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Schmalz G, Kollmar O, Vasko R, Müller GA, Haak R, Ziebolz D. Oral health-related quality of life in patients on chronic haemodialysis and after kidney transplantation. Oral Dis 2016; 22:665-72. [PMID: 27265431 DOI: 10.1111/odi.12519] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/07/2016] [Accepted: 06/01/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The objective of the study was to evaluate oral health-related quality of life (OHRQoL) depending on dental and periodontal situation in patients on haemodialysis (HD) and after kidney transplantation (KTx) compared to healthy controls (HC). SUBJECTS AND METHODS OHRQoL was assessed using the German short form of Oral Health Impact Profile (OHIP G14). Dental health was estimated using the decayed, missing and filled teeth index (DMF-T). Periodontal health was classified as healthy/mild or moderate/severe periodontitis. STATISTICAL ANALYSIS Mann-Whitney U-test, Kruskal-Wallis test, chi-square test and Fisher's test. RESULTS Eighty-seven HD patients, 39 KTx patients and 91 HC were included. Significant differences in DMF-T, D-T, M-T and F-T scores were identified between groups (P < 0.001). The prevalence of moderate/severe periodontitis was significantly higher in the HD and KTx group compared to HC (P = 0.002). Differences in OHIP G14 between groups were neither clinical relevant nor statistically significant (P = 0.199). A significant effect of DMF-T (P = 0.012), M-T (P < 0.001) and periodontitis (P = 0.023) on the OHIP G14 scores was identified only in HC. CONCLUSIONS Improvement in dental care of HD and KTx patients is required. OHIP G14 values provide a subjectively considered low importance of oral health in HD and KTx patients, leading to need of motivation and sensitisation of these patients.
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Affiliation(s)
- G Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - O Kollmar
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Germany
| | - R Vasko
- Department of Nephrology and Rheumatology, University Medical Center, Goettingen, Germany
| | - G A Müller
- Department of Nephrology and Rheumatology, University Medical Center, Goettingen, Germany
| | - R Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - D Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany.
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152
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Belaïch R, Boujraf S, Benzagmout M, Maaroufi M, Housni A, Batta F, Tizniti S, Magoul R, Sqalli T. Indices of adrenal deficiency involved in brain plasticity and functional control reorganization in hemodialysis patients with polysulfone membrane: BOLD-fMRI study. J Integr Neurosci 2016; 15:191-203. [PMID: 27301905 DOI: 10.1142/s0219635216500126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This work purpose was to estimate the implication of suspected adrenal function deficiencies, which was influenced by oxidative stress (OS) that are generating brain plasticity, and reorganization of the functional control. This phenomenon was revealed in two-hemodialysis patients described in this paper. Blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) revealed a significant activation of the motor cortex. Hemodialysis seems to originate an inflammatory state of the cerebral tissue reflected by increased OS, while expected to decrease since hemodialysis eliminates free radicals responsible for OS. Considering adrenal function deficiencies, sensitivity to OS and assessed hyponatremia and hypercalcemia, adrenal function deficiencies is strongly suspected in both patients. This probably contributes to amplify brain plasticity and a reorganization of functional control after hemodialysis that is compared to earlier reported studies. Brain plasticity and functional control reorganization was revealed by BOLD-fMRI with a remarkable sensitivity. Brain plastic changes are originated by elevated OS associating indices of adrenal function deficiencies. These results raise important issues about adrenal functional deficiencies impact on brain plasticity in chronic hemodialysis-patients. This motivates more global studies of plasticity induced factors in this category of patients including adrenal functional deficiencies and OS.
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Affiliation(s)
- Rachida Belaïch
- * Department of Biophysics and Clinical MRI Methods, Faculty of Medicine of Fez; Fez, Morocco.,† The Clinical Neuroscience Laboratory, Faculty of Medicine of Fez; Fez, Morocco
| | - Saïd Boujraf
- * Department of Biophysics and Clinical MRI Methods, Faculty of Medicine of Fez; Fez, Morocco.,† The Clinical Neuroscience Laboratory, Faculty of Medicine of Fez; Fez, Morocco
| | - Mohammed Benzagmout
- † The Clinical Neuroscience Laboratory, Faculty of Medicine of Fez; Fez, Morocco
| | - Mustapha Maaroufi
- † The Clinical Neuroscience Laboratory, Faculty of Medicine of Fez; Fez, Morocco.,‡ Department of Radiology and Clinical Imaging, University Hospital of Fez; Fez, Morocco
| | - Abdelkhalek Housni
- † The Clinical Neuroscience Laboratory, Faculty of Medicine of Fez; Fez, Morocco
| | - Fatima Batta
- * Department of Biophysics and Clinical MRI Methods, Faculty of Medicine of Fez; Fez, Morocco.,† The Clinical Neuroscience Laboratory, Faculty of Medicine of Fez; Fez, Morocco.,§ Department of Nephrology, University Hospital of Fez, Fez, Morocco
| | - Siham Tizniti
- † The Clinical Neuroscience Laboratory, Faculty of Medicine of Fez; Fez, Morocco.,‡ Department of Radiology and Clinical Imaging, University Hospital of Fez; Fez, Morocco
| | - Rabia Magoul
- ¶ Laboratory of Neuroendocrinology and Nutritional and Climatic Environment, Faculty of Sciences Dhar El Mahraz, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Tarik Sqalli
- § Department of Nephrology, University Hospital of Fez, Fez, Morocco
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153
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Sandoval Y, Herzog CA, Love SA, Cao J, Hu Y, Wu AHB, Gilbertson D, Brunelli SM, Young A, Ler R, Apple FS. Prognostic Value of Serial Changes in High-Sensitivity Cardiac Troponin I and T over 3 Months Using Reference Change Values in Hemodialysis Patients. Clin Chem 2016; 62:631-8. [DOI: 10.1373/clinchem.2015.251835] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/07/2016] [Indexed: 11/06/2022]
Abstract
Abstract
INTRODUCTION
Serial changes in cardiac troponin in hemodialysis (HD) patients have uncertain clinical implications. We evaluated associations of adverse outcomes in HD patients with reference change value (RCV) data and tertile concentrations for cardiac troponin I (cTnI) and cTnT measured by high-sensitivity (hs) assays.
METHODS
RCV data and tertiles for hs-cTnI and hs-cTnT were determined from plasma samples collected 3 months apart in 677 stable outpatient HD patients and assessed for their associations with adverse outcomes using adjusted Cox models. Primary outcomes were all-cause mortality and sudden cardiac death (SCD).
RESULTS
During a median follow-up of 23 months, 18.6% of patients died. RCVs were: hs-cTnI +37% and −30%; hs-cTnT +25% and −20%. Patients with serial hs-cTnI and hs-cTnT changes >RCV (increase or decrease) had all-cause mortality of 25.2% and 23.8% respectively, compared to 15.0% and 16.5% with changes ≤RCV [adjusted hazard ratios (aHRs): 1.9, P = 0.0003 and 1.7, P = 0.0066), respectively]. Only hs-cTnI changes >RCV were predictive of SCD (aHR 2.6, P = 0.005). hs–Cardiac troponin changes >RCV improved all-cause mortality prognostication compared to changes ≤RCV in tertile 2: hs-cTnI aHR, 2.70 (P = 0.003); hs-cTnT aHR, 1.98 (P = 0.043). The aHR of changes in hs-cTnI in tertile 2 >RCV for SCD was 5.62 (P = 0.039).
CONCLUSIONS
Changes over 3 months in hs-cTnI and hs-cTnT of >RCV identified patients at greater risk of all-cause mortality, and for hs-cTnI were also predictive of SCD. Among patients with middle tertile cardiac troponin concentrations, hs-cTnI changes >RCV provided additive prognostic value for both SCD and all-cause mortality, whereas those for hs-cTnT provided additive prognostic value only for all-cause mortality.
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Affiliation(s)
- Yader Sandoval
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN
- Chronic Disease Research Group (CDRG), Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Sara A Love
- Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN
| | - Jing Cao
- Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Yan Hu
- Chronic Disease Research Group (CDRG), Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA
| | - David Gilbertson
- Chronic Disease Research Group (CDRG), Minneapolis Medical Research Foundation, Minneapolis, MN
| | | | - Amy Young
- DaVita Clinical Research, Minneapolis, MN
| | - Ranka Ler
- Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Fred S Apple
- Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN
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154
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Bacle A, Thevenot S, Grignon C, Belmouaz M, Bauwens M, Teychene B, Venisse N, Migeot V, Dupuis A. Determination of bisphenol A in water and the medical devices used in hemodialysis treatment. Int J Pharm 2016; 505:115-21. [PMID: 27012980 DOI: 10.1016/j.ijpharm.2016.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/22/2022]
Abstract
Bisphenol A (BPA) is an endocrine disruptor found in food containers and plastic beverages and also in medical devices such as dialyzers. The aim of this study is while taking into account the BPA originating in medical devices and the water used in dialysate production, to provide the first published investigation of overall potential exposure to BPA during hemodialysis treatment in patients suffering from end-stage renal disease. BPA concentration in water (at each step of purification treatment) and in dialysate and BPA leaching from dialyzers were determined using solid-phase extraction coupled to ultra-high-performance-liquid chromatography tandem mass spectrometry. We have corroborated the hypothesis that a significant amount of BPA may migrate from dialyzers and also demonstrated that BPA is provided by the water used in dialysate production (8.0±5.2ngL(-1) on average) and by dialysis machine and dialysate cartridges, leading to dialysate contamination of 22.7±15.6ngL(-1) on average. Taking into account all the sources of BPA contamination that may come into play during a hemodialysis session, the highest exposure could reach an estimated 140ng/kg b.w./day for hemodialyzed patients, directly available for systemic exposure. Finally, BPA contamination should be taken into account as concerns both the medical devices commonly used in hemodialysis and purified water production systems.
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Affiliation(s)
- Astrid Bacle
- University of Poitiers, CNRS-UMR 7285 IC2MP, School of Medicine and Pharmacy (Department of Analytical Chemistry, Pharmaceutics and Epidemiology), 6 rue de la Milétrie, 86034 Poitiers Cedex, France; University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Sarah Thevenot
- University of Poitiers, CNRS-UMR 7285 IC2MP, School of Medicine and Pharmacy (Department of Analytical Chemistry, Pharmaceutics and Epidemiology), 6 rue de la Milétrie, 86034 Poitiers Cedex, France; University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Claire Grignon
- University of Poitiers, CNRS-UMR 7285 IC2MP, School of Medicine and Pharmacy (Department of Analytical Chemistry, Pharmaceutics and Epidemiology), 6 rue de la Milétrie, 86034 Poitiers Cedex, France; University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Mohamed Belmouaz
- University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Marc Bauwens
- University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Benoit Teychene
- University of Poitiers, CNRS-UMR 7285 IC2MP, ENSIP, 1 rue Marcel Doré, 86022 Poitiers Cedex, France
| | - Nicolas Venisse
- University of Poitiers, CNRS-UMR 7285 IC2MP, School of Medicine and Pharmacy (Department of Analytical Chemistry, Pharmaceutics and Epidemiology), 6 rue de la Milétrie, 86034 Poitiers Cedex, France; University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Virginie Migeot
- University of Poitiers, CNRS-UMR 7285 IC2MP, School of Medicine and Pharmacy (Department of Analytical Chemistry, Pharmaceutics and Epidemiology), 6 rue de la Milétrie, 86034 Poitiers Cedex, France; University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Antoine Dupuis
- University of Poitiers, CNRS-UMR 7285 IC2MP, School of Medicine and Pharmacy (Department of Analytical Chemistry, Pharmaceutics and Epidemiology), 6 rue de la Milétrie, 86034 Poitiers Cedex, France; University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France.
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155
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Ríos A, López-Navas A, López-López A, Gómez FJ, Iriarte J, Herruzo R, Blanco G, Llorca FJ, Asunsolo A, Sánchez P, Gutiérrez PR, Fernández A, de Jesús MT, Martínez-Alarcón L, del Olivo M, Fuentes L, Hernández JR, Virseda J, Yelamos J, Bondía JA, Hernández A, Ayala MA, Ramírez P, Parrilla P. Medical students faced with related and unrelated living kidney donation: a stratified and multicentre study in Spain. World J Urol 2016; 34:1673-1684. [DOI: 10.1007/s00345-016-1797-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022] Open
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156
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Butler CR, Mehrotra R, Tonelli MR, Lam DY. The Evolving Ethics of Dialysis in the United States: A Principlist Bioethics Approach. Clin J Am Soc Nephrol 2016; 11:704-9. [PMID: 26912540 DOI: 10.2215/cjn.04780515] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Throughout the history of dialysis, four bioethical principles - beneficence, nonmaleficence, autonomy and justice - have been weighted differently based upon changing forces of technologic innovation, resource limitation, and societal values. In the 1960s, a committee of lay people in Seattle attempted to fairly distribute a limited number of maintenance hemodialysis stations guided by considerations of justice. As technology advanced and dialysis was funded under an amendment to the Social Security Act in 1972, focus shifted to providing dialysis for all in need while balancing the burdens of treatment and quality of life, supported by the concepts of beneficence and nonmaleficence. At the end of the last century, the importance of patient preferences and personal values became paramount in medical decisions, reflecting a focus on the principle of autonomy. More recently, greater recognition that health care financial resources are limited makes fair allocation more pressing, again highlighting the importance of distributive justice. The varying application and prioritization of these four principles to both policy and clinical decisions in the United States over the last 50 years makes the history of hemodialysis an instructive platform for understanding principlist bioethics. As medical technology evolves in a landscape of changing personal and societal values, a comprehensive understanding of an ethical framework for evaluating appropriate use of medical interventions enables the clinician to systematically negotiate and optimize difficult ethical situations.
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Affiliation(s)
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; and
| | - Mark R Tonelli
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington
| | - Daniel Y Lam
- Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
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157
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Burgin T, Johnson D, Chung H, Clark A, McGrath J. Analytical and Finite Element Modeling of Nanomembranes for Miniaturized, Continuous Hemodialysis. MEMBRANES 2015; 6:membranes6010006. [PMID: 26729179 PMCID: PMC4812412 DOI: 10.3390/membranes6010006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 11/24/2022]
Abstract
Hemodialysis involves large, periodic treatment doses using large-area membranes. If the permeability of dialysis membranes could be increased, it would reduce the necessary dialyzer size and could enable a wearable device that administers a continuous, low dose treatment of chronic kidney disease. This paper explores the application of ultrathin silicon membranes to this purpose, by way of analytical and finite element models of diffusive and convective transport of plasma solutes during hemodialysis, which we show to be predictive of experimental results. A proof-of-concept miniature nanomembrane dialyzer design is then proposed and analytically predicted to clear uremic toxins at near-ideal levels, as measured by several markers of dialysis adequacy. This work suggests the feasibility of miniature nanomembrane-based dialyzers that achieve therapeutic levels of uremic toxin clearance for patients with kidney failure.
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Affiliation(s)
- Tucker Burgin
- Department of Biomedical Engineering, University of Rochester, 252 Elmwood Ave, Rochester, NY 14627, USA.
| | - Dean Johnson
- Department of Biomedical Engineering, University of Rochester, 252 Elmwood Ave, Rochester, NY 14627, USA.
| | - Henry Chung
- Department of Biomedical Engineering, University of Rochester, 252 Elmwood Ave, Rochester, NY 14627, USA.
| | - Alfred Clark
- Department of Mechanical Engineering, University of Rochester, 252 Elmwood Ave, Rochester, NY 14627, USA.
| | - James McGrath
- Department of Biomedical Engineering, University of Rochester, 252 Elmwood Ave, Rochester, NY 14627, USA.
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158
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Cruz RND, Retzlaff G, Gomes RZ, Reche PM. Influência do diabetes mellitus sobre a perviedade da fístula arteriovenosa para hemodiálise. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ResumoContextoA incapacidade das fístulas arteriovenosas (FAVs) atenderem aos quesitos mínimos para realização da hemodiálise (HD) corresponde a uma das maiores causas de morbidade nos pacientes em terapia renal substitutiva. Identificar os fatores de risco associados com a falência do acesso vascular é fundamental para o manejo e sucesso da terapia hemodialítica.ObjetivoComparar o tempo médio de patência e a sobrevida das fístulas arteriovenosas realizadas nos pacientes portadores de diabetes mellitus com pacientes não portadores de diabetes mellitus (DM) em HD.MétodosTrata-se de um estudo retrospectivo observacional, no qual foram observados os prontuários médicos de todos os pacientes em HD no Hospital Santa Casa de Misericórdia de Ponta Grossa, no período de fevereiro de 2014. Foram analisados dados clínicos referentes à confecção, manutenção e utilização das FAVs como adjuvante na terapia dialítica, comparando o tempo médio de patência das fístulas em uso para HD, bem como a sobrevida das FAVs ocluídas. Os pacientes selecionados foram divididos em dois grupos para comparação, conforme a presença ou ausência de DM.ResultadosOs indivíduos do Grupo DM apresentaram maior média de idade (59,97 ± 10,12), menor tempo de acompanhamento no serviço de hemodiálise (25,42 ± 21,03 meses), menor tempo médio até a oclusão da fístula arteriovenosa (9,03 ± 11,60 meses) e menor média de sobrevida dos acessos vasculares em 24 meses (50,25%).ConclusõesO estudo concluiu que para os pacientes diabéticos houve um menor tempo médio da patência das FAVs e menor taxa de sobrevida dos acessos em 24 meses.
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159
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Weeks AC, Kimple ME. Spontaneous Tumor Lysis Syndrome: A Case Report and Critical Evaluation of Current Diagnostic Criteria and Optimal Treatment Regimens. J Investig Med High Impact Case Rep 2015; 3:2324709615603199. [PMID: 26904699 PMCID: PMC4748506 DOI: 10.1177/2324709615603199] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a known complication of malignancy and its treatment. The incidence varies on malignancy type, but is most common with hematologic neoplasms during cytotoxic treatment. Spontaneous TLS is thought to be rare. This case study is of a 62-year-old female admitted with multisystem organ failure, with subsequent diagnosis of aggressive B cell lymphoma. On admission, laboratory abnormalities included renal failure, elevated uric acid (20.7 mg/dL), and 3+ amorphous urates on urinalysis. Oliguric renal failure persisted despite aggressive hydration and diuretic use, requiring initiation of hemodialysis prior to chemotherapy. Antihyperuricemic therapy and hemodialysis were used to resolve hyperuricemia. However, due to multisystem organ dysfunction syndrome with extremely poor prognosis, the patient ultimately expired in the setting of a terminal ventilator wean. Although our patient did not meet current TLS criteria, she required hemodialysis due to uric acid nephropathy, a complication of TLS. This poses the clinical question of whether adequate diagnostic criteria exist for spontaneous TLS and if the lack of currently accepted guidelines has resulted in the underestimation of its incidence. Allopurinol and rasburicase are commonly used for prevention and treatment of TLS. Although both drugs decrease uric acid levels, allopurinol mechanistically prevents formation of the substrate rasburicase acts to solubilize. These drugs were administered together in our patient, although no established guidelines recommend combined use. This raises the clinical question of whether combined therapy is truly beneficial or, conversely, detrimental to patient outcomes.
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Affiliation(s)
- Alicia C Weeks
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin, Madison, WI, USA
| | - Michelle E Kimple
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin, Madison, WI, USA
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160
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Rodríguez-Ribera L, Pastor S, Corredor Z, Silva I, Diaz JM, Ballarin J, Marcos R, Coll E. Genetic damage in patients moving from hemodialysis to online hemodiafiltration. Mutagenesis 2015; 31:131-5. [DOI: 10.1093/mutage/gev063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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161
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Linni K, Ugurluoglu A, Aspalter M, Hitzl W, Hölzenbein T. Stent-supported percutaneous transluminal angioplasty in patients suffering from symptomatic benign or malignant central venous occlusive disease. Eur Surg 2015. [DOI: 10.1007/s10353-015-0325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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162
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Reese PP, Shults J, Bloom RD, Mussell A, Harhay MN, Abt P, Levine M, Johansen KL, Karlawish JT, Feldman HI. Functional status, time to transplantation, and survival benefit of kidney transplantation among wait-listed candidates. Am J Kidney Dis 2015; 66:837-45. [PMID: 26162652 DOI: 10.1053/j.ajkd.2015.05.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/09/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND In the context of an aging end-stage renal disease population with multiple comorbid conditions, transplantation professionals face challenges in evaluating the global health of patients awaiting kidney transplantation. Functional status might be useful for identifying which patients will derive a survival benefit from transplantation versus dialysis. STUDY DESIGN Retrospective cohort study of wait-listed patients using data for functional status from a national dialysis provider linked to United Network for Organ Sharing registry data. SETTING & PARTICIPANTS Adult kidney transplantation candidates added to the waiting list between 2000 and 2006. PREDICTOR Physical Functioning scale of the Medical Outcomes Study 36-Item Short Form Health Survey, analyzed as a time-varying covariate. OUTCOMES Kidney transplantation; survival benefit of transplantation versus remaining wait-listed. MEASUREMENTS We used multivariable Cox regression to assess the association between physical function with study outcomes. In survival benefit analyses, transplantation status was modeled as a time-varying covariate. RESULTS The cohort comprised 19,242 kidney transplantation candidates (median age, 51 years; 36% black race) receiving maintenance dialysis. Candidates in the lowest baseline Physical Functioning score quartile were more likely to be inactivated (adjusted HR vs highest quartile, 1.30; 95% CI, 1.21-1.39) and less likely to undergo transplantation (adjusted HR vs highest quartile, 0.64; 95% CI, 0.61-0.68). After transplantation, worse Physical Functioning score was associated with shorter 3-year survival (84% vs 92% for the lowest vs highest function quartiles). However, compared to dialysis, transplantation was associated with a statistically significant survival benefit by 9 months for patients in every function quartile. LIMITATIONS Functional status is self-reported. CONCLUSIONS Even patients with low function appear to live longer with kidney transplantation versus dialysis. For wait-listed patients, global health measures such as functional status may be more useful in counseling patients about the probability of transplantation than in identifying who will derive a survival benefit from it.
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Affiliation(s)
- Peter P Reese
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
| | - Justine Shults
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Roy D Bloom
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Adam Mussell
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Meera N Harhay
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Peter Abt
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew Levine
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kirsten L Johansen
- Division of Nephrology, University of California-San Francisco, San Francisco, CA
| | - Jason T Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA; Division of Geriatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Harold I Feldman
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
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163
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Reese PP, Shults J, Bloom RD, Mussell A, Harhay MN, Abt P, Levine M, Johansen KL, Karlawish JT, Feldman HI. Functional status, time to transplantation, and survival benefit of kidney transplantation among wait-listed candidates. Am J Kidney Dis 2015. [PMID: 26162652 DOI: 10.1053/j.ajkd.20 15.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In the context of an aging end-stage renal disease population with multiple comorbid conditions, transplantation professionals face challenges in evaluating the global health of patients awaiting kidney transplantation. Functional status might be useful for identifying which patients will derive a survival benefit from transplantation versus dialysis. STUDY DESIGN Retrospective cohort study of wait-listed patients using data for functional status from a national dialysis provider linked to United Network for Organ Sharing registry data. SETTING & PARTICIPANTS Adult kidney transplantation candidates added to the waiting list between 2000 and 2006. PREDICTOR Physical Functioning scale of the Medical Outcomes Study 36-Item Short Form Health Survey, analyzed as a time-varying covariate. OUTCOMES Kidney transplantation; survival benefit of transplantation versus remaining wait-listed. MEASUREMENTS We used multivariable Cox regression to assess the association between physical function with study outcomes. In survival benefit analyses, transplantation status was modeled as a time-varying covariate. RESULTS The cohort comprised 19,242 kidney transplantation candidates (median age, 51 years; 36% black race) receiving maintenance dialysis. Candidates in the lowest baseline Physical Functioning score quartile were more likely to be inactivated (adjusted HR vs highest quartile, 1.30; 95% CI, 1.21-1.39) and less likely to undergo transplantation (adjusted HR vs highest quartile, 0.64; 95% CI, 0.61-0.68). After transplantation, worse Physical Functioning score was associated with shorter 3-year survival (84% vs 92% for the lowest vs highest function quartiles). However, compared to dialysis, transplantation was associated with a statistically significant survival benefit by 9 months for patients in every function quartile. LIMITATIONS Functional status is self-reported. CONCLUSIONS Even patients with low function appear to live longer with kidney transplantation versus dialysis. For wait-listed patients, global health measures such as functional status may be more useful in counseling patients about the probability of transplantation than in identifying who will derive a survival benefit from it.
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Affiliation(s)
- Peter P Reese
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
| | - Justine Shults
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Roy D Bloom
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Adam Mussell
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Meera N Harhay
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Peter Abt
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew Levine
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kirsten L Johansen
- Division of Nephrology, University of California-San Francisco, San Francisco, CA
| | - Jason T Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA; Division of Geriatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Harold I Feldman
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
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164
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Lovink MH, Kars MC, de Man-van Ginkel JM, Schoonhoven L. Patients’ experiences of safety during haemodialysis treatment - a qualitative study. J Adv Nurs 2015; 71:2374-83. [DOI: 10.1111/jan.12690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Marleen H. Lovink
- Radboud Institute for Health Sciences; IQ healthcare; Radboud university medical center; Nijmegen The Netherlands
- Dialysis Department; Radboud university medical center; Nijmegen The Netherlands
| | - Marijke C. Kars
- Nursing Science; Program in Clinical Health Sciences; University Medical Center Utrecht; The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Janneke M. de Man-van Ginkel
- Nursing Science; Program in Clinical Health Sciences; University Medical Center Utrecht; The Netherlands
- Department of Rehabilitation, Nursing Science and Sport; University Medical Center Utrecht; The Netherlands
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165
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Renal systems biology of patients with systemic inflammatory response syndrome. Kidney Int 2015; 88:804-14. [PMID: 25993322 PMCID: PMC4591107 DOI: 10.1038/ki.2015.150] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 03/17/2015] [Accepted: 04/02/2015] [Indexed: 12/31/2022]
Abstract
A systems biology approach was used to comprehensively examine the impact of renal disease and hemodialysis (HD) on patient response during critical illness. To achieve this we examined the metabolome, proteome, and transcriptome of 150 patients with critical illness, stratified by renal function. Quantification of plasma metabolites indicated greater change as renal function declined, with the greatest derangements in patients receiving chronic HD. Specifically, 6 uremic retention molecules, 17 other protein catabolites, 7 modified nucleosides, and 7 pentose phosphate sugars increased as renal function declined, consistent with decreased excretion or increased catabolism of amino acids and ribonucleotides. Similarly, the proteome showed increased levels of low-molecular weight proteins and acute phase reactants. The transcriptome revealed a broad-based decrease in mRNA levels among patients on HD. Systems integration revealed an unrecognized association between plasma RNASE1 and several RNA catabolites and modified nucleosides. Further, allantoin, N1-methyl-4-pyridone-3-carboxamide, and n-acetylaspartate were inversely correlated with the majority of significantly down-regulated genes. Thus, renal function broadly affected the plasma metabolome, proteome, and peripheral blood transcriptome during critical illness; changes not effectively mitigated by hemodialysis. These studies allude to several novel mechanisms whereby renal dysfunction contributes to critical illness.
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166
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A Paired Survival Analysis Comparing Hemodialysis and Kidney Transplantation From Deceased Elderly Donors Older Than 65 Years. Transplantation 2015; 99:991-6. [DOI: 10.1097/tp.0000000000000474] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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167
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Zhumadilov A, Boyko M, Gruenbaum SE, Brotfain E, Bilotta F, Zlotnik A. Extracorporeal methods of blood glutamate scavenging: a novel therapeutic modality. Expert Rev Neurother 2015; 15:501-508. [PMID: 25865745 DOI: 10.1586/14737175.2015.1032259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pathologically elevated glutamate concentrations in the brain's extracellular fluid are associated with several acute and chronic brain insults. Studies have demonstrated that by decreasing the concentration of glutamate in the blood, thereby increasing the concentration gradient between the brain and the blood, the rate of brain-to-blood glutamate efflux can be increased. Blood glutamate scavengers, pyruvate and oxaloacetate have shown great promise in providing neuroprotection in many animal models of acute brain insults. However, glutamate scavengers' potential systemic toxicity, side effects and pharmacokinetic properties may limit their use in clinical practice. In contrast, extracorporeal methods of blood glutamate reduction, in which glutamate is filtered from the blood and eliminated, may be an advantageous adjunct in treating acute brain insults. Here, we review the current evidence for the glutamate-lowering effects of hemodialysis, peritoneal dialysis and hemofiltration. The evidence reviewed here highlights the need for clinical trials.
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Affiliation(s)
- Agzam Zhumadilov
- Department of Anesthesiology and Critical Care, National Research Center for Oncology and Transplantation, Astana, Kazakhstan.,Department of Anesthesiology and Critical Care, National Research Center for Oncology and Transplantation, Astana, Kazakhstan
| | - Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shaun E Gruenbaum
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Evgeny Brotfain
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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168
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Assis RP, Castro JFA, Gutierres VO, Arcaro CA, Brotto RS, Oliveira OMMF, Baviera AM, Brunetti IL. Effects of uremic solutes on reactive oxygen species in vitro model systems as a possibility of support the renal function management. BMC Nephrol 2015; 16:50. [PMID: 25886160 PMCID: PMC4399422 DOI: 10.1186/s12882-015-0029-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 03/06/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In view of the prevalence of oxidative stress in chronic kidney disease (CKD) patients, the loss of low-molecular-weight biomolecules by hemodialysis and the antioxidant potential of some uremic solutes that accumulate in CKD, we used in vitro model systems to test the antioxidant potential of the following uremic solutes: uric acid, hippuric acid, p-cresol, phenol, methylguanidine, L-arginine, L-tyrosine, creatinine and urea. METHODS The in vitro antioxidant efficiencies of the uremic solutes, isolated or in mixtures, were tested with the following assays: i) ABTS radical cation decolorization assay; ii) hypochlorous acid (HOCl/OCl(-)) scavenging activity; iii) superoxide anion radical (O2(•-)) scavenging activity; iv) crocin bleaching assay (capture of peroxyl radical, ROO(•)); v) hydrogen peroxide (H2O2) scavenging activity. RESULTS Four of the tested uremic solutes (p-cresol, phenol, L-tyrosine, uric acid) were effective antioxidants and their IC50 were found in three model systems: ABTS(•+), HOCl/OCl(-) and crocin bleaching assay. In the 4-solutes mixtures, each one of the solute captured 12.5% for the IC50 of the mixture to ABTS(•+) or HOCl/OCl(-), exhibiting a virtually exact additive effect. In the 2-solutes mixtures, for ROO(•) capture, it was observed the need of more mass of uremic solutes to reach an IC50 value that was higher than the projected IC50, obtained from the IC50 of single solutes (25% of each, in the binary mixtures) in the same assay. In model systems for O2(•-) and H2O2, none of the uremic solutes showed scavenging activity. CONCLUSIONS The use of the IC50 as an analytical tool to prepare and analyze mixtures allows the determination of their scavenging capacities and may be useful for the assessment of the antioxidant status of biological samples under conditions of altered levels of the endogenous antioxidant network and/or in the employment and monitoring of exogenous antioxidant therapy.
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Affiliation(s)
- Renata P Assis
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University - UNESP, Rua Expedicionários do Brasil 1621, Araraquara, CEP 14801-902, São Paulo, Brazil.
| | - Juliana F A Castro
- Department of Biochemistry and Technological Chemistry, Institute of Chemistry, São Paulo State University - UNESP, Rua Prof. Francisco Degni 55, Araraquara, CEP 14800-900, São Paulo, Brazil.
| | - Vânia O Gutierres
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University - UNESP, Rua Expedicionários do Brasil 1621, Araraquara, CEP 14801-902, São Paulo, Brazil.
| | - Carlos A Arcaro
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University - UNESP, Rua Expedicionários do Brasil 1621, Araraquara, CEP 14801-902, São Paulo, Brazil.
| | - Renata S Brotto
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University - UNESP, Rua Expedicionários do Brasil 1621, Araraquara, CEP 14801-902, São Paulo, Brazil.
| | - Olga M M F Oliveira
- Department of Biochemistry and Technological Chemistry, Institute of Chemistry, São Paulo State University - UNESP, Rua Prof. Francisco Degni 55, Araraquara, CEP 14800-900, São Paulo, Brazil.
| | - Amanda M Baviera
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University - UNESP, Rua Expedicionários do Brasil 1621, Araraquara, CEP 14801-902, São Paulo, Brazil.
| | - Iguatemy L Brunetti
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University - UNESP, Rua Expedicionários do Brasil 1621, Araraquara, CEP 14801-902, São Paulo, Brazil.
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169
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Ramos AM, González-Guerrero C, Sanz A, Sanchez-Niño MD, Rodríguez-Osorio L, Martín-Cleary C, Fernández-Fernández B, Ruiz-Ortega M, Ortiz A. Designing drugs that combat kidney damage. Expert Opin Drug Discov 2015; 10:541-56. [PMID: 25840605 DOI: 10.1517/17460441.2015.1033394] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Kidney disease remains one of the last worldwide frontiers in the field of non-communicable human disease. From 1990 to 2013, chronic kidney disease (CKD) was the top non-communicable cause of death with a greatest increase in global years of life lost while mortality of acute kidney injury (AKI) still hovers around 50%. This reflects the paucity (for CKD) or lack of (for AKI) therapeutic approaches beyond replacing renal function. Understanding what the barriers are and what potential pathways may facilitate the design of new drugs to combat kidney disease is a key public health priority. AREAS COVERED The authors discuss the hurdles and opportunities for future drug development for kidney disease in light of experience accumulated with drugs that made it to clinical trials. EXPERT OPINION Inflammation, cell death and fibrosis are key therapeutic targets to combat kidney damage. While the specific targeting of drugs to kidney cells would be desirable, the technology is only working at the preclinical stage and with mixed success. Nanomedicines hold promise in this respect. Most drugs undergoing clinical trials for kidney disease have been repurposed from other indications. Currently, the chemokine receptor inhibitor CCX140 holds promise for CKD and the p53 inhibitor QPI-1002 for AKI.
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Affiliation(s)
- Adrián M Ramos
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), Laboratory of Renal and Vascular Pathology and Diabetes , Av. Reyes Católicos 2, 28040, Madrid , Spain
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170
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Belaïch R, Boujraf S, Housni A, Maaroufi M, Batta F, Magoul R, Sqalli T, Errasfa M, Tizniti S. Assessment of hemodialysis impact by Polysulfone membrane on brain plasticity using BOLD-fMRI. Neuroscience 2014; 288:94-104. [PMID: 25522721 DOI: 10.1016/j.neuroscience.2014.11.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/21/2014] [Accepted: 11/23/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Hemodialysis (HD) is considered the most common alternative for overcoming renal failure. Studies have shown the involvement of HD membrane in the genesis of oxidative stress (OS) which has a direct impact on the brain tissue and is expected to be involved in brain plasticity and also reorganization of brain function control. The goal of this paper was to demonstrate the sensitivity of the blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) to characterize the OS before and after the HD session. PATIENTS, MATERIALS AND METHODS Twelve male patient-volunteers following chronic HD for more than 6months were recruited among 86 HD-patients. All patients underwent identical assessment immediately before and after the full HD-session. This consisted of full biological assessment, including malondialdehyde (MDA) and total antioxidant activity (TAOA); and brain BOLD-fMRI using the motor paradigm in block-design. RESULTS Functional BOLD-fMRI maps of motor area M1 were obtained from the HD patient before and after the hemodialysis session, important decrease in the intensity of brain activation of the motor area after HD, and important increase of the size of the volume of brain activation were observed, these changes are reflecting brain plasticity that is well correlated to OS levels. Individual patients MDA and TAOA before and after the hemodialysis sessions demonstrated a clear and systematic increase of the OS after HD (P-value=0.03). Correlation of BOLD-fMRI maximal signal intensity and volume of activated cortical brain area behaviors to MDA and total TAOA were close to 1. CONCLUSION OS is systematically increased in HD-patients after the HD-process. Indeed, the BOLD-fMRI shows a remarkable sensitivity to brain plasticity studied cortical areas. Our results confirm the superiority of the BOLD-fMRI quantities compared to the biological method used for assessing the OS while not being specific, and reflect the increase in OS generated by the HD. BOLD-fMRI is expected to be a suitable tool for evaluating the plasticity process evolution in hemodialysis brain patients.
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Affiliation(s)
- R Belaïch
- Department of Biophysics and Clinical MRI Methods, Faculty of Medicine, Fez, Morocco; The Clinical Neuroscience Laboratory, Faculty of Medicine, Fez, Morocco
| | - S Boujraf
- Department of Biophysics and Clinical MRI Methods, Faculty of Medicine, Fez, Morocco; The Clinical Neuroscience Laboratory, Faculty of Medicine, Fez, Morocco.
| | - A Housni
- The Clinical Neuroscience Laboratory, Faculty of Medicine, Fez, Morocco; Department of Radiology and Clinical Imaging, University Hospital of Fez, Fez, Morocco
| | - M Maaroufi
- The Clinical Neuroscience Laboratory, Faculty of Medicine, Fez, Morocco; Department of Radiology and Clinical Imaging, University Hospital of Fez, Fez, Morocco
| | - F Batta
- The Clinical Neuroscience Laboratory, Faculty of Medicine, Fez, Morocco; Department of Nephrology, University Hospital of Fez, Fez, Morocco
| | - R Magoul
- Laboratory of Neuroendocrinology and Nutritional and Climatic Environment, Faculty of Sciences Dhar El Mahraz, University Sidi Mohammed Ben Abdellah, Fez-Atlas, BP 1796, Fez, Morocco
| | - T Sqalli
- Department of Nephrology, University Hospital of Fez, Fez, Morocco
| | - M Errasfa
- Department of Pharmacology, Faculty of Medicine, University of Fez, Fez, Morocco; The Laboratory of Molecular Basis in Human Pathology and Therapeutical Tools, Faculty of Medicine, University of Fez, Fez, Morocco
| | - S Tizniti
- The Clinical Neuroscience Laboratory, Faculty of Medicine, Fez, Morocco; Department of Radiology and Clinical Imaging, University Hospital of Fez, Fez, Morocco
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171
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Recipient-related risk factors for graft failure and death in elderly kidney transplant recipients. PLoS One 2014; 9:e112938. [PMID: 25389964 PMCID: PMC4229296 DOI: 10.1371/journal.pone.0112938] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/17/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elderly patients with end-stage renal disease have become the fastest growing population of kidney transplant candidates in recent years. However, the risk factors associated with long-term outcomes in these patients remain unclear. METHODS We retrospectively analyzed 166 recipients aged 60 years or older who underwent primary deceased kidney transplantation between 2002 and 2013 in our center. The main outcomes included 1-, 3- and 5-year patient survival as well as overall and death-censored graft survival. The independent risk factors affecting graft and patient survival were analyzed using Cox regression analysis. RESULTS The 1-, 3-, 5-year death-censored graft survival rates were 93.6%, 89.4% and 83.6%, respectively. Based on the Cox multivariate analysis, panel reactive antibody (PRA)>5% [hazard ratio (HR) 4.295, 95% confidence interval (CI) 1.321-13.97], delayed graft function (HR 4.744, 95% CI 1.611-13.973) and acute rejection (HR 4.971, 95% CI 1.516-16.301) were independent risk factors for graft failure. The 1-, 3-, 5-year patient survival rates were 84.8%, 82.1% and 77.1%, respectively. Longer dialysis time (HR 1.011 for 1-month increase, 95% CI 1.002-1.020), graft loss (HR 3.501, 95% CI 1.559-7.865) and low-dose ganciclovir prophylaxis (1.5 g/d for 3 months) (HR 3.173, 95% CI 1.063-9.473) were risk factors associated with patient death. CONCLUSIONS The five-year results show an excellent graft and patient survival in elderly kidney transplant recipients aged ≥60 years. PRA>5%, delayed graft function, and acute rejection are risk factors for graft failure, while longer duration of dialysis, graft loss and low-dose ganciclovir prophylaxis are risk factors for mortality in elderly recipients. These factors represent potential targets for interventions aimed at improving graft and patient survival in elderly recipients.
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172
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Canaud B, Bowry SK. Revisiting frontiers of tolerability and efficacy in renal replacement therapy. Am J Kidney Dis 2014; 64:171-3. [PMID: 25060003 DOI: 10.1053/j.ajkd.2014.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Bernard Canaud
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
| | - Sudhir K Bowry
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
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173
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Pretransplant Dialysis Duration and Risk of Death After Kidney Transplantation in the Current Era. Transplantation 2014; 98:458-64. [DOI: 10.1097/tp.0000000000000085] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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174
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Weidmer BA, Cleary PD, Keller S, Evensen C, Hurtado MP, Kosiak B, Gallagher PM, Levine R, Hays RD. Development and evaluation of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey for in-center hemodialysis patients. Am J Kidney Dis 2014; 64:753-60. [PMID: 24998035 DOI: 10.1053/j.ajkd.2014.04.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/06/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The US Centers for Medicare & Medicaid Services assess patient experiences of care as part of the end-stage renal disease prospective payment system and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) In-Center Hemodialysis Survey. STUDY DESIGN We conducted formative research to generate survey questions and performed statistical analyses to evaluate the survey's measurement properties. SETTING & PARTICIPANTS Formative research included focus groups, cognitive interviews, and field testing the survey with dialysis patients. MEASUREMENTS & OUTCOMES We assessed internal consistency reliability (Cronbach alpha) and center-level reliability for 3 multi-item scales. We evaluated construct validity using correlations of the scales with global ratings of the kidney doctor, staff, and dialysis center. RESULTS Response rate was 46% (1,454 completed surveys). Analyses support 3 multi-item scales: Nephrologists' Communication and Caring (7 items, alpha=0.89), Quality of Dialysis Center Care and Operations (22 items, alpha=0.93), and Providing Information to Patients (11 items, alpha=0.75). The communication scale was correlated the most strongly with the global rating of the "kidney doctor" (r=0.78). The Dialysis Center Care and Operations scale was correlated most strongly with global ratings of staff (r=0.75) and the center (r=0.69). Providing Information to Patients was correlated most strongly with the global rating of the staff (r=0.41). LIMITATIONS A relatively small number of patients completed the survey in Spanish. CONCLUSIONS This study provides support for the reliability and validity of the CAHPS In-Center Hemodialysis Survey for assessing patient experiences of care at dialysis facilities. The survey can be used to compare care provided at different facilities.
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Affiliation(s)
| | | | - San Keller
- American Institutes for Research, Chapel Hill, NC
| | | | | | - Beth Kosiak
- Agency for Healthcare Research and Quality, Rockville, MD
| | | | | | - Ron D Hays
- UCLA Department of Medicine, Los Angeles, CA
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175
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Ríos A, López-Navas A, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, Martínez-Alarcón L, Ramírez EJ, Muñoz G, Palacios G, Suárez-López J, Castellanos R, González B, Martínez MA, Díaz E, Ramírez P, Parrilla P. The attitude toward living kidney donation among personnel from units related to donation and transplantation in Spain, Mexico and Cuba. Ren Fail 2014; 36:489-94. [DOI: 10.3109/0886022x.2013.875814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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176
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Nowacki M, Kloskowski T, Pokrywczyńska M, Nazarewski Ł, Jundziłł A, Pietkun K, Tyloch D, Rasmus M, Warda K, Habib SL, Drewa T. Is regenerative medicine a new hope for kidney replacement? J Artif Organs 2014; 17:123-34. [DOI: 10.1007/s10047-014-0767-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 04/01/2014] [Indexed: 12/24/2022]
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177
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Chow E, Wong H, Hahn-Goldberg S, Chan CT, Morra D. Inpatient and emergent resource use of patients on dialysis at an academic medical center. Nephron Clin Pract 2014; 126:124-7. [PMID: 24732261 DOI: 10.1159/000360541] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 02/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM End-stage renal disease patients require resources for emergent and inpatient care in addition to ambulatory dialysis. There are two dialysis modalities and settings which patients switch between. Our aim was to characterize the patterns and reasons for switching, as well as the emergent and inpatient utilization of these patients at the University Health Network. METHODS Patients who received chronic dialysis between March 1, 2006, and April 30, 2011, were identified. Utilization was measured by emergency department (ED) visits, inpatient hospitalizations, and bed-days occupied per year. RESULTS Out of 576 patients identified, 18.6% switched modality and/or setting. The majority of switches occurred during the first year of dialysis. Patients who switched had increased utilization compared to those on a continuous modality/setting. Overall, patients had a median rate of 0.91 ED visits per patient-year, compared to 1.56 for patients who switched modality and setting. Median inpatient bed resource requirement was 4.46 bed-days/patient-year overall, compared to 8.91 for patients who switched modality and setting. CONCLUSIONS Emergent and inpatient utilization is related to the setting and modality of dialysis, although differences are partly explained by comorbidities. Patients who switch modalities use more resources and may be a prime population for interventions.
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Affiliation(s)
- Eric Chow
- The Centre for Innovation in Complex Care, University Health Network (UHN), Toronto, Ont., Canada
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178
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Innovative strategy with potential to increase hemodialysis efficiency and safety. Sci Rep 2014; 4:4425. [PMID: 24651843 PMCID: PMC3961733 DOI: 10.1038/srep04425] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/04/2014] [Indexed: 01/22/2023] Open
Abstract
Uremic toxins are mainly represented by blood urine nitrogen (BUN) and creatinine (Crea) whose removal is critically important in hemodialysis (HD) for kidney disease. Patients undergoing HD have a complex illness, resulting from: inadequate removal of organic waste, dialysis-induced oxidative stress and membrane-induced inflammation. Here we report innovative breakthroughs for efficient and safe HD by using a plasmon-induced dialysate comprising Au nanoparticles (NPs)-treated (AuNT) water that is distinguishable from conventional deionized (DI) water. The diffusion coefficient of K3Fe(CN)6 in saline solution can be significantly increased from 2.76, to 4.62 × 10−6 cm s−1, by using AuNT water prepared under illumination by green light-emitting diodes (LED). In vitro HD experiments suggest that the treatment times for the removals of 70% BUN and Crea are reduced by 47 and 59%, respectively, using AuNT water instead of DI water in dialysate, while additionally suppressing NO release from lipopolysaccharide (LPS)-induced inflammatory cells.
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179
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Lavainne F, Meffray E, Pepper RJ, Néel M, Delcroix C, Salama AD, Fakhouri F. Heparin use during dialysis sessions induces an increase in the antiangiogenic factor soluble Flt1. Nephrol Dial Transplant 2014; 29:1225-31. [DOI: 10.1093/ndt/gft517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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180
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Verhoest G, Patard J, Oger E, Rioux-Leclercq N, Peyronnet B, Bessède T, Laguna P, Barwari K, Rigaud J, Roupret M, Coffin G, Bernhard J, Long J, Zisman A, Berger J, Paparel P, Maurin C, Lechevallier E, Bertini R, Ouzaid I, Salomon L, Bex A, Farfara R, Ljungberg B, Rodriguez A, Bensalah K. Predictive factors of chronic kidney disease stage V after partial nephrectomy in a solitary kidney: a multi-institutional study. Urol Oncol 2014; 32:28.e21-6. [DOI: 10.1016/j.urolonc.2012.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
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Minakata K, Bando K, Tanaka S, Takanashi S, Konishi H, Miyamoto Y, Ueshima K, Yasuno S, Ueda Y, Okita Y, Masuda I, Okabayashi H, Yaku H, Okamura Y, Tanemoto K, Arinaga K, Hisashi Y, Sakata R. Preoperative Chronic Kidney Disease as a Strong Predictor of Postoperative Infection and Mortality After Coronary Artery Bypass Grafting. Circ J 2014; 78:2225-31. [DOI: 10.1253/circj.cj-14-0328] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ko Bando
- Jikei University School of Medicine
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- Kagoshima University Graduate School of Medicine and Dental Science
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182
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Kagawa Y, Toyofuku M, Masaoka Y, Muraoka Y, Okimoto T, Otsuka M, Tamekiyo H, Mito S, Kawase T, Yamane K, Amioka M, Shiode N, Hayashi Y. Effect of statin on the 5 years clinical outcomes in dialysis patients treated with sirolimus-eluting stent. Intern Med 2014; 53:89-94. [PMID: 24429446 DOI: 10.2169/internalmedicine.53.1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The optimal medication therapies are recommended in patients with coronary artery disease even after the coronary revascularization. However, the information of optimal medical therapy in dialysis population is scant. We assessed the efficacy of statin on the clinical outcomes after Sirolimus-eluting stent (SES) implantation in patients with and without dialysis. METHODS AND RESULTS We analyzed date from 843 consecutive patients who successfully treated with SES in our institution between August 2004 and November 2006. Among patients, 96 patients (11.4%) were undergoing dialysis. In non-dialysis patients, 405 patients (54%) were treated with statin at hospital discharge. In dialysis patients, only 16 patients (17%) were treated with statin. In non-dialysis patients, mortality rate was significantly lower in patients treated with statin than those without statin (4.4% vs. 13.9%, p<0.0001). While in dialysis patients, mortality rate was similar between patients treated with and without statin (56.3% vs. 57.6%, p=0.86). After adjusting for confounders, the hazard ratios for mortality were 0.39 (95% confidence interval (CI), 0.14-0.99; p=0.047) in non-dialysis patients and 1.79 (95% CI, 0.39-7.86; 0.45) for dialysis patients. The interaction probability between statin use and dialysis for mortality was 0.016. CONCLUSION The use of statin may have beneficial effect on reducing mortality rate in patients after SES implantation in non-dialysis patients. However, such favorable effect was not observed in dialysis population.
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Affiliation(s)
- Yuzo Kagawa
- Division of Cardiology, Tsuchiya General Hospital, Japan
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183
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Ting SMS, Iqbal H, Kanji H, Hamborg T, Aldridge N, Krishnan N, Imray CHE, Banerjee P, Bland R, Higgins R, Zehnder D. Functional cardiovascular reserve predicts survival pre-kidney and post-kidney transplantation. J Am Soc Nephrol 2013; 25:187-95. [PMID: 24231666 DOI: 10.1681/asn.2013040348] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Exercise intolerance is an important comorbidity in patients with CKD. Anaerobic threshold (AT) determines the upper limits of aerobic exercise and is a measure of cardiovascular reserve. This study investigated the prognostic capacity of AT on survival in patients with advanced CKD and the effect of kidney transplantation on survival in those with reduced cardiovascular reserve. Using cardiopulmonary exercise testing, cardiovascular reserve was evaluated in 240 patients who were waitlisted for kidney transplantation between 2008 and 2010, and patients were followed for ≤5 years. Survival time was the primary endpoint. Cumulative survival for the entire cohort was 72.6% (24 deaths), with cardiovascular events being the most common cause of death (54.2%). According to Kaplan-Meier estimates, patients with AT <40% of predicted peak VO2 had a significantly reduced 5-year cumulative overall survival rate compared with those with AT ≥40% (P<0.001). Regarding the cohort with AT <40%, patients who underwent kidney transplantation (6 deaths) had significantly better survival compared with nontransplanted patients (17 deaths) (hazard ratio, 4.48; 95% confidence interval, 1.78 to 11.38; P=0.002). Survival did not differ significantly among patients with AT ≥40%, with one death in the nontransplanted group and no deaths in the transplanted group. In summary, this is the first prospective study to demonstrate a significant association of AT, as the objective index of cardiovascular reserve, with survival in patients with advanced CKD. High-risk patients with reduced cardiovascular reserve had a better survival rate after receiving a kidney transplant.
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184
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Wańkowicz Z. The role of technological progress vs. accidental discoveries and clinical experience. Med Sci Monit 2013; 19:984-92. [PMID: 24226207 PMCID: PMC3843571 DOI: 10.12659/msm.889710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The 50th anniversary of dialysotherapy celebrated by nephrologists around the world in 2012 provided an opportunity for discussion on the role of clinical experience in relation to technological progress in the evolution of dialysis, especially of recently observed inadequate decrease in mortality/morbidity rates of patients on chronic dialysis. My report, based on almost 50 years of career in nephrology, refers the evolution of dialysis, from catharsis to modern dialysotherapy with special attention devoted to nowadays gravely underestimated role of clinical experience and personalized professional care for patients.
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185
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Kelly KJ, Zhang J, Han L, Wang M, Zhang S, Dominguez JH. Intravenous renal cell transplantation with SAA1-positive cells prevents the progression of chronic renal failure in rats with ischemic-diabetic nephropathy. Am J Physiol Renal Physiol 2013; 305:F1804-12. [PMID: 24133118 DOI: 10.1152/ajprenal.00097.2013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diabetic nephropathy, the most common cause of progressive chronic renal failure and end-stage renal disease, has now reached global proportions. The only means to rescue diabetic patients on dialysis is renal transplantation, a very effective therapy but severely limited by the availability of donor kidneys. Hence, we tested the role of intravenous renal cell transplantation (IRCT) on obese/diabetic Zucker/SHHF F1 hybrid (ZS) female rats with severe ischemic and diabetic nephropathy. Renal ischemia was produced by bilateral renal clamping of the renal arteries at 10 wk of age, and IRCT with genetically modified normal ZS male tubular cells was given intravenously at 15 and 20 wk of age. Rats were euthanized at 34 wk of age. IRCT with cells expressing serum amyloid A had strong and long-lasting beneficial effects on renal function and structure, including tubules and glomeruli. However, donor cells were found engrafted only in renal tubules 14 wk after the second infusion. The results indicate that IRCT with serum amyloid A-positive cells is effective in preventing the progression of chronic kidney disease in rats with diabetic and ischemic nephropathy.
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Affiliation(s)
- Katherine J Kelly
- Veterans Affairs Medical Center, N111, 1481 W. 10th St., Indianapolis, IN 46202.
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186
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Herrmann IK, Schlegel A, Graf R, Schumacher CM, Senn N, Hasler M, Gschwind S, Hirt AM, Günther D, Clavien PA, Stark WJ, Beck-Schimmer B. Nanomagnet-based removal of lead and digoxin from living rats. NANOSCALE 2013; 5:8718-8723. [PMID: 23900264 DOI: 10.1039/c3nr02468g] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In a number of clinical conditions such as intoxication, bacteraemia or autoimmune diseases the removal of the disease-causing factor from blood would be the most direct cure. However, physicochemical characteristics of the target compounds limit the applicability of classical filtration and diffusion-based processes. In this work, we present a first in vivo magnetic blood purification rodent animal model and demonstrate its ability to rapidly clear toxins from blood circulation using two model toxins with stable plasma levels (lead (Pb(2+)) and digoxin). Ultra-strong functionalized metal nanomagnets are employed to eliminate the toxin from whole blood in an extracorporeal circuit. In the present experimental demonstration over 40% of the toxin (i.e. lead or digoxin) was removed within the first 10 minutes and over 75% within 40 minutes. After capturing the target substance, a magnetic trap prevents the toxin-loaded nanoparticles from entering the blood circulation. Elemental analysis and magnetic hysteresis measurements confirm full particle recovery by simple magnetic separation (residual particle concentration below 1 μg mL(-1) (detection limit)). We demonstrate that magnetic separation-based blood purification offers rapid blood cleaning from noxious agents, germs or other deleterious materials with relevance to a number of clinical conditions. Based on this new approach, current blood purification technologies can be extended to efficiently remove disease-causing factors, e.g. overdosed drugs, bacteria or cancer cells without being limited by filter cut-offs or column surface saturation.
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Affiliation(s)
- Inge K Herrmann
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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187
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Huang WH, Lin JL, Lin-Tan DT, Chen KH, Hsu CW, Yen TH. Education level is associated with mortality in male patients undergoing maintenance hemodialysis. Blood Purif 2013; 35:316-26. [PMID: 23920269 DOI: 10.1159/000351613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of the correlation between education levels and mortality in hemodialysis (HD) patients are rare. The aim of this multi-center study was to investigate the relationship between education levels and 3-year mortality rates in HD patients. METHODS A total of 935 HD patients from 3 HD centers participated in this 3-year prospective observational study. Education levels were categorized as either less than senior high school and above or equal to senior high school. The causes of death and mortality rates were also analyzed for each subgroup. RESULTS At the end of the 3-year follow-up period, 164 patients had died. In the male group, forward stepwise Cox regression analysis revealed that age, HD duration, hypertension, creatinine level, serum albumin level ≥3.6 g/dl, anuria, Kt/Vurea, and high education level were significant predictive factors for 3-year mortality rates. CONCLUSION This prospective observational study demonstrated that education level was associated with mortality in men undergoing HD.
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Affiliation(s)
- Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei and Lin-Kou Medical Center, Taoyuan, and Chang Gung University and School of Medicine, Taipei, Taiwan, ROC
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Hilborn ED, Soares RM, Servaites JC, Delgado AG, Magalhães VF, Carmichael WW, Azevedo SMFO. Sublethal microcystin exposure and biochemical outcomes among hemodialysis patients. PLoS One 2013; 8:e69518. [PMID: 23894497 PMCID: PMC3722218 DOI: 10.1371/journal.pone.0069518] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/09/2013] [Indexed: 12/21/2022] Open
Abstract
Cyanobacteria are commonly-occurring contaminants of surface waters worldwide. Microcystins, potent hepatotoxins, are among the best characterized cyanotoxins. During November, 2001, a group of 44 hemodialysis patients were exposed to microcystins via contaminated dialysate. Serum microcystin concentrations were quantified with enzyme-linked immunosorbent assay which measures free serum microcystin LR equivalents (ME). We describe serum ME concentrations and biochemical outcomes among a subset of patients during 8 weeks following exposure. Thirteen patients were included; 6 were males, patients’ median age was 45 years (range 16–80), one was seropositive for hepatitis B surface antigen. The median serum ME concentration was 0.33 ng/mL (range: <0.16–0.96). One hundred thirty nine blood samples were collected following exposure. Patients’ biochemical outcomes varied, but overall indicated a mixed liver injury. Linear regression evaluated each patient’s weekly mean biochemical outcome with their maximum serum ME concentration; a measure of the extrinsic pathway of clotting function, prothrombin time, was negatively and significantly associated with serum ME concentrations. This group of exposed patients’ biochemical outcomes display evidence of a mixed liver injury temporally associated with microcystin exposure. Interpretation of biochemical outcomes are complicated by the study population’s underlying chronic disease status. It is clear that dialysis patients are a distinct ‘at risk’ group for cyanotoxin exposures due to direct intravenous exposure to dialysate prepared from surface drinking water supplies. Careful monitoring and treatment of water supplies used to prepare dialysate is required to prevent future cyanotoxin exposure events.
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Affiliation(s)
- Elizabeth D Hilborn
- United States Environmental Protection Agency, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, North Carolina, United States of America.
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189
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Low-density lipoprotein modified by myeloperoxidase in inflammatory pathways and clinical studies. Mediators Inflamm 2013; 2013:971579. [PMID: 23983406 PMCID: PMC3742028 DOI: 10.1155/2013/971579] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/26/2013] [Indexed: 02/07/2023] Open
Abstract
Oxidation of low-density lipoprotein (LDL) has a key role in atherogenesis. Among the different models of oxidation that have been studied, the one using myeloperoxidase (MPO) is thought to be more physiopathologically relevant. Apolipoprotein B-100 is the unique protein of LDL and is the major target of MPO. Furthermore, MPO rapidly adsorbs at the surface of LDL, promoting oxidation of amino acid residues and formation of oxidized lipoproteins that are commonly named Mox-LDL. The latter is not recognized by the LDL receptor and is accumulated by macrophages. In the context of atherogenesis, Mox-LDL accumulates in macrophages leading to foam cell formation. Furthermore, Mox-LDL seems to have specific effects and triggers inflammation. Indeed, those oxidized lipoproteins activate endothelial cells and monocytes/macrophages and induce proinflammatory molecules such as TNFα and IL-8. Mox-LDL may also inhibit fibrinolysis mediated via endothelial cells and consecutively increase the risk of thrombus formation. Finally, Mox-LDL has been involved in the physiopathology of several diseases linked to atherosclerosis such as kidney failure and consequent hemodialysis therapy, erectile dysfunction, and sleep restriction. All these issues show that the investigations of MPO-dependent LDL oxidation are of importance to better understand the inflammatory context of atherosclerosis.
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190
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Ting SMS, Iqbal H, Hamborg T, Imray CHE, Hewins S, Banerjee P, Bland R, Higgins R, Zehnder D. Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation. PLoS One 2013; 8:e64335. [PMID: 23724043 PMCID: PMC3664577 DOI: 10.1371/journal.pone.0064335] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/13/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO₂AT) could identify these patients. METHODS Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET), echocardiography and arterial applanation tonometry were performed. RESULTS There were 70 participants (age 41.7±14.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were desensitized). 14 patients (20%) required escalation of care from the ward to CCU following transplantation. Reduced anaerobic threshold (VO₂AT) was the most significant predictor, independently (OR = 0.43; 95% CI 0.27-0.68; p<0.001) and in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12-0.59; p = 0.001). The area under the receiver-operating-characteristic curve was 0.93, based on a risk prediction model that incorporated VO₂AT, body mass index and desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU admission. CONCLUSIONS To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO₂AT has the potential to predict perioperative morbidity in kidney transplant recipients.
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Affiliation(s)
- Stephen M. S. Ting
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
- * E-mail: (ST); (DZ)
| | - Hasan Iqbal
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Thomas Hamborg
- Division of Health Sciences Statistics and Epidemiology, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Chris H. E. Imray
- Department of Vascular and Renal Transplantation Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Susan Hewins
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Prithwish Banerjee
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Rosemary Bland
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Robert Higgins
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Daniel Zehnder
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
- * E-mail: (ST); (DZ)
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Use of Complementary and Alternative Medicine among Patients with End-Stage Renal Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:654109. [PMID: 23710227 PMCID: PMC3655568 DOI: 10.1155/2013/654109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/31/2013] [Indexed: 11/30/2022]
Abstract
Among patients with end-stage renal disease (ESRD), few studies have examined the use of complementary and alternative medicine (CAM) and patients' interest in learning mind-body interventions to address health issues. We surveyed 89 adult patients (response rate 84%) at an outpatient hemodialysis center in Brookline, MA, USA regarding the utilization of CAM, including mind-body practices, and willingness to learn mind-body practices. Of respondents, 47% were female, 63% were black, and mean age was 62 years. 61% reported using CAM for health in their lifetime, and 36% reported using CAM within a month of the survey. The most frequent CAM modalities reported in ones' lifetime and in the last month were mind-body practices (42% and 27%, resp.). Overall lifetime CAM use did not differ significantly by sex, race, dialysis vintage, diagnosis of ESRD, employment status, or education level. Subjects reported that mind-body interactions were very important to health with a median score of 9 on a 10-point Likert scale (ranging from 0 for not important to 10 for extremely important). Most patients (74%) reported interest in learning mind-body practices during maintenance hemodialysis. In summary, CAM use, particularly mind-body practice, is frequent among patients with ESRD providing opportunities for future clinical research.
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Schmid H, Romanos A, Schiffl H, Lederer SR. Persistent nasal methicillin-resistant staphylococcus aureus carriage in hemodialysis outpatients: a predictor of worse outcome. BMC Nephrol 2013; 14:93. [PMID: 23617360 PMCID: PMC3651301 DOI: 10.1186/1471-2369-14-93] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 04/17/2013] [Indexed: 11/11/2022] Open
Abstract
Background Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a well defined risk factor for subsequent bacteremia and death in various groups of patients, but its impact on outcome in patients receiving long-term hemodialysis (HD) is under debate. Methods This prospective interventional cohort study (performed 2004 to 2010) enrolled 289 HD outpatients of an urban dialysis-unit. Nasal swab cultures for MRSA were performed in all patients upon first admission, at transfer from another dialysis facility or readmission after hospitalisation. Nasal MRSA carriers were treated in a separate ward and received mupirocin nasal ointment. Concomitant extra-nasal MRSA colonization was treated with 0.2% chlorhexidine mouth rinse (throat) or octenidine dihydrochloride containing antiseptic soaps and 2% chlorhexidine body washes (skin). Clinical data and outcome of carriers and noncarriers were systematically analyzed. Results The screening approach identified 34 nasal MRSA carriers (11.7%). Extra-nasal MRSA colonization was observed in 11/34 (32%) nasal MRSA carriers. History of malignancy and an increased Charlson Comorbidity Index were significant predictors for nasal MRSA carriers, whereas traditional risk factors for MRSA colonization or markers of inflammation or malnutrition were not able to discriminate. Kaplan-Meier analysis demonstrated significant survival differences between MRSA carriers and noncarriers. Mupirocin ointment persistently eliminated nasal MRSA colonization in 26/34 (73.5%) patients. Persistent nasal MRSA carriers with failure of this eradication approach had an extremely poor prognosis with an all-cause mortality rate >85%. Conclusions Nasal MRSA carriage with failure of mupirocin decolonization was associated with increased mortality despite a lack of overt clinical signs of infection. Further studies are needed to demonstrate whether nasal MRSA colonization represents a novel predictor of worse outcome or just another surrogate marker of the burden of comorbid diseases leading to fatal outcome in HD patients.
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Affiliation(s)
- Holger Schmid
- KFH Nierenzentrum Muenchen-Laim, Elsenheimerstr 36, 80687 Munich, Germany.
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193
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Cherng YG, Liao CC, Chen TH, Xiao D, Wu CH, Chen TL. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study. PLoS One 2013; 8:e58942. [PMID: 23516581 PMCID: PMC3597566 DOI: 10.1371/journal.pone.0058942] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 02/11/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33) when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31) and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47) than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.
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Affiliation(s)
- Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, affiliated with Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tso-Hsiao Chen
- Department of Nephrology, Wan Fang Medical Center, affiliated with Department of Internal Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Duan Xiao
- Department of Coloproctology, the Second People’s Hospital of Shi-Fang City, Shi-Fang City, Sichuan Province, People Republic of China
| | - Chih-Hsiung Wu
- Department of Surgery, Shuang Ho Hospital, affiliated with Taipei Medical University, New Taipei City, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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Prognostic utility of plasma S100A12 levels to establish a novel scoring system for predicting mortality in maintenance hemodialysis patients: a two-year prospective observational study in Japan. BMC Nephrol 2013; 14:16. [PMID: 23324110 PMCID: PMC3552940 DOI: 10.1186/1471-2369-14-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 01/11/2013] [Indexed: 11/24/2022] Open
Abstract
Background S100A12 protein is an endogenous receptor ligand for advanced glycation end products. In this study, the plasma S100A12 level was assessed as an independent predictor of mortality, and its utility in clinical settings was examined. Methods In a previous cross-sectional study, plasma S100A12 levels were measured in 550 maintenance hemodialysis patients to determine the association between S100A12 and the prevalence of cardiovascular diseases (CVD). In this prospective study, the risk of mortality within a two-year period was determined. An integer scoring system was developed to predict mortality on the basis of the plasma S100A12 levels. Results Higher plasma S100A12 levels (≥18.79 ng/mL) were more closely associated with higher all-cause mortality than lower plasma S100A12 levels (<18.79 ng/mL; P = 0.001). Multivariate Cox proportional hazards analysis revealed higher plasma S100A12 levels [hazard ratio (HR), 2.267; 95% confidence interval (CI), 1.195–4.302; P = 0.012], age ≥65 years (HR, 1.961; 95%CI, 1.017–3.781; P = 0.044), serum albumin levels <3.5 g/dL (HR, 2.198; 95%CI, 1.218–3.968; P = 0.012), and history of CVD (HR, 2.068; 95%CI, 1.146–3.732; P = 0.016) to be independent predictors of two-year all-cause mortality. The integer score was derived by assigning points to these factors and determining total scores. The scoring system revealed trends across increasing scores for predicting the all-cause mortality [c-statistic = 0.730 (0.656–0.804)]. The resulting model demonstrated good discriminative power for distinguishing the validation population of 303 hemodialysis patients [c-statistic = 0.721 (0.627–0.815)]. Conclusion The results indicate that plasma S100A12 level is an independent predictor for two-year all-cause mortality. A simple integer scoring system was therefore established for predicting mortality on the basis of plasma S100A12 levels.
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195
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Campbell LJ, Desai M, Hegazi A, Ibrahim F, Melikian N, Hay P, Fox JM, Post FA. Renal impairment is associated with coronary heart disease in HIV-positive men. HIV CLINICAL TRIALS 2013. [PMID: 23195672 DOI: 10.1310/hct1306-343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic kidney disease is a risk factor for coronary heart disease (CHD). The association between renal impairment and CHD in HIV-positive patients remains poorly described. OBJECTIVE To describe the CHD incidence in a cohort of HIV-positive patients and to examine the relationship between reduced estimated glomerular filtration rate (eGFR) and incident CHD. METHODS We studied 7,828 HIV-positive patients who were followed up at 3 South London clinics between January 2004 and December 2009. CHD events were identified from electronic records and through elevated troponin levels. Multivariate Poisson regression analysis was used to identify factors associated with CHD among HIV-positive men. RESULTS The incidence of CHD among men was 1.2 (95% CI, 0.8-1.8) per 1,000 person-years of follow-up, with 28 patients (0.4%) having experienced 32 CHD events. In adjusted analyses, older age (incidence rate ratios [IRR], 2.81; 95% CI, 1.51-5.25) and hepatitis C virus (HCV) status (IRR, 3.94; 95% CI, 1.00-15.5) were significantly associated with CHD. Although eGFR as a continuous variable was not associated with CHD, an eGFR <75 mL/min remained associated with incident CHD (IRR, 4.30; 95% CI, 1.33-14.5) after adjustment for age. No association between CHD and abacavir exposure was observed (IRR, 0.94; 95% CI, 0.30-2.99). CONCLUSIONS The incidence of CHD in this ethnically diverse cohort was low. Our data suggest that impaired renal function identifies patients at increased risk of CHD events in whom management of traditional CHD risk factors should be prioritized.
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196
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Theoretical Application of Irreversible (Nonequilibrium) Thermodynamic Principles to Enhance Solute Fluxes across Nanofabricated Hemodialysis Membranes. Int J Nephrol 2012; 2012:718085. [PMID: 23209903 PMCID: PMC3502860 DOI: 10.1155/2012/718085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/19/2012] [Accepted: 08/06/2012] [Indexed: 11/17/2022] Open
Abstract
Objective. Nanotechnology has the potential to improve hemodialysis membrane technology. Thus, a major objective is to understand how to enhance toxic solute fluxes across these membranes. The aim of this concept building study is to review the application of irreversible thermodynamic (IT) to solute fluxes. Methods. We expanded the application of the Nernst-Planck equation to include the Kedem-Katchalsky equation, pH, membrane thickness, pore size, and electric potential as variables. Results. (1) Reducing the membrane's thickness from 25 μm to 25 nm increased the flux of creatinine, β2-microglobulin, and tumor necrosis factor-α (TNF-α) by a thousand times but prevented completely albumin flux, (2) applying an electric potential of 50–400 mV across the membrane enhanced the flux of the respective molecules by 71.167 × 10−3, 38.7905 × 10−8, and 0.595 × 10−13 mol/s, and (3) changing the pH from 7.35 to 7.42 altered the fluxes minimally. Conclusions. The results supported an argument to investigate the application of IT to study forces of fluxes across membranes. Reducing the membrane's thickness—together with the application of an electrical potential—qualities achievable by nanotechnology, can enhance the removal of uremic toxins by many folds. However, changing the pH at a specific membrane thickness does not affect the flux significantly.
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197
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Chandra A, Mix D, Varble N. Hemodynamic study of arteriovenous fistulas for hemodialysis access. Vascular 2012; 21:54-62. [PMID: 23104825 DOI: 10.1258/vasc.2011.201204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dialysis access failure and associated complications represent a major cause of morbidity in patients with renal failure. This is due to an incomplete understanding of the hemodynamics associated with both arteriovenous fistula (AVF) successes and complications. Several decades of research have been performed studying these complex hemodynamic changes. This review provides an overview of work undertaken in three key areas of AVF hemodynamic research: mathematical modeling, in vivo fluid dynamic measurements and in vitro fluid dynamic modeling. Current and future work is then summarized involving the application of a comprehensive, systematic study of dialysis access hemodynamics. The ultimate goal is the ability to predict clinical outcomes of dialysis access procedures through personalized, patient-specific surgical planning. If successful, this type of tool would allow surgeons to predict multiple-dialysis access intervention outcomes and choose a personalized approach to maximize success.
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Affiliation(s)
- Ankur Chandra
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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198
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Ziebolz D, Fischer P, Hornecker E, Mausberg RF. Oral health of hemodialysis patients: a cross-sectional study at two German dialysis centers. Hemodial Int 2012; 16:69-75. [PMID: 22098671 DOI: 10.1111/j.1542-4758.2011.00606.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the study was to investigate the oral hygiene behavior and state of oral health of hemodialysis (HD) patients in Germany. HD patients attending two dialysis centers were asked to participate in the study. Anamneses and oral hygiene behavior were recorded in a questionnaire. Dental examination included the dental status (DMF-T) and the degree of gingival inflammation (PDI: Periodontol Disease Index). Of 129 patients contacted, 54 (42%), aged 63.9 ± 13.0 years (23 women and 31 men), took part in the study. At an average, dialysis was required for 4.1 years. The cause of terminal renal failure was glomerulonephritis in 30% of patients and diabetic nephropathy in 22% of patients. Since dialysis therapy, 63% of the patients (n = 34) only visited a dentist when they had complaints. In 46 cases (85%), the dentist had been informed about the patient's requirement for dialysis, and in most cases (70%), the dental treatment took place on the day after dialysis. The mean DMF-T of the HD patients was 22.1 ± 6.5. The proportion of carious teeth was low (D-T: 0.7 ± 1.2), of missing teeth (M-T) high (16.2 ± 9.3). The median degree of gingival inflammation (PDI) was 1. Availing themselves of dental treatment after patients needed to have dialysis was mostly "complaint oriented." In addition to a high proportion of missing teeth, a good level of restoration of caries was found. The gingiva showed only a low level of inflammatory changes.
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Affiliation(s)
- Dirk Ziebolz
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Goettingen, Goettingen, Germany.
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199
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Jimenez ZNC, Pereira BJ, Romão JE, Makida SCDS, Abensur H, Moyses RMA, Elias RM. Ankle-brachial index: a simple way to predict mortality among patients on hemodialysis--a prospective study. PLoS One 2012; 7:e42290. [PMID: 22860108 PMCID: PMC3408472 DOI: 10.1371/journal.pone.0042290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022] Open
Abstract
Background Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. Methodology/Principal Findings We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9–1.3) or abnormal (<0.9 and >1.3). There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months). Age (1 year) (hazard of ratio, 1.026; p = 0.014) and ABI abnormal (hazard ratio, 3.664; p = 0.001) were independently related to mortality in a multiple regression analysis. Conclusions An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population.
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Affiliation(s)
- Zaida Noemy Cabrera Jimenez
- Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Benedito Jorge Pereira
- Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - João Egidio Romão
- Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Hugo Abensur
- Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rosa Maria Affonso Moyses
- Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rosilene Motta Elias
- Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- * E-mail:
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Lin YP, Yang CY, Liao CC, Yu WC, Chi CW, Lin CH. Plasma protein characteristics of long-term hemodialysis survivors. PLoS One 2012; 7:e40232. [PMID: 22792249 PMCID: PMC3391220 DOI: 10.1371/journal.pone.0040232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 06/03/2012] [Indexed: 01/19/2023] Open
Abstract
Hemodialysis (HD) patients are under recurrent circulatory stress, and hemodialysis has a high mortality rate. The characteristics of plasma proteomes in patients surviving long-term HD remain obscure, as well as the potential biomarkers in predicting prognoses. This study reports the proteome analyses of patient plasma from non-diabetic long-term HD (LHD, dialysis vintage 14.9±4.1 years, n = 6) and the age/sex/uremic etiology-comparable short-term HD (SHD, dialysis vintage 5.3±2.9 years, n = 6) using 2-DE and mass spectrometry. In addition, a 4-year longitudinal follow-up of 60 non-diabetic HD patients was subsequently conducted to analyze the baseline plasma proteins by ELISA in predicting prognosis. Compared to the SHD, the LHD survivors had increased plasma vitamin D binding proteins (DBP) and decreased clusterin, apolipoprotein A-IV, haptoglobin, hemopexin, complement factors B and H, and altered isoforms of α1-antitrypsin and fibrinogen gamma. During the 45.7±15 months for follow-up of the 60 HD patient cases, 16 patients died. Kaplan-Meier analysis demonstrated that HD patients with the lowest tertile of the baseline plasma DBP level have a significantly higher mortality rate. Multivariate Cox regression analysis further indicated that DBP is an independent predictor of mortality. In summary, the altered plasma proteins in LHD implicated accelerated atherosclerosis, defective antioxidative activity, increased inflammation/infection, and organ dysfunction. Furthermore, lower baseline plasma DBP in HD patients is related to mortality. The results suggest that the proteomic approach could help discover the potential biomarker in HD prognoses.
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Affiliation(s)
- Yao-Ping Lin
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yu Yang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Chung Liao
- Proteomics Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Wen Chi
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Hsiung Lin
- Proteomics Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Life Sciences and Institute of Genomic Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- * E-mail:
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