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Qiu Z, Pang X, Xiang Q, Cui Y. The Crosstalk between Nephropathy and Coagulation Disorder: Pathogenesis, Treatment, and Dilemmas. J Am Soc Nephrol 2023; 34:1793-1811. [PMID: 37487015 PMCID: PMC10631605 DOI: 10.1681/asn.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
ABSTRACT The interaction between the kidney and the coagulation system greatly affects each other because of the abundant vessel distribution and blood perfusion in the kidney. Clinically, the risks of complicated thrombosis and bleeding have become important concerns in the treatment of nephropathies, especially nephrotic syndrome, CKD, ESKD, and patients with nephropathy undergoing RRTs. Adverse effects of anticoagulant or procoagulant therapies in patients with nephropathy, especially anticoagulation-related nephropathy, heparin-induced thrombocytopenia, and bleeding, seriously worsen the prognosis of patients, which have become challenges for clinicians. Over the decades, the interaction between the kidney and the coagulation system has been widely studied. However, the effects of the kidney on the coagulation system have not been systematically investigated. Although some coagulation-related proteins and signaling pathways have been shown to improve coagulation abnormalities while avoiding additional kidney damage in certain kidney diseases, their potential as anticoagulation targets in nephropathy requires further investigation. Here, we review the progression of research on the crosstalk between the coagulation system and kidney diseases and systematically analyze the significance and shortcomings of previous studies to provide new sight into future research. In addition, we highlight the status of clinical treatment for coagulation disorder and nephropathy caused by each other, indicating guidance for the formulation of therapeutic strategies or drug development.
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Affiliation(s)
- Zhiwei Qiu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Xiaocong Pang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
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2
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Zhang Y, Gao W, Li X. Vitamin E‑coated dialyzer alleviates erythrocyte deformability dysfunction in patients with end‑stage renal disease undergoing hemodialysis. Exp Ther Med 2022; 24:480. [PMID: 35761813 PMCID: PMC9214592 DOI: 10.3892/etm.2022.11407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Patients with end-stage renal disease (ESRD) are characterized by augmented oxidative stress (OS) due to the imbalance between the generation of increased concentrations of oxidative molecules and decreased antioxidant capacity. Vitamin E-coated dialyzer membranes (VEMs) have previously been reported to alleviate the imbalance of redox metabolism in patients with ESRD undergoing hemodialysis (HD); however, their effect on the deformability of red blood cells (RBCs) remains unknown. In the present study, 48 patients with ESRD undergoing HD were enrolled and randomly assigned into two groups: HD with VEMs (VEM group; n=24) and HD with polysulfone dialyzer membranes (PM group; n=24), and another 24 healthy volunteers served as the control group. The present study investigated the morphological changes and deformability of RBCs in patients with ESRD and healthy volunteers. The concentration of serum vitamin E, the parameters of antioxidant stress and OS, and the degree of oxidative phosphorylation and clustering of anion exchanger 1 (Band 3) in RBCs were measured. The results obtained suggested that VEM treatment markedly ameliorated the abnormalities of RBC morphology and deformability in patients with ESRD undergoing HD. Mechanistic studies showed that VEM treatment led to a marked improvement in the concentration of serum vitamin E, which was positively associated with the restored antioxidant capacity, and decreased oxidative phosphorylation and clustering of Band 3 in RBCs of patients with ESRD undergoing HD. Taken together, the results of the present study have demonstrated that VEM treatment effectively restored the imbalance of redox metabolism, and improved the oxidative phosphorylation and clustering of Band 3 in RBCs of patients with ESRD undergoing HD via delivering vitamin E, which may alleviate the abnormal morphological and mechanical properties of RBCs. These findings are anticipated to be useful with respect to improving the nursing care and cure rate of patients with ESRD.
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Affiliation(s)
- Ying Zhang
- Department of Blood Dialysis Room, Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong 264001, P.R. China
| | - Wei Gao
- Department of Blood Dialysis Room, Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong 264001, P.R. China
| | - Xia Li
- Department of Blood Dialysis Room, Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong 264001, P.R. China
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3
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Lee D, Lee R, Fassihi SC, Stadecker M, Heyer JH, Stake S, Rakoczy K, Rodenhouse T, Pandarinath R. Risk Factors for Blood Transfusions in Primary Anatomic and Reverse Total Shoulder Arthroplasty for Osteoarthritis. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:217-225. [PMID: 35821928 PMCID: PMC9210430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of this study was to determine risk factors for blood transfusion in primary anatomic and reverse total shoulder arthroplasty (TSA) performed for osteoarthritis. METHODS Patients who underwent anatomic or reverse TSA for a diagnosis of primary osteoarthritis were identified in a national surgical database from 2005 to 2018 by utilizing both CPT and ICD-9/ICD-10 codes. Univariate analysis was performed on the two transfused versus non-transfused cohorts to compare for differences in comorbidities and demographics. Independent risk factors for perioperative blood transfusions were identified via multivariate regression models. RESULTS 305 transfused and 18,124 nontransfused patients were identified. Female sex (p<0.001), age >85 years (p=0.001), insulin-dependent diabetes mellitus (p=0.001), dialysis dependence (p=0.001), acute renal failure (p=0.012), hematologic disorders (p=0.010), disseminated cancer (p<0.001), ASA ≥ 3 (p<0.001), and functional dependence (p=0.001) were shown to be independent risk factors for blood transfusions on multivariate logistic regression analysis. CONCLUSION Several independent risk factors for blood transfusion following anatomic/reverse TSA for osteoarthritis were identified. Awareness of these risk factors can help surgeons and perioperative care teams to both identify and optimize high-risk patients to decrease both transfusion requirements and its associated complications in this patient population. Level of Evidence: III.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Ryan Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Safa C. Fassihi
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Jessica H. Heyer
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Seth Stake
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Kyla Rakoczy
- University of Miami Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Thomas Rodenhouse
- Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Rajeev Pandarinath
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
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Li YL, Cheng F, Chen Y, Wang J, Xiao ZD, Li B. Effect of traditional Chinese medicine Bailing capsule on renal anemia in maintenance hemodialysis patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29086. [PMID: 35475796 PMCID: PMC9276363 DOI: 10.1097/md.0000000000029086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Renal anemia (RA) is one of the most common complications in patients with end-stage renal disease, and it is also one of the reasons for the decline of quality of life and functional status in patients with end-stage renal disease. Traditional treatment methods often fail to achieve satisfactory therapeutic effects, so it is very necessary to find effective adjuvant treatment methods. Bailing capsule (BLC), a traditional Chinese medicine, which has been widely used in the treatment of RA in maintenance hemodialysis patients, but a systematic review of the efficacy and safety of this drug is currently lacking. Therefore, this study used meta-analysis to evaluate the efficacy and safety of BLC in the treatment of RA, in order to provide guidance for finding effective auxiliary methods for the treatment of RA in maintenance hemodialysis patients (MHP). METHODS Using the computer to retrieve PubMed, EMbase, Cochrane Library, CNKI, VIP Database, WANFANG Database, SinoMed from 1990 to 2021 and collecting the clinical randomized controlled trial and retrospective cohort study of BLC in the treatment of RA in MHP. Two researchers independently read and screened the literature, followed by evaluating the retrospective cohort studies that met the selection criteria using the Newcastle-Ottawa Scale (NOS) scale. The randomized controlled trial used the Cochrane manual standards to assess the risk of bias, and the RevMan 5.3 software was used to conduct a meta-analysis of the result data. RESULTS This study will use the method of meta-analysis to evaluate the clinical efficacy and incidence of adverse reactions of BLC in the treatment of RA in MHP through the primary and secondary outcome indicators. CONCLUSION The results of this study will help clinicians find safe and effective adjuvant therapy in the treatment of RA in MHP. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/732KP (https://osf.io/732kp).
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Affiliation(s)
- Yan-Lin Li
- Department of Pharmacy, Haibin People's Hospital of Binhai New Area, Binhai New Area, Tianjin, China
| | - Fang Cheng
- Department of Pharmacy, Haibin People's Hospital of Binhai New Area, Binhai New Area, Tianjin, China
| | - Yan Chen
- Department of Pharmacy, Haibin People's Hospital of Binhai New Area, Binhai New Area, Tianjin, China
| | - Jun Wang
- Department of Pharmacy, Haibin People's Hospital of Binhai New Area, Binhai New Area, Tianjin, China
| | - Zeng-Dong Xiao
- Department of Traditional Chinese Medicine, Haibin People's Hospital of Binhai New Area, Binhai New Area, Tianjin, China
| | - Bin Li
- Department of Psychiatry, Haibin People's Hospital of Binhai New Area, Binhai New Area, Tianjin, China
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Liu H, Su LL, Ren Y, Wang WY. Rehmannia glutinosa polysaccharide increases the expression of erythropoietin and vascular endothelial growth factor in rats with chronic renal failure by activating hypoxia-inducible factor-2α. Pharmacogn Mag 2021. [DOI: 10.4103/pm.pm_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Li J, Guo W, Zhao W, Wang X, Hu W, Zhou J, Xu S, Lei H. Ultrasound-Guided Unilateral Transversus Abdominis Plane Combined with Rectus Sheath Block versus Subarachnoid Anesthesia in Patients Undergoing Peritoneal Dialysis Catheter Surgery: A Randomized Prospective Controlled Trial. J Pain Res 2020; 13:2279-2287. [PMID: 32982391 PMCID: PMC7500835 DOI: 10.2147/jpr.s264255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Peritoneal dialysis catheter placement can be performed under general anesthesia, local anesthesia or subarachnoid anesthesia (SA). Recently, studies have reported the successful placement of peritoneal dialysis catheters using a transversus abdominis plane (TAP) block and rectus sheath (RS) block. This study compared the TAP + RS block with SA for patients undergoing peritoneal dialysis catheter placement. Methods Sixty patients were randomly divided into two groups, with 30 receiving unilateral ultrasound-guided TAP + RS block anesthesia and 30 receiving SA. The demographic characteristics, anesthesia efficacy, indicators related to anesthesia or operation, hemodynamic index, postoperative pain numeric rating score (NRS), postoperative recovery indicators, complications related to anesthesia or surgery, and dosage of sedative or analgesic medication were analyzed. Results Anesthesia operation time was significantly shorter in the TAP + RS block group than in the SA group (P<0.001), while there was no significant difference in success rates (TAP + RS 93.33% [95% confidence interval, 95% CI, 83.9–102.8%] vs SA 100.00% [95% CI, 100–100%], P=0.472). Two patients in the TAP + RS group needed extra analgesia, although the dermatome pinprick sensation test gave negative results for all patients. Patients who received the TAP + RS block expressed significantly less pain on movement or at rest at 4 h and 8 h postoperative. Fewer patients needed rescue analgesia with tramadol in the postoperative period in the TAP + RS block group than in the SA group (P<0.05). The intraoperative MAP was more stable (P<0.05) in the TAP + RS group compared to the SA group. Conclusion The TAP + RS block is a safe, effective method for use as the principal anesthesia technique in PD catheter placement. Compared to SA, it has the advantages of less influence on hemodynamics and a better postoperative analgesic effect.
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Affiliation(s)
- Ji Li
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenjing Guo
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wei Zhao
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiang Wang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenmin Hu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Zhou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongyi Lei
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Vaziri ND, Nunes ACF, Said H, Khazaeli M, Liu H, Zhao Y, Jing W, Cogburn K, Alikhani L, Lau WL. Route of intestinal absorption and tissue distribution of iron contained in the novel phosphate binder ferric citrate. Nephrol Dial Transplant 2020; 35:1136-1144. [PMID: 32514572 DOI: 10.1093/ndt/gfaa053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Anemia of chronic kidney disease (CKD) is, in part, caused by hepcidin-mediated impaired iron absorption. However, phosphate binder, ferric citrate (FC) overcomes the CKD-induced impairment of iron absorption and increases serum iron, transferrin saturation, and iron stores and reduces erythropoietin requirements in CKD/ESRD patients. The mechanism and sites of intestinal absorption of iron contained in FC were explored here. METHODS Eight-week old rats were randomized to sham-operated or 5/6 nephrectomized (CKD) groups and fed either regular rat chow or rat chow containing 4% FC for 6 weeks. They were then euthanized, and tissues were processed for histological and biochemical analysis using Prussian blue staining, Western blot analysis to quantify intestinal epithelial tight junction proteins and real-time PCR to measure Fatty Acid receptors 2 (FFA2) and 3 (FFA3) expressions. RESULTS CKD rats exhibited hypertension, anemia, azotemia, and hyperphosphatemia. FC-treated CKD rats showed significant reductions in blood pressure, serum urea, phosphate and creatinine levels and higher serum iron and blood hemoglobin levels. This was associated with marked increase in iron content of the epithelial and subepithelial wall of the descending colon and modest iron deposits in the proximal tubular epithelial cells of their remnant kidneys. No significant difference was found in hepatic tissue iron content between untreated and FC-treated CKD or control groups. Distal colon's epithelial tight Junction proteins, Occludin, JAM-1 and ZO-1 were markedly reduced in the CKD groups. The FFA2 expression in the jejunum and FFA3 expression in the distal colon were significantly reduced in the CKD rats and markedly increased with FC administration. CONCLUSION Iron contained in the phosphate binder, FC, is absorbed by the distal colon of the CKD animals via disrupted colonic epithelial barrier and upregulation of short chain fatty acid transporters.
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Affiliation(s)
- Nosratola D Vaziri
- Division of Nephrology, University of California Irvine, Irvine, CA, USA
| | - Ane C F Nunes
- Division of Nephrology, University of California Irvine, Irvine, CA, USA
| | - Hyder Said
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Mahyar Khazaeli
- Division of Nephrology, University of California Irvine, Irvine, CA, USA
| | - Han Liu
- Division of Nephrology, University of California Irvine, Irvine, CA, USA
| | - Yitong Zhao
- Division of Nephrology, University of California Irvine, Irvine, CA, USA
| | - Wanghui Jing
- Division of Nephrology, University of California Irvine, Irvine, CA, USA.,School of Pharmacy, Xi'an Jiaotong University, Xi'an, PR China
| | - Kyle Cogburn
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, PR China
| | - Leila Alikhani
- Division of Nephrology, University of California Irvine, Irvine, CA, USA
| | - Wei Ling Lau
- Division of Nephrology, University of California Irvine, Irvine, CA, USA
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Georgatzakou HT, Pavlou EG, Papageorgiou EG, Papassideri IS, Kriebardis AG, Antonelou MH. The Multi-Faced Extracellular Vesicles in the Plasma of Chronic Kidney Disease Patients. Front Cell Dev Biol 2020; 8:227. [PMID: 32351956 PMCID: PMC7174738 DOI: 10.3389/fcell.2020.00227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Extracellular vesicles (EVs) are membrane-enclosed nanoparticles released by most cells in body fluids and extracellular matrix. They function as signal transducers in intercellular communication, contributing to the maintenance of cell and tissue integrity. EVs biogenesis is deregulated in various pathologies, in structural and functional connection to the pathophysiology of donor cells. Consequently, EVs are considered diagnostic and monitoring factors in many diseases. Despite consensus as to their activity in promoting coagulation and inflammation, there is evidence suggesting protective roles for EVs in stress states. Chronic kidney disease (CKD) patients are at high risk of developing cardiovascular defects. The pathophysiology, comorbidities, and treatment of CKD may individually and in synergy affect extracellular vesiculation in the kidney, endothelium, and blood cells. Oxidative and mechanical stresses, chronic inflammation, and deregulation of calcium and phosphate homeostasis are established stressors of EV release. EVs may affect the clinical severity of CKD by transferring biological response modifiers between renal, vascular, blood, and inflammatory cells. In this Review, we focus on EVs circulating in the plasma of CKD patients. We highlight some recent advances in the understanding of their biogenesis, the effects of dialysis, and pharmacological treatments on them and their potential impact on thrombosis and vascular defects. The strong interest of the scientific community to this exciting field of research may reveal hidden pieces in the pathophysiology of CKD and thus, innovative ways to treat it. Overcoming gaps in EV biology and technical difficulties related to their size and heterogeneity will define the success of the project.
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Affiliation(s)
- Hara T Georgatzakou
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health & Welfare Sciences, University of West Attica, Athens, Greece
| | - Efthimia G Pavlou
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health & Welfare Sciences, University of West Attica, Athens, Greece
| | - Effie G Papageorgiou
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health & Welfare Sciences, University of West Attica, Athens, Greece
| | - Issidora S Papassideri
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Anastasios G Kriebardis
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health & Welfare Sciences, University of West Attica, Athens, Greece
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
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"Valar morghulis": all red cells must die. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:83-85. [PMID: 32203010 DOI: 10.2450/2020.0028-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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Pedrini LA, Comelli M, Ruggiero P, Feliciani A, Manfrini V, Cozzi G, Castellano A, Pezzotta M, Gatti G, Arazzi M, Auriemma L, di Benedetto A, Stuard S. Mixed hemodiafiltration reduces erythropoiesis stimulating agents requirement in dialysis patients: a prospective randomized study. J Nephrol 2020; 33:1037-1048. [PMID: 32036610 DOI: 10.1007/s40620-020-00709-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improved responsiveness to erythropoiesis stimulating agents (ESAs) in patients on on-line post-dilution hemodiafiltration (Post-HDF) compared with conventional hemodialysis (HD) was reported by some authors but challenged by others. This prospective, cross-over randomized study tested the hypothesis that an alternative infusion modality of HDF, mixed-dilution HDF (Mixed HDF), could further reduce ESAs requirement in dialysis patients compared to the traditional Post-HDF. METHODS One-hundred-twenty prevalent patients from 6 Dialysis Centers were randomly assigned to two six-months treatment sequences: A-B and B-A (A, Mixed HDF; B, Post-HDF). Primary outcome was comparative evaluation of ESA (darbepoetin alfa) requirement and ESA resistance. Treatments efficiency, iron and vitamins status, inflammation and nutrition parameters were monitored. RESULTS In sequence A, darbepoetin requirement decreased during Mixed HDF from 29.5 to 23.7 µg/month and increased significantly during Post-HDF (32.3 µg/month at 6th month) while, in sequence B, it increased during Post-HDF from 38.2 to 43.7 µg/month and decreased during Mixed HDF (23.9 µg/month at 6th month). Overall, EPO doses at 6 months on Mixed and Post-HDF were 23.8 and 38.4 µg/month, respectively, P < 0.01. A multiple linear model confirmed that Mixed HDF vs Post-HDF reduced significantly ESA requirement and ESA resistance (P < 0.0001), by a mean of 29% (CI 23-35%) in the last three months of the observation periods. CONCLUSIONS Mixed HDF decreased darbepoetin-alfa requirement in dialysis patients. This might help preventing the untoward side effects of high ESA doses, besides having a remarkable economic impact. Additional evidence is needed to confirm this potential benefit of Mixed-HDF.
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Affiliation(s)
- Luciano A Pedrini
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy.
| | - Mario Comelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Pio Ruggiero
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Annalisa Feliciani
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Vania Manfrini
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Giorgio Cozzi
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Angelo Castellano
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Mauro Pezzotta
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Guido Gatti
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Marta Arazzi
- Nephrology and Dialysis Unit, NephroCare, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Laura Auriemma
- Biochemistry Unit, ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | | | - Stefano Stuard
- Fresenius Medical Care, Clinical and Therapeutical Governance, Bad Homburg, Germany
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Bronze-da-Rocha E, Santos-Silva A. Neutrophil Elastase Inhibitors and Chronic Kidney Disease. Int J Biol Sci 2018; 14:1343-1360. [PMID: 30123081 PMCID: PMC6097478 DOI: 10.7150/ijbs.26111] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022] Open
Abstract
End-stage renal disease (ESRD), the last stage of chronic kidney disease (CKD), is characterized by chronic inflammation and oxidative stress. Neutrophils are the front line cells that mediate an inflammatory response against microorganisms as they can migrate, produce reactive oxygen species (ROS), secrete neutrophil serine proteases (NSPs), and release neutrophil extracellular traps (NETs). Serine proteases inhibitors regulate the activity of serine proteases and reduce neutrophil accumulation at inflammatory sites. This review intends to relate the role of neutrophil elastase in CKD and the effects of neutrophil elastase inhibitors in predicting or preventing inflammation.
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Affiliation(s)
- Elsa Bronze-da-Rocha
- UCIBIO/REQUIMTE, Laboratório de Bioquímica, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal
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Indoxyl Sulfate, a Uremic Toxin, Stimulates Reactive Oxygen Species Production and Erythrocyte Cell Death Supposedly by an Organic Anion Transporter 2 (OAT2) and NADPH Oxidase Activity-Dependent Pathways. Toxins (Basel) 2018; 10:toxins10070280. [PMID: 29976888 PMCID: PMC6071035 DOI: 10.3390/toxins10070280] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 02/08/2023] Open
Abstract
It is hypothesized that the uremic toxin indoxyl sulfate (IS) plays a role in the pathogenesis of renal anemia. To further explore that hypothesis, we examined the effects of IS on reactive oxygen species (ROS) production, levels of reduced glutathione (GSH), and erythrocyte death (eryptosis) in red blood cells (RBC) from healthy controls (CON-RBC) and hemodialyzed patients (HD-RBC), respectively. RBC were incubated either in either TRIS-Glc-BSA buffer or IS at concentrations of 0.01, 0.09, and 0.17 mM, respectively. We measured ROS generation (expressed as % of DCFH-DA positive RBC), eryptosis (expressed as % of annexin-V positive RBC), and GSH levels after 6, 12, and 24 h. When incubated in buffer, ROS production was approximately seven-fold higher at all time points HD-RBC when compared to CON-RBC. Incubation with IS increased ROS production in CON-RBS dose-dependently up to 10-fold. Eryptosis in buffer-incubated HD-RBC was up to seven-fold higher as compared to COB-RBC. Incubation of CON-RBC with IS increased the eryptosis rate dose-dependently up to 6-fold. Pretreatment of CON-RBC with the organic anion transporter 2 (OAT2) specific inhibitor ketoprofen or with NADPH oxidase inhibitor diphenyleneiodonium-Cl blunted the IS effect on both ROS production and eryptosis induction. While GSH levels in HD-RBC were reduced when compared to CON-RBC, they were not affected by IS incubation. In summary, IS increases ROS generation and eryptosis in CON-RBC by an activity dependent of the IS influx through OAT2, and NADPH oxidase activity-dependent, and a GSH-independent mechanism. These findings lend support to a putative role of IS in the pathogenesis of renal anemia.
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Yurkovich JT, Palsson BO. Quantitative -omic data empowers bottom-up systems biology. Curr Opin Biotechnol 2018; 51:130-136. [DOI: 10.1016/j.copbio.2018.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/24/2022]
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Georgatzakou HT, Tzounakas VL, Kriebardis AG, Velentzas AD, Kokkalis AC, Antonelou MH, Papassideri IS. Short-term effects of hemodiafiltration versus conventional hemodialysis on erythrocyte performance. Can J Physiol Pharmacol 2017; 96:249-257. [PMID: 28854342 DOI: 10.1139/cjpp-2017-0285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hemodiafiltration (HDF) is a renal replacement therapy that is based on the principles of diffusion and convection for the elimination of uremic toxins. A significant and increasing number of end-stage renal disease (ESRD) patients are treated with HDF, even in the absence of definite and conclusive survival and anemia treatment data. However, its effects on red blood cell (RBC) physiological features have not been examined in depth. In this study, ESRD patients under regular HDF or conventional hemodialysis (cHD) treatment were examined for RBC-related parameters, including anemia, hemolysis, cell shape, redox status, removal signaling, membrane protein composition, and microvesiculation, in repeated paired measurements accomplished before and right after each dialysis session. The HDF group was characterized by better redox potential and suppressed exovesiculation of blood cells compared with the cHD group pre-dialysis. However, HDF was associated with a temporary but acute, oxidative-stress-driven increase in hemolysis, RBC removal signaling, and stomatocytosis, probably associated with the effective clearance of dialyzable natural antioxidant components, including uric acid, from the uremic plasma. The nature of these adverse short-term effects of HDF on post-dialysis plasma and RBCs strongly suggests the use of a parallel antioxidant therapy during the HDF session.
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Affiliation(s)
- Hara T Georgatzakou
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | - Vassilis L Tzounakas
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | - Anastasios G Kriebardis
- b Department of Medical Laboratories, Faculty of Health and Caring Professions, Technological and Educational Institute (TEI) of Athens, Greece
| | - Athanassios D Velentzas
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | | | - Marianna H Antonelou
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | - Issidora S Papassideri
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
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Erythrocyte Alterations and Increased Cardiovascular Risk in Chronic Renal Failure. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.45866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Georgatzakou HT, Tzounakas VL, Kriebardis AG, Velentzas AD, Papageorgiou EG, Voulgaridou AI, Kokkalis AC, Antonelou MH, Papassideri IS. Pathophysiological aspects of red blood cells in end-stage renal disease patients resistant to recombinant human erythropoietin therapy. Eur J Haematol 2017; 98:590-600. [DOI: 10.1111/ejh.12875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Hara T. Georgatzakou
- Department of Biology; Section of Cell Biology & Biophysics; School of Science; National and Kapodistrian University of Athens (NKUA); Athens Greece
| | - Vassilis L. Tzounakas
- Department of Biology; Section of Cell Biology & Biophysics; School of Science; National and Kapodistrian University of Athens (NKUA); Athens Greece
| | - Anastasios G. Kriebardis
- Department of Medical Laboratories; Faculty of Health and Caring Professions; Technological and Educational Institute (TEI) of Athens; Athens Greece
| | - Athanassios D. Velentzas
- Department of Biology; Section of Cell Biology & Biophysics; School of Science; National and Kapodistrian University of Athens (NKUA); Athens Greece
| | - Effie G. Papageorgiou
- Department of Medical Laboratories; Faculty of Health and Caring Professions; Technological and Educational Institute (TEI) of Athens; Athens Greece
| | | | | | - Marianna H. Antonelou
- Department of Biology; Section of Cell Biology & Biophysics; School of Science; National and Kapodistrian University of Athens (NKUA); Athens Greece
| | - Issidora S. Papassideri
- Department of Biology; Section of Cell Biology & Biophysics; School of Science; National and Kapodistrian University of Athens (NKUA); Athens Greece
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Abstract
Impaired iron homeostasis and the suppressive effects of proinflammatory cytokines on erythropoiesis, together with alterations of the erythrocyte membrane that impair its survival, cause anemia of inflammation. Recent epidemiologic studies have connected inflammatory anemia with critical illness, obesity, aging, kidney failure, cancer, chronic infection, and autoimmune disease. The proinflammatory cytokine, interleukin-6, the iron regulatory hormone, hepcidin, and the iron exporter, ferroportin, interact to cause iron sequestration in the setting of inflammation. Although severe anemia is associated with adverse outcomes in critical illness, experimental models suggest that iron sequestration is part of a natural defense against pathogens.
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Affiliation(s)
- Paula G Fraenkel
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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