browne T, Charytan DM, Flythe JE, Hickson LJ, Hung AM, Jadoul M, Lee TC, Meyer KB, Moradi H, Shafi T, Teitelbaum I, Wong LP, Chan CT. The Use of a Multidimensional Measure of Dialysis Adequacy-Moving beyond Small Solute Kinetics. Clin J Am Soc Nephrol 2017; 12:839-847. [PMID: 28314806 PMCID: PMC5477210 DOI: 10.2215/cjn.08460816] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/Vurea, has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy. This review aims to (1) understand the strengths and limitations of small solute kinetics as a surrogate marker of dialysis dose, and (2) present the prospect of a more comprehensive construct for dialysis dose, one that considers more broadly the goals of ESRD care to maximize both quality of life and survival. On behalf of the American Society of Nephrology Dialysis Advisory Group, we propose the need to ascertain the validity and utility of a multidimensional measure that moves beyond small solute kinetics alone to quantify optimal dialysis derived from both patient-reported and comprehensive clinical and dialysis-related measures.
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Affiliation(s)
- Jeffrey Perl
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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143
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Gong W, Jia J, Zhang B, Mi S, Zhang L, Xie X, Guo H, Shi J, Tu C. Serum Metabolomic Profiling of Piglets Infected with Virulent Classical Swine Fever Virus. Front Microbiol 2017; 8:731. [PMID: 28496435 PMCID: PMC5406397 DOI: 10.3389/fmicb.2017.00731] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 12/14/2022] Open
Abstract
Classical swine fever (CSF) is a highly contagious swine infectious disease and causes significant economic losses for the pig industry worldwide. The objective of this study was to determine whether small molecule metabolites contribute to the pathogenesis of CSF. Birefly, serum metabolomics of CSFV Shimen strain-infected piglets were analyzed by ultraperformance liquid chromatography/electrospray ionization time-of-flight mass spectrometry (UPLC/ESI-Q-TOF/MS) in combination with multivariate statistical analysis. In CSFV-infected piglets at days 3 and 7 post-infection changes were found in metabolites associated with several key metabolic pathways, including tryptophan catabolism and the kynurenine pathway, phenylalanine metabolism, fatty acid and lipid metabolism, the tricarboxylic acid and urea cycles, branched-chain amino acid metabolism, and nucleotide metabolism. Several pathways involved in energy metabolism including fatty acid biosynthesis and β-oxidation, branched-chain amino acid metabolism, and the tricarboxylic acid cycle were significantly inhibited. Changes were also observed in several metabolites exclusively associated with gut microbiota. The metabolomic profiles indicate that CSFV-host gut microbiome interactions play a role in the development of CSF.
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Affiliation(s)
- Wenjie Gong
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China.,Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State UniversityManhattan, KS, USA
| | - Junjie Jia
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China
| | - Bikai Zhang
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China
| | - Shijiang Mi
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China
| | - Li Zhang
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China
| | - Xiaoming Xie
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China
| | - Huancheng Guo
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China
| | - Jishu Shi
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State UniversityManhattan, KS, USA
| | - Changchun Tu
- Department of Virology, Institute of Military Veterinary, Academy of Military Medical SciencesChangchun, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and ZoonosesYangzhou, China
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144
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Markić D, Vujičić B, Ivanovski M, Krpina K, Gršković A, Rahelić D, Rubinić N, Župan Ž, Lasić H, Materljan M, Rački S. Peritoneal Dialysis Catheter Surgery using Transversus Abdominis Plane Block. Perit Dial Int 2017; 37:429-433. [PMID: 28408712 DOI: 10.3747/pdi.2016.00198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/16/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) catheter surgery can be performed using regional anesthesia. We present our PD catheter placement and extraction experience using ultrasound-guided transversus abdominis plane (TAP) block. METHODS In the present study, we analyzed 74 patients from our center with end-stage renal disease (ESRD) who underwent PD catheter placement (60 patients) and removal (14 patients) using a TAP block between June 2011 and December 2015. RESULTS The TAP block was successful for 55/60 (91.7%) patients (insertion) and 13/14 (92.9%) patients (extraction). Other patients had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or PD catheter-related complications. CONCLUSION The TAP block is a safe and effective technique not only for high-risk ESRD patients but for all patients undergoing PD catheter placement or extraction.
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Affiliation(s)
- Dean Markić
- Department of Urology, University Hospital Rijeka, Rijeka, Croatia
| | - Božidar Vujičić
- Department of Nephrology, Dialysis and Transplantation, University Hospital Rijeka, Rijeka, Croatia
| | - Mladen Ivanovski
- Department of Anesthesiology and Intensive Care, University Hospital Rijeka, Rijeka, Croatia
| | - Kristian Krpina
- Department of Urology, University Hospital Rijeka, Rijeka, Croatia
| | - Antun Gršković
- Department of Urology, University Hospital Rijeka, Rijeka, Croatia
| | - Dražen Rahelić
- Department of Urology, University Hospital Rijeka, Rijeka, Croatia
| | - Nino Rubinić
- Department of Urology, University Hospital Rijeka, Rijeka, Croatia
| | - Željko Župan
- Department of Anesthesiology and Intensive Care, University Hospital Rijeka, Rijeka, Croatia
| | - Hrvoje Lasić
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mauro Materljan
- Department of Urology, University Hospital Rijeka, Rijeka, Croatia
| | - Sanjin Rački
- Department of Nephrology, Dialysis and Transplantation, University Hospital Rijeka, Rijeka, Croatia
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145
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Kortman GAM, Reijnders D, Swinkels DW. Oral iron supplementation: Potential implications for the gut microbiome and metabolome in patients with CKD. Hemodial Int 2017; 21 Suppl 1:S28-S36. [PMID: 28328083 DOI: 10.1111/hdi.12553] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with chronic kidney disease (CKD) and loss of kidney function are at increased risk for morbidity and mortality. The risks of CKD are attributed to "uremia," an increased concentration of uremic retention solutes (toxins) in the plasma. Recently, a colo-renal axis became clearly apparent and uremia has been associated with an altered gut microbiome composition and metabolism. There is a high prevalence of anemia in patients with CKD, for which patients are often treated with oral or intravenous iron. Recent in vivo and in vitro studies have reported adverse effects of oral iron supplementation on the gut microbiota composition, gut metabolome, and intestinal health, which in turn may result in an increased production of uremic toxins. It may also affect circulating levels of other microbe-derived molecules, that can act as mediators of immune regulation. Changes in body iron levels have also been reported to exert subtle effects on host immune function by modulating immune cell proliferation and differentiation, and by directly regulating cytokine formation and antimicrobial immune effector mechanisms. Based on the foregoing it is conceivable that oral iron supplementation in iron deficient predialysis CKD patients adversely changes gut microbiota composition, the gut and systemic metabolome, and host immunity and infection. Future studies are needed to confirm these hypotheses and to assess whether, compared to IV iron supplementation, oral iron supplementation negatively impacts on morbidity of CKD, and whether these adverse effects depend on the iron bioavailability of the iron formulation to the microbiota.
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Affiliation(s)
- Guus A M Kortman
- Department of Laboratory Medicine - Translational Metabolic Laboratory-830, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorien Reijnders
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine - Translational Metabolic Laboratory-830, Radboud University Medical Center, Nijmegen, The Netherlands
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146
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Rivara MB, Zelnick LR, Hoofnagle AN, Newitt R, Tracy RP, Kratz M, Weigle DS, Kestenbaum BR. Diurnal and Long-term Variation in Plasma Concentrations and Renal Clearances of Circulating Markers of Kidney Proximal Tubular Secretion. Clin Chem 2017; 63:915-923. [PMID: 28188231 DOI: 10.1373/clinchem.2016.260117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 12/20/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND The renal proximal tubule is essential for removing organic solutes and exogenous medications from the circulation. We evaluated diurnal, prandial, and long-term biological variation of 4 candidate endogenous markers of proximal tubular secretion. METHODS We used LC-MS to measure plasma and urine concentrations of hippurate (HA), cinnamoylglycine (CMG), indoxyl sulfate (IS), and p-cresol sulfate (PCS) in 25 healthy adults. We measured plasma concentrations of secreted solutes at 13 time points over a 24-h period, and again after 2 weeks and 14 weeks of follow-up. We further measured 24-h renal clearances of secreted solutes at baseline, 2 weeks, and 14 weeks. RESULTS Plasma concentrations of secreted solutes varied over the 24-h baseline period. Diurnal variation was greatest for HA, followed by CMG, IS, and PCS. Plasma concentrations of HA (P = 0.002) and IS (P = 0.02), but not CMG and PCS, increased significantly following meals. Long-term intraindividual biological variation (CVI) in plasma concentrations of secreted solutes over 14 weeks varied from 21.8% for IS to 67.3% for PCS, and exceeded that for plasma creatinine (CVI, 7.1%). Variation in 24-h renal clearances was similar among the secreted solutes [intraindividual variation (CVA+I), 33.6%-47.3%] and was lower using pooled plasma samples from each study visit. CONCLUSIONS Plasma concentrations of HA, CMG, IS, and PCS fluctuate within individuals throughout the day and over weeks. Renal clearances of these secreted solutes, which serve as estimates of renal proximal tubule secretion, are also subject to intraindividual biological variation that can be improved by additional plasma measurements.
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Affiliation(s)
- Matthew B Rivara
- Kidney Research Institute, Seattle, WA.,Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Leila R Zelnick
- Kidney Research Institute, Seattle, WA.,Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Andrew N Hoofnagle
- Kidney Research Institute, Seattle, WA.,Division of Clinical Chemistry, Department of Laboratory Medicine, University of Washington, Seattle, WA
| | | | - Russell P Tracy
- Kidney Research Institute, Seattle, WA.,Departments of Pathology and Biochemistry, University of Vermont College of Medicine, Burlington, VT
| | - Mario Kratz
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Epidemiology, University of Washington, Seattle, WA.,Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA
| | - David S Weigle
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA
| | - Bryan R Kestenbaum
- Kidney Research Institute, Seattle, WA; .,Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.,Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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147
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Zeng YQ, Dai Z, Lu F, Lu Z, Liu X, Chen C, Qu P, Li D, Hua Z, Qu Y, Zou C. Emodin via colonic irrigation modulates gut microbiota and reduces uremic toxins in rats with chronic kidney disease. Oncotarget 2017; 7:17468-78. [PMID: 27003359 PMCID: PMC4951226 DOI: 10.18632/oncotarget.8160] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/01/2016] [Indexed: 11/25/2022] Open
Abstract
Gut microbiota plays a dual role in chronic kidney disease (CKD) and is closely linked to production of uremic toxins. Strategies of reducing uremic toxins by targeting gut microbiota are emerging. It is known that Chinese medicine rhubarb enema can reduce uremic toxins and improve renal function. However, it remains unknown which ingredient or mechanism mediates its effect. Here we utilized a rat CKD model of 5/6 nephrectomy to evaluate the effect of emodin, a main ingredient of rhubarb, on gut microbiota and uremic toxins in CKD. Emodin was administered via colonic irrigation at 5ml (1mg/day) for four weeks. We found that emodin via colonic irrigation (ECI) altered levels of two important uremic toxins, urea and indoxyl sulfate (IS), and changed gut microbiota in rats with CKD. ECI remarkably reduced urea and IS and improved renal function. Pyrosequencing and Real-Time qPCR analyses revealed that ECI resumed the microbial balance from an abnormal status in CKD. We also demonstrated that ten genera were positively correlated with Urea while four genera exhibited the negative correlation. Moreover, three genera were positively correlated with IS. Therefore, emodin altered the gut microbiota structure. It reduced the number of harmful bacteria, such as Clostridium spp. that is positively correlated with both urea and IS, but augmented the number of beneficial bacteria, including Lactobacillus spp. that is negatively correlated with urea. Thus, changes in gut microbiota induced by emodin via colonic irrigation are closely associated with reduction in uremic toxins and mitigation of renal injury.
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Affiliation(s)
- Yu-Qun Zeng
- Department of Nephrology, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Zhenhua Dai
- Section of Immunology, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Fuhua Lu
- Department of Nephrology, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Zhaoyu Lu
- Department of Nephrology, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Xusheng Liu
- Department of Nephrology, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Cha Chen
- Department of Laboratory Medicine, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Pinghua Qu
- Department of Laboratory Medicine, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Dingcheng Li
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America
| | - Zhengshuang Hua
- State Key Laboratory of Biocontrol, Key Laboratory of Biodiversity Dynamics and Conservation of Guangdong Higher Education Institutes, College of Ecology and Evolution, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Yanni Qu
- State Key Laboratory of Biocontrol, Key Laboratory of Biodiversity Dynamics and Conservation of Guangdong Higher Education Institutes, College of Ecology and Evolution, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Chuan Zou
- Department of Nephrology, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China
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148
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Soleimani A, Zarrati Mojarrad M, Bahmani F, Taghizadeh M, Ramezani M, Tajabadi-Ebrahimi M, Jafari P, Esmaillzadeh A, Asemi Z. Probiotic supplementation in diabetic hemodialysis patients has beneficial metabolic effects. Kidney Int 2017; 91:435-442. [DOI: 10.1016/j.kint.2016.09.040] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 12/22/2022]
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Gryp T, Vanholder R, Vaneechoutte M, Glorieux G. p-Cresyl Sulfate. Toxins (Basel) 2017; 9:toxins9020052. [PMID: 28146081 PMCID: PMC5331431 DOI: 10.3390/toxins9020052] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 12/16/2022] Open
Abstract
If chronic kidney disease (CKD) is associated with an impairment of kidney function, several uremic solutes are retained. Some of these exert toxic effects, which are called uremic toxins. p-Cresyl sulfate (pCS) is a prototype protein-bound uremic toxin to which many biological and biochemical (toxic) effects have been attributed. In addition, increased levels of pCS have been associated with worsening outcomes in CKD patients. pCS finds its origin in the intestine where gut bacteria metabolize aromatic amino acids, such as tyrosine and phenylalanine, leading to phenolic end products, of which pCS is one of the components. In this review we summarize the biological effects of pCS and its metabolic origin in the intestine. It appears that, according to in vitro studies, the intestinal bacteria generating phenolic compounds mainly belong to the families Bacteroidaceae, Bifidobacteriaceae, Clostridiaceae, Enterobacteriaceae, Enterococcaceae, Eubacteriaceae, Fusobacteriaceae, Lachnospiraceae, Lactobacillaceae, Porphyromonadaceae, Staphylococcaceae, Ruminococcaceae, and Veillonellaceae. Since pCS remains difficult to remove by dialysis, the gut microbiota could be a future target to decrease pCS levels and its toxicity, even at earlier stages of CKD, aiming at slowing down the progression of the disease and decreasing the cardiovascular burden.
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Affiliation(s)
- Tessa Gryp
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
- Laboratory for Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, Ghent University, 9000 Ghent, Belgium.
| | - Raymond Vanholder
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Mario Vaneechoutte
- Laboratory for Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, Ghent University, 9000 Ghent, Belgium.
| | - Griet Glorieux
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
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150
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Cheng L, Yonggui W. Co-Expression Analysis of Blood Cell Genome Expression to Preliminary Investigation of Regulatory Mechanisms in Uremia. Med Sci Monit 2017; 23:38-45. [PMID: 28050009 PMCID: PMC5228761 DOI: 10.12659/msm.899385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Uremia involves a series of clinical manifestations and is a common syndrome that occurs in nearly all end-stage kidney diseases. However, the exact genetic and/or molecular mechanisms that underlie uremia remain poorly understood. Material/Methods In this case-control study, we analyzed whole-genome microarray of 75 uremia patients and 20 healthy controls to investigate changes in gene expression and cellular mechanisms relevant to uremia. Gene co-expression network analysis was performed to construct co-expression networks using differentially expressed genes (DEGs) in uremia. We then determined hub models of co-expressed gene networks by MCODE, and we used miRNA enrichment analysis to detect key miRNAs in each hub module. Results We found nine co-expressed hub modules implicated in uremia. These modules were enriched in specific biological functions, including “proteolysis”, “membrane-enclosed lumen”, and “apoptosis”. Finally, miRNA enrichment analysis to detect key miRNAs in each hub module found 15 miRNAs that were specifically targeted to uremia-related hub modules. Of these, miRNA-21-3p and miRNA-210-3p have been identified in other studies as being important for uremia. Conclusions In summary, our study connected biological functions, genes, and miRNAs that underpin the network modules that can be used to elucidate the molecular mechanisms involved in uremia.
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Affiliation(s)
- Liu Cheng
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Wu Yonggui
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
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