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Heo CM, Lee WH, Park BS, Lee YJ, Park S, Kim YW, Lee DA, Yoo BC, Park KM. Glymphatic Dysfunction in Patients With End-Stage Renal Disease. Front Neurol 2022; 12:809438. [PMID: 35145471 PMCID: PMC8821099 DOI: 10.3389/fneur.2021.809438] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background We aimed to compare glymphatic dysfunction between patients with end-stage renal disease (ESRD) and healthy controls and analyze the correlation between the glymphatic function and clinical characteristics using the diffusion tensor image analysis along with the perivascular space (DTI-ALPS) index. Methods We prospectively enrolled neurologically asymptomatic 49 patients with ESRD undergoing dialysis and 38 healthy controls. Diffusion tensor image was conducted using the same 3T scanner, and the DTI-ALPS index was calculated. We compared the DTI-ALPS index between the patients with ESRD and healthy controls. In addition, we conducted a correlation analysis between the clinical characteristics and DTI-ALPS index in patients with ESRD. Results There were significant differences in the DTI-ALPS index between patients with ESRD and healthy controls. The DTI-ALPS index in patients with ESRD was lower than that in healthy controls (1.460 vs. 1.632, p = 0.003). In addition, there was a significant positive correlation between the DTI-ALPS index and serum parathyroid hormone levels (r = 0.357, p = 0.011). Conclusion We demonstrated glymphatic dysfunction in patients with ESRD, as revealed by the DTI-ALPS index. This study also reveals the feasibility of the DTI-ALPS method to determine glymphatic function in patients with ESRD, which could be used in future research studies.
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Affiliation(s)
- Chang Min Heo
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Won Ho Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sihyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | | | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
- *Correspondence: Kang Min Park
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Wong F, Reddy KR, O’Leary JG, Tandon P, Biggins SW, Garcia-Tsao G, Maliakkal BJ, Lai JC, Fallon MB, Vargas HE, Subramanian R, Thuluvath PJ, Kamath PS, Thacker L, Bajaj JS. Impact of Chronic Kidney Disease on Outcomes in Cirrhosis. Liver Transpl 2019; 25:870-880. [PMID: 30908855 PMCID: PMC11075743 DOI: 10.1002/lt.25454] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/01/2019] [Indexed: 02/07/2023]
Abstract
We hypothesize that the prevalence of chronic kidney disease (CKD) among patients with cirrhosis has increased due to the increased prevalence of CKD-associated comorbidities, such as diabetes. We aimed to assess the characteristics of hospitalized patients with cirrhosis with CKD and its impact on renal and patient outcomes. The North American Consortium for the Study of End-Stage Liver Disease (NACSELD) prospectively enrolled nonelectively admitted patients with cirrhosis and collected data on demographics, laboratory results, in-hospital clinical course, and postdischarge 3-month outcomes. CKD positive (CKD+) patients, defined as having an estimated glomerular filtration rate (eGFR; Modification of Diet in Renal Disease-4 variable formula) of ≤60 mL/minute for >3 months, were compared with chronic kidney disease negative (CKD-) patients for development of organ failures, hospital course, and survival. There were 1099 CKD+ patients (46.8% of 2346 enrolled patients) who had significantly higher serum creatinine (2.21 ± 1.33 versus 0.83 ± 0.21 mg/dL in the CKD- group) on admission, higher prevalence of nonalcoholic steatohepatitis cirrhosis etiology, diabetes, refractory ascites, and hospital admissions in the previous 6 months compared with the CKD- group (all P < 0.001). Propensity matching (n = 922 in each group) by Child-Pugh scores (9.78 ± 2.05 versus 9.74 ± 2.04, P = 0.70) showed that CKD+ patients had significantly higher rates of superimposed acute kidney injury (AKI; 68% versus 21%; P < 0.001) and eventual need for dialysis (11% versus 2%; P < 0.001) than CKD- patients. CKD+ patients also had more cases of acute-on-chronic liver failure as defined by the NACSELD group, which was associated with reduced 30- and 90-day overall survival (P < 0.001 for both). A 10 mL/minute drop in eGFR was associated with a 13.1% increase in the risk of 30-day mortality. In conclusion, patients with CKD should be treated as a high-risk group among hospitalized patients with cirrhosis due to their poor survival, and they should be monitored carefully for the development of superimposed AKI.
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Affiliation(s)
- Florence Wong
- Toronto General Hospital, University of Toronto, Toronto,
Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | - Leroy Thacker
- Department of Statistics, Commonwealth University of
Virginia, Richmond, VA
| | - Jasmohan S. Bajaj
- Commonwealth University of Virginia and McGuire VA
Medical Center, Richmond, VA
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3
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Auffret V, Regueiro A, Del Trigo M, Abdul-Jawad Altisent O, Campelo-Parada F, Chiche O, Puri R, Rodés-Cabau J. Predictors of Early Cerebrovascular Events in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 68:673-84. [PMID: 27515325 DOI: 10.1016/j.jacc.2016.05.065] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/14/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying transcatheter aortic valve replacement (TAVR) patients at high risk for cerebrovascular events (CVE) is of major clinical relevance. However, predictors have varied across studies. OBJECTIVES The purpose of this study was to analyze the predictors of 30-day CVE post-TAVR. METHODS A systematic review of studies that reported the incidence of CVE post-TAVR while providing raw data for predictors of interest was performed. Data on study, patient, and procedural characteristics were extracted. Crude risk ratios (RRs) and 95% confidence intervals for each predictor were calculated. RESULTS Sixty-four studies involving 72,318 patients (2,385 patients with a CVE within 30 days post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median 4%) without significant differences between single and multicenter studies, or according to CVE adjudication availability. The summary RRs indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for patients with chronic kidney disease (RR: 1.29; p = 0.03) and with new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for procedures performed within the first half of center experience (RR: 1.55; p = 0.003). The use of balloon post-dilation tended to be associated with a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable vs. self-expandable, p = 0.26) and approach (transfemoral vs. nontransfemoral, p = 0.81) did not predict CVE. CONCLUSIONS Female sex, chronic kidney disease, enrollment date, and new-onset atrial fibrillation were predictors of CVE post-TAVR. This study provides effect estimates to identify high-risk TAVR patients for early CVE, providing possible guidance for tailored preventive strategies.
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Affiliation(s)
- Vincent Auffret
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Rennes 1 University, Signal and Image Processing Laboratory, Rennes, France
| | - Ander Regueiro
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - María Del Trigo
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Olivier Chiche
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Rishi Puri
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Adekunle-Olarinde IR, McCall SJ, Barlas RS, Wood AD, Clark AB, Bettencourt-Silva JH, Metcalf AK, Bowles KM, Soiza RL, Potter JF, Myint PK. Addition of sodium criterion to SOAR stroke score. Acta Neurol Scand 2017; 135:553-559. [PMID: 27397108 DOI: 10.1111/ane.12634] [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] [Accepted: 06/17/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the usefulness of including sodium (Na) levels as a criterion to the SOAR stroke score in predicting inpatient and 7-day mortality in stroke. MATERIALS AND METHODS Data from the Norfolk and Norwich University Hospital Stroke & TIA register (2003-2015) were analysed. Univariate and then multivariate models controlling for SOAR variables were used to assess the association between admission sodium levels and inpatient and 7-day mortality. The prognostic ability of the SOAR and SOAR Na scores for mortality outcomes at both time points were then compared using the Area Under the Curve (AUC) values from the Receiver Operating Characteristic curves. RESULTS A total of 8493 cases were included (male=47.4%, mean (SD) 77.7 (11.6) years). Compared with normonatremia (135-145 mmol/L), hypernatraemia (>145 mmol/L) was associated with inpatient mortality and moderate (125-129 mmol/L) and severe hypontraemia (<125 mmol/L) with 7-day mortality after adjustment for stroke type, Oxfordshire Community Stroke Project classification, age, prestroke modified Rankin score and sex. The SOAR and SOAR-Na scores both performed well in predicting inpatient mortality with AUC values of .794 (.78-.81) and .796 (.78-.81), respectively. 7-day mortality showed similar results. Both scores were less predictive in those with chronic kidney disease (CKD) and more so in those with hypoglycaemia. CONCLUSION The SOAR-Na did not perform considerably better than the SOAR stroke score. However, the performance of SOAR-Na in those with CKD and dysglycaemias requires further investigation.
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Affiliation(s)
- I. R. Adekunle-Olarinde
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - S. J. McCall
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
- Nuffield Department of Population Health; University of Oxford; Oxford UK
| | - R. S. Barlas
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - A. D. Wood
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - A. B. Clark
- Norwich Medical School; University of East Anglia; Norwich UK
| | - J. H. Bettencourt-Silva
- Clinical Informatics; Department of Medicine; University of Cambridge; Cambridge UK
- Norfolk and Norwich University Hospital; Norwich UK
| | | | - K. M. Bowles
- Norwich Medical School; University of East Anglia; Norwich UK
- Norfolk and Norwich University Hospital; Norwich UK
| | - R. L. Soiza
- Health Services Research Unit; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
- Academic Department of Medicine for the Elderly; Aberdeen Royal Infirmary; NHS Grampian; Aberdeen UK
| | - J. F. Potter
- Norwich Medical School; University of East Anglia; Norwich UK
- Norfolk and Norwich University Hospital; Norwich UK
| | - P. K. Myint
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
- Academic Department of Medicine for the Elderly; Aberdeen Royal Infirmary; NHS Grampian; Aberdeen UK
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Abstract
Neurological manifestations related to electrolyte disorders, drug toxicity, and uremia are common in chronic kidney disease (CKD). Seizures and coma are frequent complications of acute renal insufficiency (uremia), whereas peripheral neuropathy and encephalopathy, observed in progressive uremia, are terminal events. Failure to excrete metabolic products causes their accumulation and can lead to severe intoxication. Clinically, the signs and symptoms of uremia can vary widely, depending on the biological characteristics of the patient, the specific type of renal disease, and the time of the uremic intoxication. CKD is an increasing problem worldwide and is now being recognized as a global health burden particularly for cardiovascular and cerebrovascular ischemic events. Despite improvements in the medical management of advanced CKD, including dialysis and transplantation, patients manifest a number of symptoms that neurologists are often confronted with. Appropriate drug dosing, awareness of potential side effects of medications, prompt diagnosis, and treatment are essential in preventing neurological long-term morbidity and mortality.
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Affiliation(s)
- Jorge H Baluarte
- From the Department of Pediatrics, Division of Nephrology, Children׳s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Pereira V, Resende L, Ponce D, Balbi A, Barretti P. EP 147. Electrophysiological evaluation of uremic patients undergoing hemodialisys: Proposal of a clinical and numerical scale for severity and prognosis. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yilmaz N, Ustundag Y, Kivrak S, Kahvecioglu S, Celik H, Kivrak I, Huysal K. Serum indoleamine 2,3 dioxygenase and tryptophan and kynurenine ratio using the UPLC-MS/MS method, in patients undergoing peritoneal dialysis, hemodialysis, and kidney transplantation. Ren Fail 2016; 38:1300-9. [PMID: 27466137 DOI: 10.1080/0886022x.2016.1209389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The level and activity of indoleamine 2,3-dioxygenase (IDO) and the concentrations of L-tryptophan and its metabolite L-kynurenine were determined in association with various renal diseases. However, there have been no data regarding these parameters in patients on peritoneal dialysis compared to those undergoing hemodialysis or kidney transplantation. METHODS This study investigated the level and activity of IDO and determined oxidative balance by calculating the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). We enrolled 60 kidney disease patients, including 20 on peritoneal dialysis (PD group), 19 on hemodialysis (HD group), and 21 with kidney transplantation (KT group), as well as 21 control group. RESULTS IDO levels were increased in the PD, HD, and KT groups compared to the control group. The concentration of kynurenine was significantly increased in the PD group compared to the other groups (p < 0.01). The kynurenine/tryptophan ratio was increased in the PD group compared to the other groups (all p < 0.01). TAS levels in the PD and HD groups were significantly decreased compared to the control group (both p < 0.05). TAS levels in the PD group were significantly decreased compared to the KT group. TOS levels in the PD group were higher than in the HD and KT groups. CONCLUSION The results showed that IDO levels were increased in peritoneal dialysis and hemodialysis patients and in renal transplant recipients, while oxidative stress was found to be related to IDO activity and was most increased in the patients on peritoneal dialysis.
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Affiliation(s)
- Nigar Yilmaz
- a Department of Biochemistry, Medical Faculty , Mugla Sitki Kocman University , Mugla , Turkey
| | - Yasemin Ustundag
- b Department of Biochemistry , Bursa Yuksek Ihtisas Education and Research Hospital , Bursa , Turkey
| | - Seyda Kivrak
- c Department of Nutrition and Dietetics, Faculty of Health Sciences , Mugla Sitki Kocman University , Mugla , Turkey
| | - Serdar Kahvecioglu
- d Department of Nephrology , Bursa Yuksek Ihtisas Education and Research Hospital , Bursa , Turkey
| | - Huseyin Celik
- e Department of Nephrology and Organ Transplantation , Acibadem Hospital , Bursa , Turkey
| | - Ibrahim Kivrak
- f Department of Chemistry and Chemical Treatment Techniques, Mugla Vocational School of Higher Education , Mugla Sitki Kocman University , Mugla , Turkey
| | - Kağan Huysal
- b Department of Biochemistry , Bursa Yuksek Ihtisas Education and Research Hospital , Bursa , Turkey
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