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Chen L, Wang Q, Li T, Li L, Wang C, Xu B, Gong X. Exploring therapeutic mechanisms of Chuan Huang Fang-II in the treatment of acute kidney injury on chronic kidney disease patients from the perspective of lipidomics. Ren Fail 2024; 46:2356021. [PMID: 38785301 PMCID: PMC11132756 DOI: 10.1080/0886022x.2024.2356021] [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: 09/19/2023] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This study aims to assess the clinical efficacy and safety of CHF-II in combination with RG for treating AKI on CKD (A on C), and to explore potential therapeutic mechanisms through lipidomics analysis. METHODS 98 patients were enrolled and randomly assigned to the RG or RG + CHF groups. Both groups received RG therapy, with RG + CHF group additionally receiving CHF-II treatment over a duration of two weeks. Evaluation endpoints included changes in renal function, blood lipid profiles, urinary AKI biomarkers, and TCM symptoms before and after treatment. Serum samples were collected for lipid metabolite analysis. RESULTS The total clinical effective rate in RG + CHF group was 73.5%, and that of RG group was 40.8%. TCM syndrome scores in RG + CHF group showed a more pronounced decrease (p < 0.05). Scr, BUN, and UA levels decreased while eGFR levels increased in both groups (p < 0.05), with a greater magnitude of change observed in the RG + CHF group. Urinary AKI biomarkers decreased more in RG + CHF group (p < 0.05). No serious adverse events occurred during the trial. 58 different lipid metabolites and 48 lipid biomarkers were identified. According to the KEGG database, the possible metabolic pathways involved triglyceride metabolic pathway and fat digestion and absorption metabolic pathways. CONCLUSION CHF-II effectively alleviated kidney injury and improved TCM syndrome scores in patients with A on C. Lipid differential metabolites could serve as diagnostic indicators for AKI in patients with CKD. The possible metabolic pathways might be implicated in therapeutic action of CHF-II in the prevention and treatment of patients with A on C.
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Affiliation(s)
- Ling Chen
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Wang
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tonglu Li
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lejia Li
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wang
- Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bing Xu
- Department of Nephrology, Minhang Branch of Yueyang Hospital of Integrative Chinese & Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuezhong Gong
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Rasmussen SB, Boyko Y, Ranucci M, de Somer F, Ravn HB. Cardiac surgery-Associated acute kidney injury - A narrative review. Perfusion 2023:2676591231211503. [PMID: 37905794 DOI: 10.1177/02676591231211503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) is a serious complication seen in approximately 20-30% of cardiac surgery patients. The underlying pathophysiology is complex, often involving both patient- and procedure related risk factors. In contrast to AKI occurring after other types of major surgery, the use of cardiopulmonary bypass comprises both additional advantages and challenges, including non-pulsatile flow, targeted blood flow and pressure as well as the ability to manipulate central venous pressure (congestion). With an increasing focus on the impact of CSA-AKI on both short and long-term mortality, early identification and management of high-risk patients for CSA-AKI has evolved. The present narrative review gives an up-to-date summary on definition, diagnosis, underlying pathophysiology, monitoring and implications of CSA-AKI, including potential preventive interventions. The review will provide the reader with an in-depth understanding of how to identify, support and provide a more personalized and tailored perioperative management to avoid development of CSA-AKI.
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Affiliation(s)
- Sebastian Buhl Rasmussen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yuliya Boyko
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesiology and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Hanne Berg Ravn
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Çankaya E, Bilen Y, Uyanık A, Dogan H, Kızıltunç A, Sevinç C. Can keto/amino acids reduce oxidative stress in peritoneal dialysis patients with hypoalbuminemia? Semin Dial 2021; 34:375-379. [PMID: 34472642 DOI: 10.1111/sdi.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/28/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is no consensus on an ideal marker of oxidative stress (OS). Disruption of the balance between free radical and antioxidant activity production by increasing oxidative markers results in OS. In this study, we aimed to investigate how OS, which increases mortality and morbidity due to various reasons, is affected by keto/amino therapy in patients with hypoalbuminemia undergoing peritoneal dialysis. MATERIALS AND METHOD Twenty patients who underwent peritoneal dialysis were included in the study. Before starting keto/amino acid therapy, primary kidney diseases were determined, body mass indexes, serum total protein, albumin, C-reactive protein, ferritin, calcium, phosphorus, parathyroid hormone, paraoxonase-1 (PON-1), sialic acid levels, arylesterase (ARE) activities, and malondialdehyde (MDA) levels were measured, and Kt/V values were calculated. Keto/amino acid treatment was initiated for those with an albumin level of <3.5 g/dL. The same parameters of the patients, followed up for 3 months, were checked again at the end of the third month. RESULTS Paraoxonase-1 and ARE activities, which are antioxidant enzyme activities, were found to be statistically significantly increased compared to the initial period (59 ± 59, 135 ± 69, 15.8 ± 19.7, and 44.7 ± 16.4, respectively; p < 0.00). MDA and sialic acid levels were significantly lower than the initial values (109 ± 99, 23 ± 9, 2.26 ± 0.44, and 2.04 ± 0.39, respectively; p < 0.01). CONCLUSION In our study, after the initiation of keto/amino acid treatment, PON-1, which is a significant antioxidant marker, and ARE plasma activities increased and tissue destruction product MDA and sialic acid significantly decreased. In the light of all these data, we think that this treatment can reduce OS, improve hypoalbuminemia, which causes both mortality and morbidity in patients, improve survival in PD patients, and may be an antioxidant treatment in suitable patients.
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Affiliation(s)
- Erdem Çankaya
- Department of Nephrology, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - Yusuf Bilen
- Department of Hematology, Medical Faculty, Adıyaman University, Erzurum, Turkey
| | - Abdullah Uyanık
- Department of Nephrology, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - Hasan Dogan
- Medical Biology Genetics, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - Ahmet Kızıltunç
- Medical Biochemistry, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - Can Sevinç
- Department of Nephrology, Medical Faculty, Atatürk University, Erzurum, Turkey
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Kon V, Yang HC, Smith LE, Vickers KC, Linton MF. High-Density Lipoproteins in Kidney Disease. Int J Mol Sci 2021; 22:ijms22158201. [PMID: 34360965 PMCID: PMC8348850 DOI: 10.3390/ijms22158201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Decades of epidemiological studies have established the strong inverse relationship between high-density lipoprotein (HDL)-cholesterol concentration and cardiovascular disease. Recent evidence suggests that HDL particle functions, including anti-inflammatory and antioxidant functions, and cholesterol efflux capacity may be more strongly associated with cardiovascular disease protection than HDL cholesterol concentration. These HDL functions are also relevant in non-cardiovascular diseases, including acute and chronic kidney disease. This review examines our current understanding of the kidneys’ role in HDL metabolism and homeostasis, and the effect of kidney disease on HDL composition and functionality. Additionally, the roles of HDL particles, proteins, and small RNA cargo on kidney cell function and on the development and progression of both acute and chronic kidney disease are examined. The effect of HDL protein modification by reactive dicarbonyls, including malondialdehyde and isolevuglandin, which form adducts with apolipoprotein A-I and impair proper HDL function in kidney disease, is also explored. Finally, the potential to develop targeted therapies that increase HDL concentration or functionality to improve acute or chronic kidney disease outcomes is discussed.
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Affiliation(s)
- Valentina Kon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (V.K.); (H.-C.Y.)
| | - Hai-Chun Yang
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (V.K.); (H.-C.Y.)
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Loren E. Smith
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Kasey C. Vickers
- Atherosclerosis Research Unit, Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - MacRae F. Linton
- Atherosclerosis Research Unit, Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
- Correspondence:
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Martin-Lorenzo M, Ramos-Barron A, Gutierrez-Garcia P, Martin-Blazquez A, Santiago-Hernandez A, Rodrigo Calabia E, Gomez-Alamillo C, Alvarez-Llamas G. Urinary Spermidine Predicts and Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery. Antioxidants (Basel) 2021; 10:antiox10060896. [PMID: 34199603 PMCID: PMC8229689 DOI: 10.3390/antiox10060896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
Acute Kidney Injury (AKI) affects up to 30% of the patients who undergo cardiac surgery (CVS) and is related to higher mortality. We aim to investigate molecular features associated with in-hospital AKI development and determine the predictive value of these features when analyzed preoperatively. This is a case-control study. From an initial cohort of 110 recruited subjects, a total of 60 patients undergoing cardiac surgery were included: 20 (33%) developed in-hospital AKI (CVS-AKI) and 40 did not (controls, CVS-C). Pre- and post-surgery samples were collected and a prospective study was carried out. A total of 312 serum samples and 258 urine samples were analyzed by nuclear magnetic resonance, mass spectrometry and ELISA. Six features predicted AKI development in pre-surgery samples: urinary kidney functional loss marker kidney injury molecule-1 (uKIM-1), 2-hydroxybutyric acid, 2-hydroxyphenylacetic acid, hippuric acid, phosphoethanolamine and spermidine. Two of them stood out as powerful predictors. Pre-surgery uKIM-1 levels were increased in CVS-AKI vs. CVS-C (AUC = 0.721, p-value = 0.0392) and associated strongly with the outcome (OR = 5.333, p-value = 0.0264). Spermidine showed higher concentration in CVS-AKI (p-value < 0.0001, AUC = 0.970) and had a strong association with the outcome (OR = 69.75, p-value < 0.0001). uKIM-1 and particularly spermidine predict in-hospital AKI associated with CVS in preoperative samples. These findings may aid in preventing postoperative AKI and improve prognosis of CVS.
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Affiliation(s)
- Marta Martin-Lorenzo
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Angeles Ramos-Barron
- Nephrology Department, Hospital Marqués de Valdecilla, IDIVAL, 39008 Santander, Spain; (A.R.-B.); (E.R.C.); (C.G.-A.)
| | - Paula Gutierrez-Garcia
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Ariadna Martin-Blazquez
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Aranzazu Santiago-Hernandez
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Emilio Rodrigo Calabia
- Nephrology Department, Hospital Marqués de Valdecilla, IDIVAL, 39008 Santander, Spain; (A.R.-B.); (E.R.C.); (C.G.-A.)
- REDInREN, 28040 Madrid, Spain
| | - Carlos Gomez-Alamillo
- Nephrology Department, Hospital Marqués de Valdecilla, IDIVAL, 39008 Santander, Spain; (A.R.-B.); (E.R.C.); (C.G.-A.)
| | - Gloria Alvarez-Llamas
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
- REDInREN, 28040 Madrid, Spain
- Correspondence:
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