101
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Innico G, Gobbi L, Bertoldi G, Rigato M, Basso A, Bonfante L, Calò LA. Oxidative stress, inflammation, and peritoneal dialysis: A molecular biology approach. Artif Organs 2021; 45:1202-1207. [PMID: 34037984 PMCID: PMC8519152 DOI: 10.1111/aor.14001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022]
Abstract
The key role of oxidative stress (OxSt) and inflammation for the induction of cardiovascular disease, the leading cause of excess morbidity/mortality in chronic kidney disease and dialysis patients, is known and both the activations of NADPH oxidase and RhoA/Rho kinase (ROCK) pathway are pivotal for their effects. While specific hemodialysis procedures, such as hemodiafiltration with on‐line reinfusion of ultrafiltrate and/or the use of vitamin E‐coated dialyzers, are beneficial for OxSt and inflammation, studies in peritoneal dialysis (PD) are instead scarce and results seem not favorable. In nine patients under PD OxSt in terms of mononuclear cell protein level of p22phox (Western blot), subunit of NADPH oxidase, essential for the generation of OxSt, and MYPT‐1 phosphorylation state (Western blot), a marker of ROCK activity, have been measured at the beginning and after 3 and 6 months of PD. Blood levels of interleukin 6 (IL‐6), ferritin, and albumin have been considered for evaluating the inflammatory state. p22phox protein expression, MYPT‐1‐phosphorylation, and ferritin level were increased both at baseline vs healthy subjects (P = .02, P < .0001, P = .004, respectively) and vs baseline after 3 and 6 months of peritoneal dialysis (P = .007, P < .001, P = .004, respectively). Albumin was lower after 6 months of PD (P = .0014). IL‐6 was increased at baseline vs reference values and remained unchanged at 3 and 6 months. OxSt and inflammation increase during PD confirming via molecular biology approach a report at biochemical level. To improve OxSt state in PD, a multitarget approach is necessary. It might include the use of more physiologic pH, low glucose degradation products, low lactate and iso‐osmolar PD solutions, patients’ strict glycemic control, optimal volume management, and antioxidant administration, such as N‐acetylcysteine.
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Affiliation(s)
- Georgie Innico
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Giovanni Bertoldi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Matteo Rigato
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Anna Basso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Luciana Bonfante
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine DIMED, University of Padova, Italy
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102
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MERHAMETSİZ Ö, DEMİR ME, SEVMİS M, UYAR M, AKTAS S, SEVMİŞ Ş. First-year mortality in living donor kidney transplantation: twelve-year experience from a single center. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.872230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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103
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Scovner KM, Correa S, Claggett BL, Barrett CD, Waikar SS, Solomon SD, Mc Causland FR. Specific Electrocardiograph Intervals Predict Hospitalization with Atrial Fibrillation in Those with Chronic Kidney Disease. Am J Nephrol 2021; 52:412-419. [PMID: 33951623 DOI: 10.1159/000515670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is common in patients with chronic kidney disease (CKD) and is associated with higher rates of hospitalization compared to those without AF. Whether routine electrocardiographic parameters are predictive of future hospitalizations with AF is not clear. METHODS The present study is an analysis of a prospective cohort of 2,759 patients without baseline AF from the Chronic Renal Insufficiency Cohort, a large prospective multicenter study of patients with nondialysis-dependent CKD. Unadjusted and adjusted Cox regression models were fit to examine the association of baseline categories of QTc, QRS, and PR intervals with time to first hospitalization with AF. Restricted cubic splines were used to display nonlinear associ-ations. RESULTS The mean age of subjects at baseline was 58 ± 11 years, 55% were male, and 44% were Black. The mean follow-up was 6.6 years during which 224 participants experienced a hospitalization with AF. The association of baseline QTc interval with risk of AF hospitalization was nonlinear, such that the lowest and highest quartiles of QTc (<407 and >431 ms, respectively) had higher adjusted risk of AF hospitalization, compared with the second quartile (407-416 ms) (aHR Q1:Q2 1.58, 95% CI 1.03-2.41; p = 0.03; aHR Q4:Q2 1.84, 95% CI 1.22-2.78; p < 0.01). Longer QRS was associated with a higher risk of hospitalization with AF among the subgroup of patients with a history of heart failure (HF). PR interval was not associated with AF hospitalization. DISCUSSION/CONCLUSION The association of QTc with risk for hospitalization with AF among patients with CKD is nonlinear, while the association of longer QRS with AF hospitalization is restricted to patients with baseline HF. Electrocardiography may represent a simple and widely accessible method for risk stratification of future AF in patients with CKD.
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Affiliation(s)
- Katherine Mikovna Scovner
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Simon Correa
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Conor D Barrett
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Scott D Solomon
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Finnian R Mc Causland
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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104
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Yagi T, Nagao K, Tachibana E, Yonemoto N, Sakamoto K, Ueki Y, Imamura H, Miyamoto T, Takahashi H, Hanada H, Chiba N, Tani S, Matsumoto N, Okumura Y. Treatment With Vasopressor Agents for Cardiovascular Shock Patients With Poor Renal Function; Results From the Japanese Circulation Society Cardiovascular Shock Registry. Front Med (Lausanne) 2021; 8:648824. [PMID: 34012971 PMCID: PMC8126606 DOI: 10.3389/fmed.2021.648824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
According to the guidelines for cardiogenic shock, norepinephrine is associated with fewer arrhythmias than dopamine and may be the better first-line vasopressor agent. This study aimed to evaluate the utility of norepinephrine vs. dopamine as first-line vasopressor agent for cardiovascular shock depending on the presence and severity of renal dysfunction at hospitalization. This was a secondary analysis of the prospective, multicenter Japanese Circulation Society Cardiovascular Shock Registry (JCS Shock Registry) conducted between 2012 and 2014, which included patients with shock complicating emergency cardiovascular disease at hospital arrival. The analysis included 240 adult patients treated with norepinephrine alone (n = 98) or dopamine alone (n = 142) as the first-line vasopressor agent. Primary endpoint was mortality at 30 days after hospital arrival. The two groups had similar baseline characteristics, including estimated glomerular filtration rate (eGFR), and similar 30-day mortality rates. The analysis of the relationship between 30-day mortality rate after hospital arrival and vasopressor agent used in patients categorized according to the eGFR-based chronic kidney disease classification revealed that norepinephrine as the first-line vasopressor agent might be associated with better prognosis of cardiovascular shock in patients with mildly compromised renal function at admission (0.0 vs. 22.6%; P = 0.010) and that dopamine as the first-line vasopressor agent might be beneficial for cardiovascular shock in patients with severely compromised renal function [odds ratio; 0.22 (95% confidence interval 0.05-0.88; P = 0.032)]. Choice of first-line vasopressor agent should be based on renal function at hospital arrival for patients in cardiovascular shock. Clinical Trial Registration: http://www.umin.ac.jp/ctr/, Unique identifier: 000008441.
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Affiliation(s)
- Tsukasa Yagi
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Ken Nagao
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Eizo Tachibana
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Naohiro Yonemoto
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Kazuo Sakamoto
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yasushi Ueki
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Center, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Imamura
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Center, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takamichi Miyamoto
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Musashino Red Cross Hospital, Musashino, Japan
| | - Hiroshi Takahashi
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Hiroyuki Hanada
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Nobutaka Chiba
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan
| | - Shigemasa Tani
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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105
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Tziastoudi M, Pissas G, Raptis G, Cholevas C, Eleftheriadis T, Dounousi E, Stefanidis I, Theoharides TC. A Systematic Review and Meta-Analysis of Pharmacogenetic Studies in Patients with Chronic Kidney Disease. Int J Mol Sci 2021; 22:ijms22094480. [PMID: 33923087 PMCID: PMC8123337 DOI: 10.3390/ijms22094480] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is an important global public health problem due to its high prevalence and morbidity. Although the treatment of nephrology patients has changed considerably, ineffectiveness and side effects of medications represent a major issue. In an effort to elucidate the contribution of genetic variants located in several genes in the response to treatment of patients with CKD, we performed a systematic review and meta-analysis of all available pharmacogenetics studies. The association between genotype distribution and response to medication was examined using the dominant, recessive, and additive inheritance models. Subgroup analysis based on ethnicity was also performed. In total, 29 studies were included in the meta-analysis, which examined the association of 11 genes (16 polymorphisms) with the response to treatment regarding CKD. Among the 29 studies, 18 studies included patients with renal transplantation, 8 involved patients with nephrotic syndrome, and 3 studies included patients with lupus nephritis. The present meta-analysis provides strong evidence for the contribution of variants harbored in the ABCB1, IL-10, ITPA, MIF, and TNF genes that creates some genetic predisposition that reduces effectiveness or is associated with adverse events of medications used in CKD.
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Affiliation(s)
- Maria Tziastoudi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
- Correspondence: ; Tel.: +30-24-1350-1667; Fax: +30-24-1350-1015
| | - Georgios Pissas
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
| | | | - Christos Cholevas
- AHEPA Hospital, First Department of Ophthalmology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece;
| | - Theodoros Eleftheriadis
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Ioannis Stefanidis
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
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106
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Tanasa A, Burlacu A, Popa C, Kanbay M, Brinza C, Macovei L, Crisan-Dabija R, Covic A. A Systematic Review on the Correlations between Left Atrial Strain and Cardiovascular Outcomes in Chronic Kidney Disease Patients. Diagnostics (Basel) 2021; 11:diagnostics11040671. [PMID: 33917937 PMCID: PMC8068338 DOI: 10.3390/diagnostics11040671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 01/11/2023] Open
Abstract
Left atrial strain (LASr) represents a relatively new but promising technique for left atrial and left ventricle function evaluation. LASr was strongly linked to myocardial fibrosis and endocardial thickness, suggesting the utility of LASr in subclinical cardiac dysfunction detection. As CKD negatively impacts cardiovascular risk and mortality, underlying structural and functional abnormalities of cardiac remodeling are widely investigated. LASr could be used in LV diastolic dysfunction grading with an excellent discriminatory power. Our objectives were to assess the impact and existing correlations between LASr and cardiovascular outcomes, as reported in clinical trials, including patients with CKD. We searched PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials for full-text papers. As reported in clinical studies, LASr was associated with adverse cardiovascular outcomes, including cardiovascular death and major adverse cardiovascular events (HR 0.89, 95% CI, 0.84–0.93, p < 0.01), paroxysmal atrial fibrillation (OR 0.847, 95% CI, 0.760–0.944, p = 0.003), reduced exercise capacity (AUC 0.83, 95% CI, 0.78–0.88, p < 0.01), diastolic dysfunction (p < 0.05), and estimated pulmonary capillary wedge pressure (p < 0.001). Despite limitations attributed to LA deformation imaging (image quality, inter-observer variability, software necessity, learning curve), LASr constitutes a promising marker for cardiovascular events prediction and risk evaluation in patients with CKD.
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Affiliation(s)
- Ana Tanasa
- Nephrology Clinic, Dialysis, and Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (C.P.); (A.C.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Alexandru Burlacu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: ; Tel.: +40-744-488-580
| | - Cristina Popa
- Nephrology Clinic, Dialysis, and Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (C.P.); (A.C.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, 34450 Istanbul, Turkey;
| | - Crischentian Brinza
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Liviu Macovei
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Radu Crisan-Dabija
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Adrian Covic
- Nephrology Clinic, Dialysis, and Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (C.P.); (A.C.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
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107
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Querfeld U. Cardiovascular disease in childhood and adolescence: Lessons from children with chronic kidney disease. Acta Paediatr 2021; 110:1125-1131. [PMID: 33080082 DOI: 10.1111/apa.15630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
Children suffering from chronic kidney disease (CKD) have the apparent highest risk for the development of cardiovascular disease (CVD) at a young age. While symptoms of CVD are characteristically absent in childhood and adolescence, remodelling of the myocardium, medium and large-sized arteries and of the microcirculation is clinically significant and can be assessed with non-invasive technology. Kidney disease and its progression are the driver of CVD, mediated by an unparalleled accumulation of risk factors converging on several comorbid conditions including hypertension, anaemia, dyslipidaemia, disturbed mineral metabolism and chronic persistent inflammation. Large prospective paediatric cohorts studies have provided valuable insights into the pathogenesis and the progression of CKD-induced cardiovascular comorbidity and have characterised the cardiovascular phenotype in young patients. They have also provided the rationale for close monitoring of risk factors and have defined therapeutic targets. Recently discovered new biomarkers could help identify the individual risk for CVD. Prevention of CVD by aggressive therapy of modifiable risk factors is essential to enable long-term survival of young patients with CKD.
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Affiliation(s)
- Uwe Querfeld
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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108
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Rysz J, Franczyk B, Radek M, Ciałkowska-Rysz A, Gluba-Brzózka A. Diabetes and Cardiovascular Risk in Renal Transplant Patients. Int J Mol Sci 2021; 22:3422. [PMID: 33810367 PMCID: PMC8036743 DOI: 10.3390/ijms22073422] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
End-stage kidney disease (ESKD) is a main public health problem, the prevalence of which is continuously increasing worldwide. Due to adverse effects of renal replacement therapies, kidney transplantation seems to be the optimal form of therapy with significantly improved survival, quality of life and diminished overall costs compared with dialysis. However, post-transplant patients frequently suffer from post-transplant diabetes mellitus (PTDM) which an important risk factor for cardiovascular and cardiovascular-related deaths after transplantation. The management of post-transplant diabetes resembles that of diabetes in the general population as it is based on strict glycemic control as well as screening and treatment of common complications. Lifestyle interventions accompanied by the tailoring of immunosuppressive regimen may be of key importance to mitigate PTDM-associated complications in kidney transplant patients. More transplant-specific approach can include the exchange of tacrolimus with an alternative immunosuppressant (cyclosporine or mammalian target of rapamycin (mTOR) inhibitor), the decrease or cessation of corticosteroid therapy and caution in the prescribing of diuretics since they are independently connected with post-transplant diabetes. Early identification of high-risk patients for cardiovascular diseases enables timely introduction of appropriate therapeutic strategy and results in higher survival rates for patients with a transplanted kidney.
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Affiliation(s)
- Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (J.R.); (B.F.)
| | - Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (J.R.); (B.F.)
| | - Maciej Radek
- Department of Neurosurgery, Surgery of Spine and Peripheral Nerves, Medical University of Lodz, 90-549 Lodz, Poland;
| | | | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (J.R.); (B.F.)
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109
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Michell DL, Shihata WA, Andrews KL, Abidin NAZ, Jefferis AM, Sampson AK, Lumsden NG, Huet O, Parat MO, Jennings GL, Parton RG, Woollard KJ, Kaye DM, Chin-Dusting JPF, Murphy AJ. High intraluminal pressure promotes vascular inflammation via caveolin-1. Sci Rep 2021; 11:5894. [PMID: 33723357 PMCID: PMC7960707 DOI: 10.1038/s41598-021-85476-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/19/2021] [Indexed: 01/18/2023] Open
Abstract
The aetiology and progression of hypertension involves various endogenous systems, such as the renin angiotensin system, the sympathetic nervous system, and endothelial dysfunction. Recent data suggest that vascular inflammation may also play a key role in the pathogenesis of hypertension. This study sought to determine whether high intraluminal pressure results in vascular inflammation. Leukocyte adhesion was assessed in rat carotid arteries exposed to 1 h of high intraluminal pressure. The effect of intraluminal pressure on signaling mechanisms including reactive oxygen species production (ROS), arginase expression, and NFĸB translocation was monitored. 1 h exposure to high intraluminal pressure (120 mmHg) resulted in increased leukocyte adhesion and inflammatory gene expression in rat carotid arteries. High intraluminal pressure also resulted in a downstream signaling cascade of ROS production, arginase expression, and NFĸB translocation. This process was found to be angiotensin II-independent and mediated by the mechanosensor caveolae, as caveolin-1 (Cav1)-deficient endothelial cells and mice were protected from pressure-induced vascular inflammatory signaling and leukocyte adhesion. Cav1 deficiency also resulted in a reduction in pressure-induced glomerular macrophage infiltration in vivo. These findings demonstrate Cav1 is an important mechanosensor in pressure-induced vascular and renal inflammation.
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Affiliation(s)
- Danielle L Michell
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Waled A Shihata
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Department of Medicine, Monash University, Clayton, VIC, Australia.
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia.
| | - Karen L Andrews
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | - Nurul Aisha Zainal Abidin
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | | | | | | | - Olivier Huet
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Marie-Odile Parat
- School of Pharmacy, University of Queensland, St Lucia, QLD, Australia
| | | | - Robert G Parton
- Institute for Molecular Bioscience and Centre for Microscopy and Microanalysis, University of Queensland, St Lucia, QLD, Australia
| | - Kevin J Woollard
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Jaye P F Chin-Dusting
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | - Andrew J Murphy
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Arginine Metabolites as Biomarkers of Myocardial Ischaemia, Assessed with Cardiac Magnetic Resonance Imaging in Chronic Kidney Disease. Biomolecules 2021; 11:biom11030416. [PMID: 33799818 PMCID: PMC8002086 DOI: 10.3390/biom11030416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Myocardial oxygenation and perfusion response to stress, using oxygen-sensitive cardiovascular magnetic resonance (OS-CMR) and stress T1 mapping respectively, are impaired in CKD patients with and without known coronary artery disease (CAD). Endothelial dysfunction, assessed by circulating levels of asymmetric dimethylarginine (ADMA) and homoarginine (HMA), promotes atherosclerosis. We hypothesized that in CKD patients, worsening endothelial dysfunction is associated with worsening myocardial oxygenation and perfusion as assessed by change in OS-CMR signal intensity (Δ OS-CMR SI) and stress T1 (ΔT1) values. (2) Methods: 38 patients with advanced CKD underwent cardiovascular magnetic resonance (CMR) scanning at 3 Tesla. OS-CMR and T1 mapping images were acquired both at rest and after adenosine stress and analyzed semi-quantitatively. Serum ADMA and HMA concentrations were assessed using mass spectrometry. (3) Results: There was no significant correlation between Δ OS-CMR SI and ADMA or HMA. Interestingly, there was a significant negative correlation seen between Δ T1 and ADMA (r = -0.419, p = 0.037, n = 30) but not between Δ T1 and HMA. (4) Conclusions: Stress T1 response is impaired in CKD patients and is independently associated with higher circulating ADMA concentrations.
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111
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Schrauben SJ, Hsu JY, Amaral S, Anderson AH, Feldman HI, Dember LM. Effect of Kidney Function on Relationships between Lifestyle Behaviors and Mortality or Cardiovascular Outcomes: A Pooled Cohort Analysis. J Am Soc Nephrol 2021; 32:663-675. [PMID: 33547215 PMCID: PMC7920187 DOI: 10.1681/asn.2020040394] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/12/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Adherence to healthy behaviors reduces risks of cardiovascular disease and death in the general population. However, among people with kidney disease, a group at higher risk for cardiovascular disease, such benefits have not been established. METHODS We pooled data from three cohort studies with a total of 27,271 participants. Kidney function was categorized on the basis of eGFR (≥60, 45 to <60, and <45 ml/min per 1.73 m2). We used proportional hazard frailty models to estimate associations between healthy behaviors (not smoking, at recommended body mass index [BMI], physical activity, healthy diet, and moderate to no alcohol intake) and outcomes (all-cause death, major coronary events, ischemic stroke, and heart failure events). RESULTS All recommended lifestyle behaviors were significantly associated with lower risks of death, regardless of eGFR. Not smoking (versus current) and any moderate to vigorous physical activity (versus none) was significantly associated with reduced risks of major coronary and heart failure events, regardless of eGFR. Any (versus no) moderate or vigorous physical activity significantly associated with decreased risk of ischemic stroke events only among those with eGFR ≥60. Moderate to no daily alcohol intake (versus excessive) was significantly associated with an increased risk of major coronary events, regardless of eGFR. For heart failure events, a BMI of 18.5 to 30 associated with decreased risk, regardless of eGFR. Across all eGFR categories, the magnitude of risk reduction for death and all cardiovascular outcomes increased with greater numbers of recommended lifestyle behaviors. CONCLUSIONS Recommended lifestyle behaviors are associated with lower risk of death and cardiovascular disease events among individuals with or without reduced kidney function, supporting lifestyle behaviors as potentially modifiable risk factors for people with kidney disease.
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Affiliation(s)
- Sarah J. Schrauben
- Renal, Electrolyte-Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Y. Hsu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandra Amaral
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amanda H. Anderson
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Harold I. Feldman
- Renal, Electrolyte-Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura M. Dember
- Renal, Electrolyte-Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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112
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Shrestha P, Yazdani S, Vivès RR, El Masri R, Dam W, van de Sluis B, van den Born J. Proteinuria converts hepatic heparan sulfate to an effective proprotein convertase subtilisin kexin type 9 enzyme binding partner. Kidney Int 2021; 99:1369-1381. [PMID: 33609572 DOI: 10.1016/j.kint.2021.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022]
Abstract
Hepatic uptake of triglyceride-rich remnant lipoproteins is mediated by the low-density lipoprotein receptor, a low-density lipoprotein receptor related protein and the heparan sulfate proteoglycan, syndecan-1. Heparan sulfate proteoglycan also mediates low-density lipoprotein receptor degradation by a regulator of cholesterol homeostasis, proprotein convertase subtilisin kexin type 9 (PCSK9), thereby hampering triglyceride-rich remnant lipoproteins uptake. In this study, we investigated the effects of proteinuria on PCSK9, hepatic heparan sulfate proteoglycan and plasma triglyceride-rich remnant lipoproteins. Adriamycin-injected rats developed proteinuria, elevated triglycerides and total cholesterol (all significantly increased). Proteinuria associated with triglycerides and total cholesterol and serum PCSK9 (all significant associations) without loss of the low-density lipoprotein receptor as evidenced by immunofluorescence staining and western blotting. In proteinuric rats, PCSK9 accumulated in sinusoids, whereas in control rats PCSK9 was localized in the cytoplasm of hepatocytes. Molecular profiling revealed that the heparan sulfate side chains of heparan sulfate proteoglycan to be hypersulfated in proteinuric rats. Competition assays revealed sulfation to be a major determinant for PCSK9 binding. PCSK9 partly colocalized with hypersulfated heparan sulfate in proteinuric rats, but not in control rats. Hence, proteinuria induces hypersulfated hepatic heparan sulfate proteoglycans, increasing their affinity to PCSK9. This might impair hepatic triglyceride-rich remnant lipoproteins uptake, causing proteinuria-associated dyslipidemia. Thus, our study reveals PCSK9/heparan sulfate may be a novel target to control dyslipidemia.
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Affiliation(s)
- Pragyi Shrestha
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Saleh Yazdani
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, Department of Biology, KU Leuven, Leuven, Belgium; Vlaams Institute of Biotechnology Leuven Center for Microbiology, Leuven, Belgium
| | - Romain R Vivès
- University Grenoble Alpes, Institute of Structural Biology (IBS), Atomic Energy and Alternative Energies Commission (CEA), French National Centre for Scientific Research (CNRS), Grenoble, France
| | - Rana El Masri
- University Grenoble Alpes, Institute of Structural Biology (IBS), Atomic Energy and Alternative Energies Commission (CEA), French National Centre for Scientific Research (CNRS), Grenoble, France
| | - Wendy Dam
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart van de Sluis
- Department of Pediatrics, Section Molecular Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jacob van den Born
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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113
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Wei X, Zhang Y, Yan G, Wang X. The Relationship Between Chronic Kidney Disease and the Severity and Long-Term Prognosis of Patients with Coronary Artery Disease After Drug-Eluting Stent Implantation. Int J Gen Med 2021; 14:399-404. [PMID: 33603445 PMCID: PMC7882450 DOI: 10.2147/ijgm.s295098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the relationship between chronic kidney disease (CKD) and the severity and long-term prognosis of patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation. Methods There were 814 patients, who consecutively received a DES implantation, selected for this study. They were divided into two groups, according to whether or not they suffered CKD. There were 254 cases in the CKD group (31.2%), while there were 560 cases (68.8%) in the control group. The clinical characteristics, coronary artery lesions, and major adverse cardiac and cerebrovascular events (MACCE) of the two groups were compared, and the relationship between risk factors and MACCEs was analyzed by multivariate logistic regression. Results Compared with the control group, the CKD group had more severe coronary artery stenosis, expressed as the more diseased arteries (2.15 ± 0.82 vs 1.87 ± 0.83, p = 0.001), a high incidence of three diseased arteries (42.0% vs 28.3%, p = 0.001), and a higher Gensini score [37 (18.6, 66) vs 27.5 (12, 52.5), p = 0.009]. The one-year post-implant incidence of MACCE was higher in the CKD group compared with the control group (17.6% vs 9.9%, p = 0.006). Conclusion CKD appears to be an important predictor for the prognosis of CAD.
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Affiliation(s)
- Xianjing Wei
- Department of Cardiology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, 110016, People's Republic of China
| | - Ying Zhang
- Department of Cardiology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, 110016, People's Republic of China
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital of Southeast University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Xiaoqing Wang
- Department of Cardiology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, 110016, People's Republic of China
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114
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Zuo Y, Wang A, Chen S, Tian X, Wu S, He Y. Distinct eGFR trajectories are associated with risk of myocardial infarction in people with diabetes or prediabetes. J Diabetes 2021; 13:124-133. [PMID: 32671918 DOI: 10.1111/1753-0407.13087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The relationship between estimated glomerular filtration rate (eGFR) trajectories and myocardial infarction (MI) has so far been unclear in people with diabetes or prediabetes. We aimed to identify common eGFR trajectories in people with diabetes or prediabetes and to examine their association with MI risk. METHODS The data of this analysis were derived from the Kailuan study, which was a prospective community-based cohort study. The eGFR trajectories of 24 723 participants from the year 2006 to 2012 were generated by latent mixture modeling. Cox proportional hazards models were used to calculate hazard ratios (HR) and their 95% CI for the subsequent risk of MI of different eGFR trajectories. RESULTS We identified five distinct eGFR trajectories during 2006 to 2012 and named them according to their eGFR range and pattern over time: low-stable (9.4%), moderate-stable (31.4%), moderate-increasing (29.5%), high-decreasing (13.9%), and high-stable (15.8%). During a mean follow-up of 4.61 years, there were a total of 235 incident MI. Although the high-decreasing group had similar eGFR levels to the moderate-stable group during the last exposure period, the risk was much higher (adjusted HR, 3.57; 95% CI, 1.63-7.85 vs adjusted HR, 2.88; 95% CI, 1.36-6.08). Notably, the moderate-increasing group had reached the normal range, but still had a significantly increased risk (adjusted HR, 2.63; 95% CI, 1.24-5.55). CONCLUSIONS eGFR trajectories were associated with MI risk in people with diabetes or prediabetes. These observations suggest that long-term trajectories of eGFR may be important for risk prediction of MI and should be highlighted in primary prevention.
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Affiliation(s)
- Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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115
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Poveda J, Vázquez-Sánchez S, Sanz AB, Ortiz A, Ruilope LM, Ruiz-Hurtado G. TWEAK-Fn14 as a common pathway in the heart and the kidneys in cardiorenal syndrome. J Pathol 2021; 254:5-19. [PMID: 33512736 DOI: 10.1002/path.5631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022]
Abstract
There is a complex relationship between cardiac and renal disease, often referred to as the cardiorenal syndrome. Heart failure adversely affects kidney function, and both acute and chronic kidney disease are associated with structural and functional changes to the myocardium. The pathological mechanisms and contributing interactions that surround this relationship remain poorly understood, limiting the opportunities for therapeutic intervention. The cytokine tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its receptor, fibroblast growth factor-inducible 14 (Fn14), are abundantly expressed in injured kidneys and heart. The TWEAK-Fn14 axis promotes responses that drive tissue injury such as inflammation, proliferation, fibrosis, and apoptosis, while restraining the expression of tissue protective factors such as the anti-aging factor Klotho and the master regulator of mitochondrial biogenesis peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α). High levels of TWEAK induce cardiac remodeling, and promote inflammation, tubular and podocyte injury and death, fibroblast proliferation, and, ultimately, renal fibrosis. Accordingly, targeting the TWEAK-Fn14 axis is protective in experimental kidney and heart disease. TWEAK has also emerged as a biomarker of kidney damage and cardiovascular outcomes and has been successfully targeted in clinical trials. In this review, we update our current knowledge of the roles of the TWEAK-Fn14 axis in cardiovascular and kidney disease and its potential contribution to the cardiorenal syndrome. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Jonay Poveda
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sara Vázquez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana B Sanz
- Research Institute - Fundacion Jimenez Diaz, Autonoma University, Madrid, Spain.,REDINREN, Madrid, Spain
| | - Alberto Ortiz
- Research Institute - Fundacion Jimenez Diaz, Autonoma University, Madrid, Spain.,REDINREN, Madrid, Spain
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.,School of Doctoral Studies and Research, European University of Madrid, Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
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116
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Timofte D, Tanasescu MD, Balan DG, Tulin A, Stiru O, Vacaroiu IA, Mihai A, Popa CC, Cosconel CI, Enyedi M, Miricescu D, Papacocea RI, Ionescu D. Management of acute intradialytic cardiovascular complications: Updated overview (Review). Exp Ther Med 2021; 21:282. [PMID: 33603889 PMCID: PMC7851674 DOI: 10.3892/etm.2021.9713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023] Open
Abstract
An increasing number of patients require renal replacement therapy through dialysis and renal transplantation. Chronic kidney disease (CKD) affects a large percentage of the world's population and has evolved into a major public health concern. Diabetes mellitus, high blood pressure and a family history of kidney failure are all major risk factors for CKD. Patients in advanced stages of CKD have varying degrees of cardiovascular damage. Comorbidities of these patients, include, on the one hand, hypertension, hyperlipidemia, hyperglycemia, hyperuricemia and, on the other hand, the presence of mineral-bone disorders associated with CKD and chronic inflammation, which contribute to cardiovascular involvement. Acute complications occur quite frequently during dialysis. Among these, the most important are cardiovascular complications, which influence the morbidity and mortality rates of this group of patients. Chronic hemodialysis patients manifest acute cardiovascular complications such as intradialytic hypotension, intradialytic hypertension, arrhythmias, acute coronary syndromes and sudden death. Thus, proper management is extremely important.
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Affiliation(s)
- Delia Timofte
- Department of Dialysis, Emergency University Hospital, 050098 Bucharest, Romania
| | - Maria-Daniela Tanasescu
- Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Daniela Gabriela Balan
- Discipline of Physiology, Faculty of Dental Medicine, Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Tulin
- Department of Anatomy, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of General Surgery, 'Prof. Dr. Agrippa Ionescu̓ Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Prof. Dr. C.C. Iliescu̓ Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Ileana Adela Vacaroiu
- Department of Nephrology and Dialysis, 'Sf. Ioan' Emergency Clinical Hospital, 042122 Bucharest, Romania.,Department of Nephrology, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andrada Mihai
- Discipline of Diabetes, 'N. C. Paulescu' Institute of Diabetes, Nutrition and Metabolic Diseases, 020474 Bucharest, Romania.,Department II of Diabetes, 'N. C. Paulescu̓ Institute of Diabetes, Nutrition and Metabolic Diseases, 020474 Bucharest, Romania
| | - Cristian Constantin Popa
- Department of Surgery, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Cristina-Ileana Cosconel
- Discipline of Foreign Languages, Faculty of Dental Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaly Enyedi
- Department of Anatomy, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Radiology, 'Victor Babes̓ Private Medical Clinic, 030303 Bucharest, Romania
| | - Daniela Miricescu
- Discipline of Biochemistry, Faculty of Dental Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Raluca Ioana Papacocea
- Discipline of Physiology, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dorin Ionescu
- Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital, 050098 Bucharest, Romania
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117
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Lee WC, Chen JB, Moi SH, Yang CH. Association of proportion of the HDL-cholesterol subclasses HDL-2b and HDL-3 and macrovascular events among patients undergoing hemodialysis. Sci Rep 2021; 11:1871. [PMID: 33479451 PMCID: PMC7820459 DOI: 10.1038/s41598-021-81636-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/07/2021] [Indexed: 12/14/2022] Open
Abstract
Altered high-density lipoprotein cholesterol (HDL-C) subclass distribution in hemodialysis (HD) patients is well documented. Aim of this study is to investigate the relationship between HDL-C subclass distribution and macrovascular events in patients undergoing HD. A total of 164 prevalent HD patients and 71 healthy individuals in one hospital-facilitated clinic were enrolled from May 2019 to July 2019 and individual HD patients was follow-up for one year. Macrovascular events (cerebral stroke, coronary heart disease) were recorded in the study period. The HDL-2b, HDL-3 proportions and biochemical parameters were measured. Pearson correlation test and logistic regression analysis were used to examine correlation and odds ratio (OR). 144 HD patients completed one-year follow-up. Cohort with macrovascular events revealed significantly lower HDL-2b and higher HDL-3 subclass proportions compared to those without events. By multivariable adjustment, HDL-3 subclass proportion revealed significantly increase risk for these events (OR 1.17, 95% CI 1.02–1.41, P = 0.044). HDL-2b subclass was significantly higher and HDL-3 subclass was significantly lower in the HD cohort under the hs-CRP level of < 3 mg/L compared to higher hs-CRP level. In conclusion, HDL-2b and HDL-3 subclasses distributions were associated with macrovascular events in HD patients. Proinflammatory status influences the distribution of HDL-2b and HDL-3 subclasses in HD patients.
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Affiliation(s)
- Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, DaPei Rd, Niao Song District, Kaohsiung, Taiwan
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, DaPei Rd, Niao Song District, Kaohsiung, Taiwan.
| | - Sin-Hua Moi
- Center of Cancer Program Development, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
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118
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Terhuerne J, van Diepen M, Kramann R, Erpenbeck J, Dekker F, Marx N, Floege J, Becker M, Schlieper G. Speckle-tracking echocardiography in comparison with ejection fraction for prediction of cardiovascular mortality in patients with end-stage renal disease. Clin Kidney J 2021; 14:1579-1585. [PMID: 34276976 PMCID: PMC8280917 DOI: 10.1093/ckj/sfaa161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular disease is the major cause of death in end-stage renal disease (ESRD). To develop better means to assess cardiovascular risk in these patients, we compared conventional echocardiography-derived left ventricular ejection fraction (EF) with the novel method of 2D speckle-tracking echocardiography to determine cardiac strain. Methods Predictive performances of conventional EF and speckle-tracking echocardiography-derived global longitudinal strain (GLS) were compared using receiver-operator curve (ROC) analyses and calibration by calibration plots. We also took into account other known cardiovascular risk factors through multivariable logistic regression analysis. Results The study comprised 171 ESRD patients (mean age 64 years, 64% male) on maintenance dialysis therapy (93% haemodialysis, 7% peritoneal dialysis) for an average period of 39 months. During 2.1 years of follow-up, 42 patients (25%) died from cardiovascular disease. ROC analysis of GLS resulted in an area under the curve of 0.700 [95% confidence interval (CI) 0.603–0.797] compared with an area under the curve of EF of 0.615 (95% CI 0.514–0.716) (P = 0.059 for difference). The total absolute deviation between predicted and observed outcome frequencies obtained by calibration plots were 13.8% for EF compared with only 6.4% for GLS. Best results of ROC analysis (area under the curve = 0.759; P = 0.06), calibration and goodness-of-fit (χ2 = 28.34, P ≤ 0.0001, R2 = 0.25) were achieved for GLS added to a baseline model consisting of known cardiovascular risk factors in a multivariate regression analysis. Conclusions In summary, in chronic dialysis patients, GLS is a more precise predictor of cardiovascular mortality than conventional echocardiography-derived EF.
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Affiliation(s)
- Janna Terhuerne
- Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rafael Kramann
- Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Johanna Erpenbeck
- Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Friedo Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nikolaus Marx
- Department of Cardiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Michael Becker
- Department of Cardiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Georg Schlieper
- Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany.,Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany
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119
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Eklund M, Hellberg O, Furuland H, Cao Y, Nilsson E. Effects of spironolactone on extrasystoles and heart rate variability in haemodialysis patients: a randomised crossover trial. Ups J Med Sci 2021; 126:5660. [PMID: 33613861 PMCID: PMC7886278 DOI: 10.48101/ujms.v126.5660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Spironolactone treatment reduces mortality in haemodialysis (HD) patients. The objective of this study was to evaluate if spironolactone affects cardiac electric activity in this population. METHODS Participants were randomised to start with spironolactone 50 mg daily or observation (12 weeks) with subsequent washout (6 weeks) and crossover to the other intervention (12 weeks). Long-term electrocardiograms were recorded and assessed with blinding to treatment. The primary outcome was premature ventricular complexes (PVC), and secondary outcomes were atrial premature contractions (APC) and heart rate variability (HRV). RESULTS Thirty participants were recruited, and data for 16 participants were included in the analysis. Treatment was associated with an increase in PVCs by 9.7 [95% confidence interval (CI): 1.5 to 18] h-1. HRV time-domain variables increased during treatment, the standard deviation of all beat-to-beat intervals by 18 (95% CI: 3.3 to 32) milliseconds (ms) and the standard deviation of the averages of beat-to-beat intervals in all 5-min segments of the entire recording by 16 (95% CI: 1.5 to 30) ms. There were no significant differences in other variables. CONCLUSION Spironolactone treatment increases PVCs in HD, indicating a possible proarrhythmic effect. However, improved cardiac autonomic function, as indicated by an increased HRV, may contribute to the survival benefit from spironolactone treatment in HD patients.
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Affiliation(s)
- Michael Eklund
- Department of Internal Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Olof Hellberg
- Department of Internal Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Hans Furuland
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Nilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
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120
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Bansal N, Glidden DV, Mehrotra R, Townsend RR, Cohen J, Linke L, Palad F, Larson H, Hsu CY. Treating Home Versus Predialysis Blood Pressure Among In-Center Hemodialysis Patients: A Pilot Randomized Trial. Am J Kidney Dis 2021; 77:12-22. [PMID: 32800842 PMCID: PMC7752836 DOI: 10.1053/j.ajkd.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/11/2020] [Indexed: 01/13/2023]
Abstract
RATIONALE & OBJECTIVE Observational studies have reported a U-shaped association between blood pressure (BP) before a hemodialysis session and death. In contrast, because a linear association between out-of-dialysis-unit BP and death has been reported, home BP may be a better target for treatment. To test the feasibility of this approach, we conducted a pilot trial of treating home versus predialysis BP in hemodialysis patients. STUDY DESIGN A 4-month, parallel, randomized, controlled trial. SETTINGS & PARTICIPANTS 50 prevalent hemodialysis patients in San Francisco and Seattle. Participants were randomly assigned using 1:1 block randomization, stratified by site. INTERVENTIONS To target home systolic BP (SBP) of 100-<140 mm Hg versus predialysis SBP of 100-<140mm Hg. Home and predialysis SBPs were ascertained every 2 weeks. Dry weight and BP medications were adjusted to reach the target SBP. OUTCOMES Primary outcomes were feasibility, adherence, safety. and tolerability. RESULTS 50 of 70 (71%) patients who were approached agreed to participate. All enrollees completed the study except for 1 who received a kidney transplant. In the home BP treatment group, adherence to obtaining/reporting home BP was 97.4% (and consistent over the 4 months). There was no increased frequency of high (defined as SBP>200mm Hg; 0.2% vs 0%) or low (defined as<90mm Hg; 1.8% vs 1.2%) predialysis BP readings in the home versus predialysis treatment arms, respectively. However, participants in the home BP arm had higher frequency of fatigue (32% vs 16%). LIMITATIONS Small sample size. CONCLUSIONS This pilot trial demonstrates feasibility and high adherence to home BP measurement and treatment in hemodialysis patients. Larger trials to test the long-term feasibility, efficacy, and safety of home BP treatment in hemodialysis patients should be conducted. FUNDERS National Institutes of Health, Satellite Healthcare, and Northwest Kidney Centers. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT03459807.
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Affiliation(s)
- Nisha Bansal
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA.
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Rajnish Mehrotra
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | | | - Jordana Cohen
- Division of Nephrology, University of Pennsylvania, Philadelphia, PA
| | - Lori Linke
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA
| | - Farshad Palad
- Division of Nephrology, University of California, San Francisco, San Francisco, CA
| | - Hannah Larson
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, CA
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Kansal N, Garg P, Mathur P, Sharma P, Shrivastava M. Study of the Prevalence of Echocardiographic Abnormalities and Their Relation to Disease Progression in Chronic Kidney Disease. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_44_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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122
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Mathew AV, Zeng L, Atkins KB, Sadri KN, Byun J, Fujiwara H, Reddy P, Pennathur S. Deletion of bone marrow myeloperoxidase attenuates chronic kidney disease accelerated atherosclerosis. J Biol Chem 2021; 296:100120. [PMID: 33234591 PMCID: PMC7948401 DOI: 10.1074/jbc.ra120.014095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Increased myeloperoxidase (MPO) expression and activity are associated with atherosclerotic disease in patients with chronic kidney disease (CKD). However, the causal relationship between MPO and the development and progression of atherosclerosis in patients with CKD is unknown. Eight-week-old male low-density-lipoprotein-receptor-deficient mice were subjected to 5/6 nephrectomy, irradiated, and transplanted with bone marrow from MPO-deficient mice to induce bone marrow MPO deletion (CKD-bMPOKO) or bone marrow from WT mice as a control to maintain preserved bone marrow MPO(CKD-bMPOWT). The mice were maintained on a high-fat/high-cholesterol diet for 16 weeks. As anticipated, both groups of mice exhibited all features of moderate CKD, including elevated plasma creatinine, lower hematocrit, and increased intact parathyroid hormone but did not demonstrate any differences between the groups. Irradiation and bone marrow transplantation did not further affect body weight, blood pressure, creatinine, or hematocrit in either group. The absence of MPO expression in the bone marrow and atherosclerotic lesions of the aorta in the CKD-bMPOKO mice was confirmed by immunoblot and immunohistochemistry, respectively. Decreased MPO activity was substantiated by the absence of 3-chlorotyrosine, a specific by-product of MPO, in aortic atherosclerotic lesions as determined by both immunohistochemistry and highly sensitive LC-MS. Quantification of the aortic lesional area stained with oil red O revealed that CKD-bMPOKO mice had significantly decreased aortic plaque area as compared with CKD-bMPOWT mice. This study demonstrates the reduction of atherosclerosis in CKD mice with the deletion of MPO in bone marrow cells, strongly implicating bone-marrow-derived MPO in the pathogenesis of CKD atherosclerosis.
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Affiliation(s)
- Anna V Mathew
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Lixia Zeng
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin B Atkins
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kiana N Sadri
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jaeman Byun
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hideaki Fujiwara
- Division of Hematology-Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pavan Reddy
- Division of Hematology-Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA.
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Roy D, Modi A, Khokhar M, Sankanagoudar S, Yadav D, Sharma S, Purohit P, Sharma P. MicroRNA 21 Emerging Role in Diabetic Complications: A Critical Update. Curr Diabetes Rev 2021; 17:122-135. [PMID: 32359340 DOI: 10.2174/1573399816666200503035035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/13/2020] [Accepted: 04/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes Mellitus is a multifactorial disease encompassing various pathogenic pathways. To avoid morbidity and mortality related to diabetic complications, early detection of disease complications as well as targeted therapeutic strategies are essential. INTRODUCTION MicroRNAs (miRs) are short non-coding RNA molecules that regulate eukaryotic posttranscriptional gene expression. MicroRNA-21 has diverse gene regulatory functions and plays a significant role in various complications of Type 2 diabetes mellitus (T2DM). METHODS The study included electronic database searches on Pubmed, Embase, and Web of Science with the search items MicroRNA21 and each of the diabetic complications. The search was carried out up to November, 2019. RESULTS MicroRNA-21 modulates diabetic cardiomyopathy by affecting vascular smooth muscle cell proliferation and apoptosis, cardiac cell growth and death, and cardiac fibroblast functions. At the renal tubules, miR-21 can regulate the mesangial expansion, interstitial fibrosis, macrophage infiltration, podocyte loss, albuminuria and fibrotic and inflammatory gene expression related to diabetic nephropathy. Overexpression of miR-21 has been seen to play a pivotal role in the pathogenesis of diabetic retinopathy by contributing to diabetes-induced endothelial dysfunction as well as low-grade inflammation. CONCLUSION Considering the raised levels of miR-21 in various diabetic complications, it may prove to be a candidate biomarker for diabetic complications. Further, miR-21 antagonists have shown great potential in the treatment of diabetic cardiomyopathy, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy related complications in the future. The current review is the first of its kind encompassing the roles miR-21 plays in various diabetic complications, with a critical discussion of its future potential role as a biomarker and therapeutic target.
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Affiliation(s)
- Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Anupama Modi
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Manoj Khokhar
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | | | - Dharamveer Yadav
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Shailja Sharma
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
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Bloom JE, Dinh DT, Noaman S, Martin C, Lim M, Batchelor R, Zheng W, Reid C, Brennan A, Lefkovits J, Cox N, Duffy SJ, Chan W. Adverse impact of chronic kidney disease on clinical outcomes following percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 97:E801-E809. [PMID: 33325620 DOI: 10.1002/ccd.29436] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/26/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022]
Abstract
AIMS We aimed to assess the impact of the severity of chronic kidney disease (CKD) with long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). METHODS We analyzed data on consecutive patients undergoing PCI enrolled in the Victorian Cardiac Outcomes Registry (VCOR) from January 2014 to December 2018. Patients were stratified into tertiles of renal function; estimated glomerular filtration (eGFR) ≥60, 30-59 and < 30 ml/min/1.73 m2 (including dialysis). The primary outcome was long-term all-cause mortality obtained from linkage with the Australian National Death Index (NDI). The secondary endpoint was a composite of 30 day major adverse cardiac and cerebrovascular events. RESULTS We identified a total of 51,480 patients (eGFR ≥60, n = 40,534; eGFR 30-59, n = 9,521; eGFR <30, n = 1,425). Compared with patients whose eGFR was ≥60, those with eGFR 30-59 and eGFR<30 were on average older (77 and 78 vs. 63 years) and had a greater burden of cardiovascular risk factors. Worsening CKD severity was independently associated with greater adjusted risk of long-term NDI mortality: eGFR<30 hazard ratio 4.21 (CI 3.7-4.8) and eGFR 30-59; 1.8 (CI 1.7-2.0), when compared to eGFR ≥60, all p < .001. CONCLUSION In this large, multicentre PCI registry, severity of CKD was associated with increased risk of all-cause mortality underscoring the high-risk nature of this patient cohort.
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Affiliation(s)
- Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Australia.,Department of Cardiology, Bendigo Health, Bendigo, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Australia.,Department of Cardiology, Western Health, Melbourne, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Lim
- Department of Cardiology, Geelong University Hospital, Geelong, Australia
| | - Riley Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Wayne Zheng
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | | | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, Western Health, Melbourne, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia.,Monash University, Melbourne, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
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125
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The impact of chronic kidney disease on long-term outcomes following semi-urgent and elective percutaneous coronary intervention. Coron Artery Dis 2020; 32:517-525. [DOI: 10.1097/mca.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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126
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Weng CY, Kuo TH, Chai LMX, Zou HB, Feng TH, Huang YJ, Tsai JC, Wu PH, Chiu YW, Lan EI, Sheen LY, Hsu CC. Rapid Quantification of Gut Microbial Short-Chain Fatty Acids by pDART-MS. Anal Chem 2020; 92:14892-14897. [PMID: 33151059 DOI: 10.1021/acs.analchem.0c03862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Short-chain fatty acids (SCFAs) are small molecules ubiquitous in nature. In mammalian guts, SCFAs are mostly produced by anaerobic intestinal microbiota through the fermentation of dietary fiber. Levels of microbe-derived SCFAs are closely relevant to human health status and indicative to gut microbiota dysbiosis. However, the quantification of SCFA using conventional chromatographic approaches is often time consuming, thus limiting high-throughput screening tests. Herein, we established a novel method to quantify SCFAs by coupling amidation derivatization of SCFAs with paper-loaded direct analysis in real time mass spectrometry (pDART-MS). Remarkably, SCFAs of a biological sample were quantitatively determined within a minute using the pDART-MS platform, which showed a limit of detection at the μM level. This platform was applied to quantify SCFAs in various biological samples, including feces from stressed rats, sera of patients with kidney disease, and fermentation products of metabolically engineered cyanobacteria. Significant differences in SCFA levels between different groups of biological practices were promptly revealed and evaluated. As there is a burgeoning demand for the analysis of SCFAs due to an increasing academic interest of gut microbiota and its metabolism, this newly developed platform will be of great potential in biological and clinical sciences as well as in industrial quality control.
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Affiliation(s)
- Cheng-Yu Weng
- Department of Chemistry, National Taiwan University, Taipei 106216, Taiwan
| | - Ting-Hao Kuo
- Department of Chemistry, National Taiwan University, Taipei 106216, Taiwan
| | | | - Hsin-Bai Zou
- Department of Chemistry, National Taiwan University, Taipei 106216, Taiwan
| | - Tzu-Hsuan Feng
- Department of Chemistry, National Taiwan University, Taipei 106216, Taiwan
| | - Yun-Ju Huang
- Institute of Food Science and Technology, National Taiwan University, Taipei 106216, Taiwan
| | - Jemmy C Tsai
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300093, Taiwan
| | - Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Ethan I Lan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300093, Taiwan
| | - Lee-Yan Sheen
- Institute of Food Science and Technology, National Taiwan University, Taipei 106216, Taiwan
| | - Cheng-Chih Hsu
- Department of Chemistry, National Taiwan University, Taipei 106216, Taiwan
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Kidney Ischemia-Reperfusion Decreases Hydrogen Sulfide and Increases Oxidative Stress in the Heart. Biomolecules 2020; 10:biom10111565. [PMID: 33212962 PMCID: PMC7698428 DOI: 10.3390/biom10111565] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/27/2022] Open
Abstract
Patients with acute kidney injury (AKI) have an increased risk of cardiovascular disease. The underlying mechanism of AKI-induced heart injury is not well-understood. Hydrogen sulfide (H2S), at physiological concentrations, has been implicated in cardiovascular protection through redox balance and vessel relaxation. Cystathionine gamma-lyase (CSE) plays an essential role in H2S production in the heart. The present study investigated the effect of AKI on H2S production and oxidative stress in the heart. AKI was induced by kidney ischemia-reperfusion in male and female Sprague-Dawley rats, which led to an increase in plasma creatinine and blood urea nitrogen levels. There was a significant increase in lipid peroxidation and a decrease in glutathione (antioxidant) levels in the plasma and heart, indicating systemic and cardiac oxidative stress. Kidney ischemia-reperfusion reduced CSE expression and H2S production in the heart. There was a decrease in antioxidant transcription factor Nrf2 level in the nucleus and an increase in inflammatory cytokine (IL-6, TNF-α) expression in the heart. These results suggest that AKI can down-regulate CSE-mediated H2S production, reduce glutathione levels and increase oxidative stress in the heart. This may contribute to an increased risk of cardiovascular disease in AKI.
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128
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Peritubular Capillary Rarefaction: An Underappreciated Regulator of CKD Progression. Int J Mol Sci 2020; 21:ijms21218255. [PMID: 33158122 PMCID: PMC7662781 DOI: 10.3390/ijms21218255] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
Peritubular capillary (PTC) rarefaction is commonly detected in chronic kidney disease (CKD) such as hypertensive nephrosclerosis and diabetic nephropathy. Moreover, PTC rarefaction prominently correlates with impaired kidney function and predicts the future development of end-stage renal disease in patients with CKD. However, it is still underappreciated that PTC rarefaction is a pivotal regulator of CKD progression, primarily because the molecular mechanisms of PTC rarefaction have not been well-elucidated. In addition to the established mechanisms (reduced proangiogenic factors and increased anti-angiogenic factors), recent studies discovered significant contribution of the following elements to PTC loss: (1) prompt susceptibility of PTC to injury, (2) impaired proliferation of PTC, (3) apoptosis/senescence of PTC, and (4) pericyte detachment from PTC. Mainly based on the recent and novel findings in basic research and clinical study, this review describes the roles of the above-mentioned elements in PTC loss and focuses on the major factors regulating PTC angiogenesis, the assessment of PTC rarefaction and its surrogate markers, and an overview of the possible therapeutic agents to mitigate PTC rarefaction during CKD progression. PTC rarefaction is not only a prominent histological characteristic of CKD but also a central driving force of CKD progression.
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Oliveira C, Pereira PMDL, Soares IT, Monteiro MG, Bastos MG, Cândido APC. Cardiovascular Risk Factors in Patients with Chronic Kidney Disease Under Conservative Treatment. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20190195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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130
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Chen Y, Liu H, Loh TP, Liu Q, Teo TL, Lee TK, Sethi SK. Measurement of urine albumin by liquid chromatography-isotope dilution tandem mass spectrometry and its application to value assignment of external quality assessment samples and certification of reference materials. Clin Chem Lab Med 2020; 59:711-720. [DOI: 10.1515/cclm-2020-0969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/27/2020] [Indexed: 12/20/2022]
Abstract
Abstract
Objectives
Urine albumin is measured in clinical laboratories by immunoturbidimetry. However, large biases are observed among the different routine methods. To standardize the measurement of urine albumin, a reference measurement procedure (RMP) and urine albumin certified reference materials (CRMs) are needed.
Methods
A candidate RMP for urine albumin based on liquid chromatography-isotope dilution tandem mass spectrometry (LC-IDMS/MS) using human serum albumin as calibration standard was developed. Isotope-labeled human albumin was used as internal standard. Urine samples were digested using trypsin and eight resulting “signature” peptides of albumin were quantified by LC-IDMS/MS. The candidate RMP was employed in value assignment of external quality assessment (EQA) samples and certification of urine albumin reference materials. The commutability of the developed CRMs was assessed against patient samples.
Results
The candidate RMP (recovery 101.5–103.2% and CV 1.2–3.3% at about 7–40 mg/L) met optimal performance goal. The lower limit of quantification was 0.03 mg/L as determined by signal-to-noise method. The EQA results from clinical laboratories using different immunoturbidimetric methods were generally comparable with assigned target values determined by the candidate RMP, with albumin concentrations ranging from 5 to 226 mg/L. Urine albumin reference materials (two levels) certified using the candidate RMP showed good commutability in a preliminary study.
Conclusions
With optimal method precision and trueness, as well as comparability with routine methods, the developed RMP may be used for value assignment of EQA samples or certification of reference materials, which are important pillars in urine albumin method standardization.
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Affiliation(s)
- Yizhao Chen
- Chemical Metrology Division, Applied Sciences Group , Health Sciences Authority , Singapore , Singapore
| | - Hong Liu
- Chemical Metrology Division, Applied Sciences Group , Health Sciences Authority , Singapore , Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine , National University Hospital , Singapore , Singapore
| | - Qinde Liu
- Chemical Metrology Division, Applied Sciences Group , Health Sciences Authority , Singapore , Singapore
| | - Tang Lin Teo
- Chemical Metrology Division, Applied Sciences Group , Health Sciences Authority , Singapore , Singapore
| | - Tong Kooi Lee
- Chemical Metrology Division, Applied Sciences Group , Health Sciences Authority , Singapore , Singapore
| | - Sunil Kumar Sethi
- Department of Laboratory Medicine , National University Hospital , Singapore , Singapore
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Current and novel imaging techniques to evaluate myocardial dysfunction during hemodialysis. Curr Opin Nephrol Hypertens 2020; 29:555-563. [PMID: 33009128 DOI: 10.1097/mnh.0000000000000645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients on hemodialysis have significantly higher rates of cardiovascular mortality resulting from a multitude of myocardial dysfunctions. Current imaging modalities allow independent assessment of cardiac morphology, contractile function, coronary arteries and cardiac perfusion. Techniques such as cardiac computed tomography (CT) imaging have been available for some time, but have not yet had widespread adoption because of technical limitations related to cardiac motion, radiation exposure and safety of contrast agents in kidney disease. RECENT FINDINGS Novel dynamic contrast-enhanced (DCE) CT imaging can be used to acquire high-resolution cardiac images, which simultaneously allow the assessment of coronary arteries and the quantitative measurement of myocardial perfusion. The advancement of recent CT scanners and cardiac protocols have allowed noninvasive imaging of the whole heart in a single imaging session with minimal cardiac motion artefact and exposure to radiation. SUMMARY DCE-CT imaging in clinical practice would allow comprehensive evaluation of the structure, function, and hemodynamics of the heart in a short, well tolerated scanning session. It is an imaging tool enabling the study of myocardial dysfunction in dialysis patients, who have greater cardiovascular risk than nonrenal cardiovascular disease populations, both at rest and under cardiac stress associated with hemodialysis itself.
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Incidence, Predictors, and Impact on Survival of Long-term Cardiovascular Events After Liver Transplantation. Transplantation 2020; 104:317-325. [PMID: 31335770 DOI: 10.1097/tp.0000000000002852] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Information on the risk factors, particularly kidney function, and impact of long-term cardiovascular events (CVE) after liver transplantation (LT) remains scarce. METHODS This is a retrospective, single-center study that included consecutive LT recipients between 2007 and 2017. The incidence of CVE, their risk factors, and their impact on patient survival were investigated. RESULTS We included 627 LT recipients. The incidence of CVE was 8% and 20% at 12 and 60 months after LT, respectively. The independent risk factors of long-term (beyond 12 mo) CVE were age at LT (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.01-1.07), male gender (HR, 2.48; 95% CI, 1.21-5.05), history of pre-LT cardiovascular disease (HR, 2.19; 95% CI, 1.2-3.98), and immunosuppression with cyclosporine A (HR, 1.93; 95% CI, 1.14-3.3). In patients with pre-LT cardiovascular disease, creatinine levels 12 months after LT significantly impacted the risk of long-term CVE. Long-term CVE (HR, 2.12; 95% CI, 1.24-3.61), hepatitis C as the etiology of liver disease (HR, 2.18; 95% CI, 1.29-3.67), cytomegalovirus infection (HR, 1.89; 95% CI, 1.08-3.3), and donor age (HR, 1.02; 95% CI, 1.01-1.04) were independent factors associated with post-LT patient death. CONCLUSIONS Age, male gender, cardiovascular disease before LT, and cyclosporine A were associated with the risk of long-term CVE. The impact of serum creatinine was restricted to patients with pre-LT cardiovascular disease. In these patients, preservation of kidney function early after LT may lessen the incidence of CVE, which are an independent predictor of post-LT death.
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Athyros VG, Polyzos SA, Kountouras J, Katsiki N, Anagnostis P, Doumas M, Mantzoros CS. Non-Alcoholic Fatty Liver Disease Treatment in Patients with Type 2 Diabetes Mellitus; New Kids on the Block. Curr Vasc Pharmacol 2020; 18:172-181. [PMID: 30961499 DOI: 10.2174/1570161117666190405164313] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD), affecting over 25% of the general population worldwide, is characterized by a spectrum of clinical and histological manifestations ranging from simple steatosis (>5% hepatic fat accumulation without inflammation) to non-alcoholic steatohepatitis (NASH) which is characterized by inflammation, and finally fibrosis, often leading to liver cirrhosis, and hepatocellular carcinoma. Up to 70% of patients with type 2 diabetes mellitus (T2DM) have NAFLD, and diabetics have much higher rates of NASH compared with the general non-diabetic population. OBJECTIVE The aim of this study is to report recent approaches to NAFLD/NASH treatment in T2DM patients. To-date, there are no approved treatments for NAFLD (apart from lifestyle measures). RESULTS Current guidelines (2016) from 3 major scientific organizations suggest that pioglitazone and vitamin E may be useful in a subset of patients for adult NAFLD/NASH patients with T2DM. Newer selective PPAR-γ modulators (SPPARMs, CHRS 131) have shown to provide even better results with fewer side effects in both animal and human studies in T2DM. Newer antidiabetic drugs might also be useful, but detailed studies with histological outcomes are largely lacking. Nevertheless, prior animal and human studies on incretin mimetics, glucagon-like peptide-1 receptor agonists (GLP-1 RA) approved for T2DM treatment, have provided indirect evidence that they may also ameliorate NAFLD/NASH, whereas dipeptidyl dipeptidase-4 inhibitors (DDP-4i) were not better than placebo in reducing liver fat in T2DM patients with NAFLD. Sodium-glucoseco-transporter-2 inhibitors (SGLT2i) have been reported to improve NAFLD/NASH. Statins, being necessary for most patients with T2DM, may also ameliorate NAFLD/NASH, and could potentially reinforce the beneficial effects of the newer antidiabetic drugs, if used in combination, but this remains to be identified. CONCLUSION Newer antidiabetic drugs (SPPARMs, GLP-1 RA and SGLT2i) alone or in combination and acting alone or with potent statin therapy which is recommended in T2DM, might contribute substantially to NAFLD/NASH amelioration, possibly reducing not only liver-specific but also cardiovascular morbidity. These observations warrant long term placebo-controlled randomized trials with appropriate power and outcomes, focusing on the general population and more specifically on T2DM with NAFLD/NASH. Certain statins may be useful for treating NAFLD/NASH, while they substantially reduce cardiovascular disease risk.
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Affiliation(s)
- Vasilios G Athyros
- 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Stergios A Polyzos
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jiannis Kountouras
- 2nd Department of Internal Medicine, Division of Gastroenterology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niki Katsiki
- 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | | | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.,VAMC and George Washington University, Washington, DC, United States
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
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Hamza E, Metzinger L, Metzinger-Le Meuth V. Uremic Toxins Affect Erythropoiesis during the Course of Chronic Kidney Disease: A Review. Cells 2020; 9:cells9092039. [PMID: 32899941 PMCID: PMC7565991 DOI: 10.3390/cells9092039] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) is a global health problem characterized by progressive kidney failure due to uremic toxicity and the complications that arise from it. Anemia consecutive to CKD is one of its most common complications affecting nearly all patients with end-stage renal disease. Anemia is a potential cause of cardiovascular disease, faster deterioration of renal failure and mortality. Erythropoietin (produced by the kidney) and iron (provided from recycled senescent red cells) deficiencies are the main reasons that contribute to CKD-associated anemia. Indeed, accumulation of uremic toxins in blood impairs erythropoietin synthesis, compromising the growth and differentiation of red blood cells in the bone marrow, leading to a subsequent impairment of erythropoiesis. In this review, we mainly focus on the most representative uremic toxins and their effects on the molecular mechanisms underlying anemia of CKD that have been studied so far. Understanding molecular mechanisms leading to anemia due to uremic toxins could lead to the development of new treatments that will specifically target the pathophysiologic processes of anemia consecutive to CKD, such as the newly marketed erythropoiesis-stimulating agents.
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Affiliation(s)
- Eya Hamza
- HEMATIM UR 4666, C.U.R.S, Université de Picardie Jules Verne, CEDEX 1, 80025 Amiens, France; (E.H.); (V.M.-L.M.)
| | - Laurent Metzinger
- HEMATIM UR 4666, C.U.R.S, Université de Picardie Jules Verne, CEDEX 1, 80025 Amiens, France; (E.H.); (V.M.-L.M.)
- Correspondence: ; Tel.: +33-2282-5356
| | - Valérie Metzinger-Le Meuth
- HEMATIM UR 4666, C.U.R.S, Université de Picardie Jules Verne, CEDEX 1, 80025 Amiens, France; (E.H.); (V.M.-L.M.)
- INSERM UMRS 1148, Laboratory for Vascular Translational Science (LVTS), UFR SMBH, Université Sorbonne Paris Nord, CEDEX, 93017 Bobigny, France
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135
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Anantha-Narayanan M, Sheikh AB, Nagpal S, Jelani QUA, Smolderen KG, Regan C, Ionescu C, Ochoa Chaar CI, Schneider M, Llanos-Chea F, Mena-Hurtado C. Systematic review and meta-analysis of outcomes of lower extremity peripheral arterial interventions in patients with and without chronic kidney disease or end-stage renal disease. J Vasc Surg 2020; 73:331-340.e4. [PMID: 32889074 DOI: 10.1016/j.jvs.2020.08.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) have a greater risk of peripheral arterial disease (PAD). Although individual studies have documented an association between CKD and/or end-stage renal disease (ESRD) and adverse outcomes in patients undergoing PAD interventions in an era of technological advances in peripheral revascularization, the magnitude of the effect size is unknown. Therefore, we performed a meta-analysis to compare the outcomes of PAD interventions for patients with CKD/ESRD with those patients with normal renal function, stratified by intervention type (endovascular vs surgical), reflecting contemporary practice. METHODS Five databases were analyzed from January 2000 to June 2019 for studies that had compared the outcomes of lower extremity PAD interventions for patients with CKD/ESRD vs normal renal function. We included both endovascular and open interventions, with an indication of either claudication or critical limb ischemia. We analyzed the pooled odds ratios (ORs) across studies with 95% confidence intervals (CIs) using a random effects model. Funnel plot and exclusion sensitivity analyses were used for bias assessment. RESULTS Seventeen observational studies with 13,140 patients were included. All included studies, except for two, had accounted for unmeasured confounding using either multivariable regression analysis or case-control matching. The maximum follow-up period was 114 months (range, 0.5-114 months). The incidence of target lesion revascularization (TLR) was greater in those with CKD/ESRD than in those with normal renal function (OR, 1.68; 95% CI, 1.25-2.27; P = .001). The incidence of major amputations (OR, 1.97; 95% CI, 1.37-2.83; P < .001) and long-term mortality (OR, 2.28; 95% CI, 1.45-3.58; P < .001) was greater in those with CKD/ESRD. The greater TLR rates with CKD/ESRD vs normal renal function were only seen with endovascular interventions, with no differences for surgical interventions. The differences in rates of major amputations and long-term mortality between the CKD/ESRD and normal renal function groups were statistically significant, regardless of the intervention type. CONCLUSIONS Patients with CKD/ESRD who have undergone lower extremity PAD interventions had worse outcomes than those of patients with normal renal function. When stratifying our results by intervention (endovascular vs open surgery), greater rates of TLR for CKD/ESRD were only seen with endovascular and not with open surgical approaches. Major amputations and all-cause mortality were greater in the CKD/ESRD group, irrespective of the indication. Evidence-based strategies to manage this at-risk population who require PAD interventions are essential.
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Affiliation(s)
| | - Azfar Bilal Sheikh
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Sameer Nagpal
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Qurat-Ul-Ain Jelani
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Kim G Smolderen
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Christopher Regan
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Costin Ionescu
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | | | - Marabel Schneider
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | | | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
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136
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1037] [Impact Index Per Article: 259.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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137
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Perelló J, Ferrer MD, Del Mar Pérez M, Kaesler N, Brandenburg VM, Behets GJ, D'Haese PC, Garg R, Isern B, Gold A, Wolf M, Salcedo C. Mechanism of action of SNF472, a novel calcification inhibitor to treat vascular calcification and calciphylaxis. Br J Pharmacol 2020; 177:4400-4415. [PMID: 32557649 PMCID: PMC7484563 DOI: 10.1111/bph.15163] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE No therapy is approved for vascular calcification or calcific uraemic arteriolopathy (calciphylaxis), which increases mortality and morbidity in patients undergoing dialysis. Deposition of hydroxyapatite (HAP) crystals in arterial walls is the common pathophysiologic mechanism. The mechanism of action of SNF472 to reduce HAP deposition in arterial walls was investigated. EXPERIMENTAL APPROACH We examined SNF472 binding features (affinity, release kinetics and antagonism type) for HAP crystals in vitro, inhibition of calcification in excised vascular smooth muscle cells from rats and bone parameters in osteoblasts from dogs and rats. KEY RESULTS SNF472 bound to HAP with affinity (KD ) of 1-10 μM and saturated HAP at 7.6 μM. SNF472 binding was fast (80% within 5 min) and insurmountable. SNF472 inhibited HAP crystal formation from 3.8 μM, with complete inhibition at 30.4 μM. SNF472 chelated free calcium with an EC50 of 539 μM. Chelation of free calcium was imperceptible for SNF472 1-10 μM in physiological calcium concentrations. The lowest concentration tested in vascular smooth muscle cells, 1 μM inhibited calcification by 67%. SNF472 showed no deleterious effects on bone mineralization in dogs or in rat osteoblasts. CONCLUSION AND IMPLICATIONS These experiments show that SNF472 binds to HAP and inhibits further HAP crystallization. The EC50 for chelation of free calcium is 50-fold greater than a maximally effective SNF472 dose, supporting the selectivity of SNF472 for HAP. These findings indicate that SNF472 may have a future role in the treatment of vascular calcification and calcific uraemic arteriolopathy in patients undergoing dialysis.
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Affiliation(s)
- Joan Perelló
- Sanifit Therapeutics, Palma, Spain.,University of the Balearic Islands, Palma, Spain
| | - Miquel D Ferrer
- Sanifit Therapeutics, Palma, Spain.,University of the Balearic Islands, Palma, Spain
| | | | | | | | - Geert J Behets
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrick C D'Haese
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Rekha Garg
- Sanifit Therapeutics, San Diego, CA, USA
| | | | - Alex Gold
- Sanifit Therapeutics, San Diego, CA, USA
| | - Myles Wolf
- Division of Nephrology, Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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138
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Zheng Y, Tang L, Zhang W, Zhao D, Zhang D, Zhang L, Cai G, Chen X. Applying the new intensive blood pressure categories to a nondialysis chronic kidney disease population: the Prevalence, Awareness and Treatment Rates in Chronic Kidney Disease Patients with Hypertension in China survey. Nephrol Dial Transplant 2020; 35:155-161. [PMID: 30304540 DOI: 10.1093/ndt/gfy301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/29/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The 2017 high blood pressure (BP) clinical practice guideline reported by the American College of Cardiology/American Heart Association put forward new categories of BP. This study aimed to assess the applicability of the new guideline in a nondialysis chronic kidney disease (CKD) population. METHODS This is a nationwide, multicenter, cross-sectional study with a large sample. A total of 8927 nondialysis CKD patients in 61 tertiary hospitals in all 31 provinces, municipalities and autonomous regions of China (except Hong Kong, Macao and Taiwan) were analyzed. The categories of BP were defined as normal BP (<120/80 mmHg), elevated BP [systolic BP (SBP) 120-130 and diastolic BP (DBP) <80 mmHg], and Stage 1 (SBP 130-139 or DBP 80-89 mmHg) and Stage 2 (SBP ≥140 or DBP ≥90 mmHg) hypertension. The prevalence and control of hypertension were estimated using a new definition, and the association between the main target organs' injury and new categories of BP was analyzed. RESULTS The prevalence, awareness and treatment of hypertension in nondialysis CKD patients were 79.8, 72.4 and 68.3%, respectively. Approximately 11.9% had BP <130/80 mmHg and 6.6% had BP <120/80 mmHg. Subgroups by categories of BP had significant differences in age, sex, body mass index category, primary cause and CKD stage (P < 0.001). After multivariable adjustment, only Stage 2 hypertension was associated with decreased renal function [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.9-3.0, P < 0.001], cardiovascular disease (OR 2.0, 95% CI 1.3-3.1, P = 0.001) and cerebrovascular disease (OR 2.7, 95% CI 1.2-5.8, P = 0.015). CONCLUSIONS Using the new definition of hypertension, the higher prevalence and lower control of hypertension were shown in nondialysis CKD participants. More studies are necessary to confirm the applicability of new categories of BP in CKD population because only Stage 2 hypertension showed statistical association with the main target organs' injury.
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Affiliation(s)
- Ying Zheng
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Li Tang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China.,Department of Nephrology, General Hospital of PLA in Hainan Branch, Sanya, Hainan, China
| | - Weiguang Zhang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Delong Zhao
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Dong Zhang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Li Zhang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, China
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139
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Jelani QUA, Mena-Hurtado C, Burg M, Soufer R, Gosch K, Jones PG, Spertus JA, Safdar B, Smolderen KG. Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences. J Am Heart Assoc 2020; 9:e014583. [PMID: 32781883 PMCID: PMC7660812 DOI: 10.1161/jaha.119.014583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The association of depressive symptoms with health status in peripheral artery disease (PAD) is understudied. No reports of differential impact on women have been described. Methods and Results The PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease Investigating Trajectories) registry enrolled 1243 patients from vascular specialty clinics with new or worsening PAD symptoms. Depressive symptoms were assessed at baseline and 3 months using the 8‐Item Patient Health Questionnaire (score ≥10 indicating clinically relevant depressive symptoms). Disease‐specific and generic health status were measured by Peripheral Artery Questionnaire and EQ‐5D Visual Analogue Scale at baseline and 3, 6, and 12 months. An adjusted general linear model for repeated measures was constructed for baseline and 3‐, 6‐, and 12‐month health status outcomes by depressive symptoms at baseline. Differences by sex were tested with interaction effects. The mean age was 67.6±9.4 years with 38% (n=470) women. More women than men (21.1% versus 12.9%; P<0.001) presented with severe depressive symptoms. In the adjusted model, patients with depressive symptoms had worse health status at each time point (all P<0.0001). Results were similar for EQ‐5D Visual Analogue Scale scores. The magnitude in 1‐year change in health status scores did not differ by sex. Depressive symptoms explained 19% of the association between sex differences in 1‐year Peripheral Artery Questionnaire summary scores. Conclusions Women with PAD have a high burden of depressive symptoms. Depressive symptoms were associated with a strikingly worse disease‐specific health status recovery path over the year following PAD diagnosis in men and women. Developing and testing interventions to address depressive symptoms in PAD are urgently needed. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01419080.
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Affiliation(s)
- Qurat-Ul-Ain Jelani
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Matthew Burg
- Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Robert Soufer
- Cardiovascular Medicine VA Connecticut Healthcare System West Haven CT
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute Kansas City MO
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City MO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City MO
| | - Basmah Safdar
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
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140
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Atlas A, Tekin İ, Yuksel Y, Yavuz A, Dosemeci L. Perioperative Anesthetic Management and Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting and Kidney Transplant in the Same Session. Transplant Proc 2020; 52:3038-3043. [PMID: 32758366 DOI: 10.1016/j.transproceed.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular disease is commonly seen in patients with end-stage renal disease (ESRD) and is a major cause of graft failure and death in patients undergoing kidney transplant. METHODS The retrospective study included 77 patients with ESRD who underwent combined coronary artery bypass grafting (CABG) and kidney transplant between May 2010 and September 2017. RESULTS The patients included 65 (84.4%) men and 12 (15.6%) women. Diabetes mellitus (DM) and hypertension (HT) were present in 71.4% and 90.9% of the patients, respectively. Mean postoperative intensive care unit (ICU) stay was 3.4 ± 1.6 days, mean time to extubation was 12.1 ± 3.7 hours, and mean hospital stay was 11.6 ± 3.5 days. In the small group with graft rejection, EF was 41.1 ± 12.3. Two patients underwent second kidney transplant, and 1 patient underwent a third kidney transplant. Mean amount of red blood cells (RBC) and fresh-frozen plasma (FFP) transfusion was 2.6 ± 0.7 and 2.1 ± 0.7 units, respectively. CONCLUSION The study showed that CABG and kidney transplant can be performed in a combined approach in the same session and that this combined approach is likely to have a more favorable effect on mortality and morbidity compared to the administration of these 2 surgeries in separate sessions.
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Affiliation(s)
- Ahmet Atlas
- Department of Anesthesiology and Reanimation, Harran University Medical Faculty, Sanliurfa, Turkey.
| | - İlker Tekin
- Department of Heart and Vascular Surgery, Medical Park Hospital, Antalya, Turkey; Department of Heart and Vascular Surgery, Bahcesehir University, Istanbul, Turkey
| | - Yucel Yuksel
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey; Department of Surgery, University of Kyrenia, Kyrenia, Cyprus
| | - Asuman Yavuz
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Levent Dosemeci
- Department of Anesthesiology and Reanimation, Medical Park Hospital, Antalya, Turkey
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141
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Ma TT, Wong ICK, Whittlesea C, Mackenzie IS, Man KKC, Lau W, Brauer R, Wei L. Initial cardiovascular treatment patterns during the first 90 days following an incident cardiovascular event. Br J Clin Pharmacol 2020; 87:1043-1055. [PMID: 32643191 DOI: 10.1111/bcp.14463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim of this study was to investigate the initial cardiovascular prescription patterns in patients after their first cardiovascular events, and to identify factors associated with cardiovascular polypharmacy. METHODS This was a cross-sectional study including patients aged ≥ 45 years with the first record of coronary heart disease (CHD) or stroke between 2007 and 2016 using The Health Improvement Network database. This study investigated the patterns of cardiovascular drugs prescribed during the first 90 days after the first cardiovascular events. Logistic regression was used to examine the association between patients' baseline characteristics and cardiovascular polypharmacy (≥5 cardiovascular drugs). RESULTS A total of 121,600 (59,843 CHD and 61,757 stroke) patients were included in the study. The mean age was 69.5 ± 11.9 years. The proportion of patients who were prescribed 0-1, 2-3, 4-5 drugs and ≥6 drugs were 11.0%, 29.8%, 38.6% and 20.5%, respectively. Factors associated with cardiovascular polypharmacy were sex (female: OR 0.74, 95% CI 0.72-0.76 vs male), age (75-84 years old: OR 0.50, 0.47-0.53 vs 45-54 years old), smoking status (current smoking: OR 1.29, 1.15-1.24 vs never), body mass index (obesity: OR 1.38, 1.34-1.43 vs normal), deprivation status (most deprived: OR 1.09, 1.04-1.14 vs least deprived) and Charlson comorbidity index (index ≥5: OR 1.25, 1.16-1.35 vs index 0). CONCLUSION Multiple cardiovascular drugs treatment was common in patients with CVD in the UK. High-risk factors of CVD were also associated with cardiovascular polypharmacy. Further studies are warranted to assess the impact of cardiovascular polypharmacy and its interaction on CVD recurrence and mortality.
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Affiliation(s)
- Tian-Tian Ma
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Isla S Mackenzie
- Medicines Monitoring Unit (MEMO Research) and Hypertension Research Centre, University of Dundee, Dundee, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Wallis Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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142
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Bessa J, Albino-Teixeira A, Reina-Couto M, Sousa T. Endocan: A novel biomarker for risk stratification, prognosis and therapeutic monitoring in human cardiovascular and renal diseases. Clin Chim Acta 2020; 509:310-335. [PMID: 32710940 DOI: 10.1016/j.cca.2020.07.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
The vascular endothelium is localized at the interface between the blood and surrounding tissues, playing a pivotal role in the maintenance of tissue-fluid homeostasis and in the regulation of host defense, inflammation, vascular tone and remodeling, angiogenesis and haemostasis. The dysfunctional endothelium was shown to be implicated in the pathophysiology of several endothelial-dependent disorders, such as arterial hypertension, coronary artery disease, heart failure and chronic kidney disease, in which it is an early predictor of cardiovascular events. Endocan is a soluble dermatan sulphate proteoglycan mainly secreted by the activated endothelium. It is upregulated by several proinflammatory cytokines and proangiogenic factors and may itself contribute to the inflammatory status. In addition of being a surrogate marker of inflammation and endothelial dysfunction, it seems to be involved in the regulation of several proliferative and neovascularization processes. Therefore, its utility as a biomarker in a wide spectrum of diseases has been increasingly explored. Here, we review the current evidence concerning the role of endocan in several human cardiovascular and renal diseases, where it seems to be a promising biomarker for risk stratification, prognosis and therapeutic monitoring.
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Affiliation(s)
- João Bessa
- Departamento de Biomedicina - Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - António Albino-Teixeira
- Departamento de Biomedicina - Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal; Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Univ. Porto, Porto, Portugal
| | - Marta Reina-Couto
- Departamento de Biomedicina - Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal; Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Univ. Porto, Porto, Portugal; Departamento de Medicina Intensiva, Centro Hospitalar São João (CHSJ), Porto, Portugal
| | - Teresa Sousa
- Departamento de Biomedicina - Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal; Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Univ. Porto, Porto, Portugal.
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143
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Noce A, Bocedi A, Campo M, Marrone G, Di Lauro M, Cattani G, Di Daniele N, Romani A. A Pilot Study of a Natural Food Supplement as New Possible Therapeutic Approach in Chronic Kidney Disease Patients. Pharmaceuticals (Basel) 2020; 13:ph13070148. [PMID: 32664308 PMCID: PMC7408446 DOI: 10.3390/ph13070148] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 02/08/2023] Open
Abstract
The identification of natural bioactive compounds, able to counteract the abnormal increase of oxidative stress and inflammatory status in chronic degenerative non-communicable diseases is useful for the clinical management of these conditions. We tested an oral food supplement (OFS), chemically characterized and evaluated for in vitro and in vivo activity. Vitamin C, analyzed by High Performance Liquid Chromatography-Diode Array Detector (HPLC-DAD), was 0.19 mg/g in rosehip dry extract and 15.74 mg/capsule in the OFS. The identification of polyphenols was performed by HPLC-DAD; the total antioxidant capacity was assessed by Folin-Ciocalteu test. Total polyphenols were 14.73 mg/g gallic acid equivalents (GAE) for rosehip extract and 1.93 mg/g GAE for OFS. A total of 21 chronic kidney disease (CKD) patients and 10 healthy volunteers were recruited. The evaluation of routine laboratory and inflammatory parameters, erythrocyte glutathione transferase (e-GST), human oxidized serum albumin (HSAox), and assessment of body composition were performed at two different times, at baseline and after 5 weeks of OFS assumption. In the study, we highlighted a significant decrease of traditional inflammatory biomarkers (such as C-reactive protein, erythrocyte sedimentation rate, platelet to lymphocyte ratio) and other laboratory parameters like e-GST, azotaemia, and albuminuria after OFS treatment in CKD patients. Moreover, we demonstrated a lipid profile improvement in CKD patients after OFS supplementation.
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Affiliation(s)
- Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.D.D.)
- Correspondence: (A.N.); (A.R.); Tel.: +39-06-20902188 (A.N.); +39-055-457377 (A.R.); Fax: +39-06-20902096 (A.N.); +39-055-2751525 (A.R.)
| | - Alessio Bocedi
- Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Via della Ricerca Scientifica 1, 00133 Rome, Italy; (A.B.); (G.C.)
| | - Margherita Campo
- PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis)-DiSIA, University of Florence, Via U. Schiff, 6, 50019 Sesto Fiorentino, Italy;
| | - Giulia Marrone
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.D.D.)
- School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy
| | - Manuela Di Lauro
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.D.D.)
| | - Giada Cattani
- Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Via della Ricerca Scientifica 1, 00133 Rome, Italy; (A.B.); (G.C.)
| | - Nicola Di Daniele
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (N.D.D.)
| | - Annalisa Romani
- PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis)-DiSIA, University of Florence, Via U. Schiff, 6, 50019 Sesto Fiorentino, Italy;
- Correspondence: (A.N.); (A.R.); Tel.: +39-06-20902188 (A.N.); +39-055-457377 (A.R.); Fax: +39-06-20902096 (A.N.); +39-055-2751525 (A.R.)
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144
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Wolide AD, Kumela K, Kerga F, Debalke S, Seboka M, Edilu B, Gashe F, Bobassa EM. Knowledge, attitude, and practices toward chronic kidney disease among care providers in Jimma town:cross-sectional study. BMC Public Health 2020; 20:1079. [PMID: 32646400 PMCID: PMC7346627 DOI: 10.1186/s12889-020-09192-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common and growing health problem that requires adequate Knowledge by health care providers to reduce the progress of the disease. Thus, this study aimed to assess the care provider's Knowledge, attitude, and practices toward CKD. METHOD A cross-sectional study conducted among 326 care providers at Jimma University Specialized hospital and three medium to higher clinics found in Jimma Town. Collected data entered into Epi-Data version 3.1 and exported to SPSS version 21 for windows for data analysis. Descriptive statistics and generalized linear modal used to analyze the data. RESULT The mean age and service year of the participants were 29.68(±4.877) and 4.28(±4.561), respectively. The overall weighted Knowledge, attitude, and practice score of the study participant were 9.0971(8.77, 9.42), 2.53(2.4, 2.65), 10.14(9.94, 10.33) respectively. Over half of the care providers had the awareness to use eGFR to assess kidney function and patient referral to Nephrologists. Also, many care providers knew the five-stage of CKD and the risk factors of CKD, such as diabetes, long-term alcohol consumption, anemia, and cardiovascular disorders, respectively. Care providers had an understanding of late detection, and referral of CKD would increase kidney disease complications. Besides, 275(84.4%) of them are worried about treatment costs related to CKD. Over half of the care providers, 238(73.0%), believed that the Ethiopian ministry of health gave less attention to the problem. Furthermore, 234(71.8%) are interested in studying more on CKD management. Majority 256(78.5%), very likely or likely refer the patient to senior physician and Nephrologist. CONCLUSION Care providers showed enough Knowledge, a favorable attitude, and practice toward CKD.
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Affiliation(s)
- Amare Desalegn Wolide
- Department of Medical Physiology, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia.
| | - Kabaye Kumela
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Fantu Kerga
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Serkadis Debalke
- Department of Medical Microbiology, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Meskerem Seboka
- Department of Health Service Management, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Birtukan Edilu
- Department of Reproductive Health, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Fanta Gashe
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Eshetu Mulisa Bobassa
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
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145
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Laine M, Lemesle G, Burtey S, Cayla G, Range G, Quaino G, Canault M, Pankert M, Paganelli F, Puymirat E, Bonello L. TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome: The TROUPER trial. Am Heart J 2020; 225:19-26. [PMID: 32473355 DOI: 10.1016/j.ahj.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease (CKD) is associated with an increased risk of acute coronary syndrome (ACS) and cardiovascular death. CKD patients suffering from ACS are exposed to an increased risk of thrombotic recurrences and a higher bleeding rate than patients with normal renal function. However, CKD patients are excluded or underrepresented in clinical trials. Therefore, determining the optimal antiplatelet strategy in this population is of utmost importance. We designed the TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome (TROUPER) trial: a prospective, controlled, multicenter, randomized trial to investigate the optimal P2Y12 antagonist in CKD patients with ACS. Patients with stage ≥3b CKD are eligible if the diagnosis of ACS is made and invasive strategy scheduled. Patients are randomized 1:1 between a control group with a 600-mg loading dose of clopidogrel followed by a 75-mg/d maintenance dose for 1 year and an experimental group with a 180-mg loading dose of ticagrelor followed by a 90-mg twice daily maintenance dose for the same duration. The primary end point is defined by the rate of major adverse cardiovascular events, including death, myocardial infarction, urgent revascularization, and stroke at 1 year. Safety will be evaluated by the bleeding rate (Bleeding Academic Research Consortium). To demonstrate the superiority of ticagrelor on major adverse cardiovascular events, we calculated that 508 patients are required. The aim of the TROUPER trial is to compare the efficacy of ticagrelor and clopidogrel in stage >3b CKD patients presenting with ACS and scheduled for an invasive strategy. RCT# NCT03357874.
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Affiliation(s)
- Marc Laine
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France.
| | - Gilles Lemesle
- Institut Cœur et Poumon, CHRU de Lille, Faculté de Médecine de l'Université de Lille, Unité INSERM UMR 1011, Lille, France
| | - Stéphane Burtey
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France; Service de Néphrologie, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | | | - Grégoire Range
- Département de Cardiologie, CHU Chartres, Chartres, France
| | - Gonzalo Quaino
- Service de Cardiologie, Centre Hospitalier Toulon, Toulon, France
| | | | - Mathieu Pankert
- Service de Cardiologie, Centre Hospitalier d'Avignon, Avignon, France
| | - Franck Paganelli
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Etienne Puymirat
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, INSERM U-970, Paris, France
| | - Laurent Bonello
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
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146
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Cardiovascular Protection of Nephropathic Male Patients by Oral Food Supplements. Cardiovasc Ther 2020; 2020:1807941. [PMID: 32670409 PMCID: PMC7334761 DOI: 10.1155/2020/1807941] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/22/2020] [Indexed: 12/25/2022] Open
Abstract
Nephropathic patients show elevated cardiovascular morbidity and mortality compared to the general population. In order to delve deeper into the understanding of this phenomenon, it is necessary to recognize risk factors that are distinctive to the uremic state, such as oxidative stress and chronic low-grade inflammation. Moreover, gender differences have been reported in nephrology, as it has been observed that chronic kidney disease has higher prevalence in males than in females. The use of an oral food supplement (OFS) containing natural active compounds from Capsicum annuum L., Garcinia cambogia, Centella asiatica L., artichoke, and Aesculus hippocastanum L. which are virtually devoid from side effects, but rich in antioxidant and antiradical properties, could represent a valid therapeutic adjunct in the clinical management of nephropathic patients. Moreover, quantitative analysis performed in vitro on such compounds showed that they expressed good total antioxidant (7.28 gallic acid equivalents) and antiradical activity (above 80%). In this study, 23 male nephropathic patients and 10 age and body composition parameter matched healthy males (control group) were enrolled and took 3 cps/day of OFS for 5 weeks. At the end of the study, the nephropathic patient group showed a statistically significant reduction in the following laboratory parameters: total cholesterol (TC) (p = 0.044), atherogenic index TC/high-density lipoprotein cholesterol (p = 0.010), inflammatory parameters (C-reactive protein, p = 0.048, and erythrocyte sedimentation rate, p = 0.019), systolic (p = 0.044), and diastolic arterial blood pressure (p = 0.003). Regarding body composition, there was an increase in total body water % (p = 0.035) with redistribution of extracellular water % (p = 0.030) and intracellular water % (p = 0.049). In the control group, there was a reduction in fat mass % (p = 0.017) and extracellular water % (p = 0.047). Therefore, this OFS may represent a valid adjunct therapy to counteract comorbidities related to uremia.
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147
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Krečak I, Holik H, Martina MP, Zekanović I, Coha B, Gverić-Krečak V. Chronic kidney disease could be a risk factor for thrombosis in essential thrombocythemia and polycythemia vera. Int J Hematol 2020; 112:377-384. [PMID: 32514928 DOI: 10.1007/s12185-020-02898-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/29/2022]
Abstract
Chronic kidney disease (CKD) is a well-known risk factor for venous thromboembolism and cardiovascular (CV) disease development in the general population, but its role in thrombotic risk in essential thrombocythemia (ET) and polycythemia vera (PV) remains poorly understood. This retrospective multicenter study analyzed clinical correlations and the potential impact of CKD on thrombosis development in ET and PV patients. We included 167 patients (76 ET and 91 PV); 25.7% had CKD at diagnosis, defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for ≥ 3 months. Lower eGFR correlated with advanced age, female sex, higher granulocytes, higher serum C-reactive protein, history of thrombosis, CV risk factors, and the presence of palpable splenomegaly. CKD was univariately associated with inferior thrombosis-free survival in the entire cohort, as well as in both ET and PV patients. These results remained significant in the multivariate Cox regression models when adjusted to disease-specific risk models. Therefore, CKD could be a risk factor for thrombosis in ET and PV patients. Additional studies on a larger number of patients are needed to confirm our findings and to elucidate whether the addition of CKD to the current risk stratification models might improve prognostication in ET and PV patients.
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Affiliation(s)
- Ivan Krečak
- Department of Internal Medicine, Šibenik-Knin County General Hospital, Stjepana Radića 83, 22000, Šibenik, Croatia.
| | - Hrvoje Holik
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia.,School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | | | - Ivan Zekanović
- Department of Internal Medicine, Zadar General Hospital, Zadar, Croatia
| | - Božena Coha
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Velka Gverić-Krečak
- Department of Internal Medicine, Šibenik-Knin County General Hospital, Stjepana Radića 83, 22000, Šibenik, Croatia
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148
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Implications of the complex biology and micro-environment of cardiac sarcomeres in the use of high affinity troponin antibodies as serum biomarkers for cardiac disorders. J Mol Cell Cardiol 2020; 143:145-158. [PMID: 32442660 PMCID: PMC7235571 DOI: 10.1016/j.yjmcc.2020.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
Cardiac troponin I (cTnI), the inhibitory-unit, and cardiac troponin T (cTnT), the tropomyosin-binding unit together with the Ca-binding unit (cTnC) of the hetero-trimeric troponin complex signal activation of the sarcomeres of the adult cardiac myocyte. The unique structure and heart myocyte restricted expression of cTnI and cTnT led to their worldwide use as biomarkers for acute myocardial infarction (AMI) beginning more than 30 years ago. Over these years, high sensitivity antibodies (hs-cTnI and hs-cTnT) have been developed. Together with careful determination of history, physical examination, and EKG, determination of serum levels using hs-cTnI and hs-cTnT permits risk stratification of patients presenting in the Emergency Department (ED) with chest pain. With the ability to determine serum levels of these troponins with high sensitivity came the question of whether such measurements may be of diagnostic and prognostic value in conditions beyond AMI. Moreover, the finding of elevated serum troponins in physiological states such as exercise and pathological states where cardiac myocytes may be affected requires understanding of how troponins may be released into the blood and whether such release may be benign. We consider these questions by relating membrane stability to the complex biology of troponin with emphasis on its sensitivity to the chemo-mechanical and micro-environment of the cardiac myocyte. We also consider the role determinations of serum troponins play in the precise phenotyping in personalized and precision medicine approaches to promote cardiac health. Serum levels of cardiac TnI and cardiac TnT permit stratification of patients with chest pain. Release of troponins into blood involves not only frank necrosis but also programmed necroptosis. Genome wide analysis of serum troponin levels in the general population may be prognostic about cardiovascular health. Significant levels of serum troponins with exhaustive exercise may not be benign. Troponin in serum can lead to important data related to personalized and precision medicine.
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149
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Interpreting troponin in renal disease: A narrative review for emergency clinicians. Am J Emerg Med 2020; 38:990-997. [DOI: 10.1016/j.ajem.2019.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/16/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
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150
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Cardiovascular Outcomes With the Use of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes and Chronic Kidney Disease. Cardiol Rev 2020; 28:116-124. [PMID: 31868769 DOI: 10.1097/crd.0000000000000265] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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