1
|
Fathi AE, Shahwan M, Hassan N, Jairoun AA, Shahwan M. Prevalence of Anemia in Type 2 Diabetic Patients and correlation with Body Mass Index and Kidney function in Palestine. Diabetes Metab Syndr Obes 2024; 17:2293-2301. [PMID: 38859997 PMCID: PMC11164194 DOI: 10.2147/dmso.s454916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/07/2024] [Indexed: 06/12/2024] Open
Abstract
Background The objective of this study was to determine the prevalence of anemia in patients with type 2 diabetes mellitus and to identify the set of anthropometric and biochemical factors that jointly influence the diabetic and anemic patients including body mass index and kidney function.. Methods A retrospective cross-sectional design study that was carried out in a private medical center in Palestine. The study included a total of 453 patients with type 2 diabetes. Inclusion criteria included all patients (18 years or older) suffering from type 2 Diabetes mellitus attended the diabetic clinic from the 1st of January 2018, till 30th of December 2018.. Results A total number of 453 diabetic patients were recruited in the study. Male constituted 48.5% (n=220) of the study sample and 51.4% (n=233) were female. Of total 453 diabetic patients, 38.4% (95% CI, 34%-43%) had anemia. The results of statistical modeling showed that female gender (AOR 18.5; 95% CI 9.35-21.97), presence of hypertension (AOR 2.11; 95% CI 1.98- 4.25), high BMI (AOR 1.101; 95% CI 1.045-1.159), high Serum Creatinine (AOR 1.72; 95% CI 1.22-2.13), high BUN level (AOR 1.22; 95% CI 1.145-1.301) and low e-GFR (AOR 0.571; 95% CI 0.271-0.872) are strong determents of anemia in type 2 diabetic patients.. Conclusion The results of the current study revealed a high prevalence of Anemia among type 2 diabetes Mellitus patients. A significant association was reported between Anemia, kidney functions and body mass index..
Collapse
Affiliation(s)
- Alaa Elsayed Fathi
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, Ajman, 346, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, Ajman, 346, United Arab Emirates
| | - Moyad Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, Ajman, 346, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, Ajman, 346, United Arab Emirates
| | - Nageeb Hassan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, Ajman, 346, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, Ajman, 346, United Arab Emirates
| | - Ammar Abdulrahman Jairoun
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, 11500, Malaysia
| | - Monzer Shahwan
- Diabetes Clinic, AL-Swity Center for Dermatology and Chronic Diseases, Ramallah, 972, Palestine
| |
Collapse
|
2
|
Rodrigues AF, Bader M. The contribution of the AT1 receptor to erythropoiesis. Biochem Pharmacol 2023; 217:115805. [PMID: 37714274 DOI: 10.1016/j.bcp.2023.115805] [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: 06/22/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
The renin-angiotensin system (RAS) comprises a broad set of functional peptides and receptors that play a role in cardiovascular homeostasis and contribute to cardiovascular pathologies. Angiotensin II (Ang II) is the most potent peptide hormone produced by the RAS due to its high abundance and its strong and pleiotropic impact on the cardiovascular system. Formation of Ang II takes place in the bloodstream and additionally in tissues in the so-called local RAS. Of the two Ang II receptors (AT1 and AT2) that Ang II binds to, AT1 is the most expressed throughout the mammalian body. AT1 expression is not restricted to cells of the cardiovascular system but in fact AT1 protein is found in nearly all organs, hence, Ang II takes part in several modulatory physiological processes one of which is erythropoiesis. In this review, we present multiple evidence supporting that Ang II modulates physiological and pathological erythropoiesis processes trough the AT1 receptor. Cumulative evidence indicates that Ang II by three distinct mechanisms influences erythropoiesis: 1) stimulation of renal erythropoietin synthesis; 2) direct action on bone marrow precursor cells; and 3) modulation of sympathetic nerve activity to the bone marrow. The text highlights clinical and preclinical evidence focusing on mechanistic studies using rodent models.
Collapse
Affiliation(s)
- André F Rodrigues
- Max Delbrück Center (MDC), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany.
| | - Michael Bader
- Max Delbrück Center (MDC), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany; Charité Universitätsmedizin Berlin, Berlin, Germany; Institute for Biology, University of Lübeck, Lübeck, Germany.
| |
Collapse
|
3
|
Bonomini M, Di Liberato L, Sirolli V. Treatment Options for Anemia in Kidney Transplant Patients: A Review. Kidney Med 2023; 5:100681. [PMID: 37415623 PMCID: PMC10320602 DOI: 10.1016/j.xkme.2023.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Anemia is common after kidney transplantation. The etiology may be multifactorial, such as causes of anemia in the general population and causes that are unique to the kidney transplant setting. Posttransplant anemia, particularly when severe, may be associated with adverse effects such as graft failure, mortality, and a decline in kidney function. After careful investigation, that is, having excluded or treated reversible causes of anemia, treatment of anemia in patients with a kidney transplant is based on iron supplementation or erythropoiesis-stimulating agents (ESA), although there are no specific guidelines on anemia management in this patient population. Iron therapy is often needed, but optimal and safe iron-deficiency management strategies remain to be defined. Evidence suggests that ESAs are safe and potentially associated with favorable outcomes. Better graft function has been reported with ESA use targeting hemoglobin levels higher than those recommended in the general population with chronic kidney disease and with no apparent increased risk of cardiovascular events. These results require further investigation. Data on the use of hypoxia-inducible factor inhibitors are limited. Prevention and treatment of anemia in kidney transplantation can improve patients' quality of life, life expectancy, allograft function, and survival.
Collapse
Affiliation(s)
- Mario Bonomini
- Address for Correspondence: Dr Mario Bonomini, MD, Nephrology and Dialysis Unit, SS. Annunziata Hospital, Via dei Vestini66100 Chieti, Italy.
| | | | | |
Collapse
|
4
|
Tariq S, Ismail D, Thapa M, Goriparthi L, Pradeep R, Khalid K, Cooper AC, Jean-Charles G. Chronic Obstructive Pulmonary Disease and Its Effect on Red Blood Cell Indices. Cureus 2023; 15:e36100. [PMID: 37065412 PMCID: PMC10097512 DOI: 10.7759/cureus.36100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) constitutes a set of heterogeneous symptoms affecting millions of people worldwide. The associated comorbidities developing in COPD involve dysregulation in physiological pathways resulting from systemic inflammation in respiratory airways. In addition to mentioning the pathophysiology, stages, and consequences of COPD, this paper also defines red blood cell (RBC) indices such as hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell distribution width, and RBC count. It explains the role of RBC indices and RBC structural abnormalities with disease severity and exacerbations in COPD patients. Although many factors have been studied as a marker of morbidity and mortality for COPD patients, RBC indices have emerged as revolutionary evidence. Therefore, the effectiveness of evaluating RBC indices in COPD patients and their importance as a negative predictor of survival, mortality, and clinical outcomes have been debated through rigorous literature reviews. Furthermore, the prevalence, mechanisms of development, and prognosis of underlying anemia and polycythemia in COPD have also been evaluated, with anemia most significantly associated with COPD. Therefore, more studies should be conducted to address underlying anemia in COPD patients to lessen the severity and disease burden. Correcting the RBC indices in COPD patients remarkably impacts the quality of life and reduces in-patient admissions, healthcare resource utilization, and costs. Hence, it is noteworthy to understand the significance of considering RBC indices while dealing with COPD patients.
Collapse
|
5
|
Abstract
Metabolic syndrome (MS), a conglomeration of several conditions including obesity, type 2 diabetes mellitus (T2DM), insulin resistance, elevated blood pressure, and dyslipidemia is reaching epidemic proportions. Anemia is caused by iron deficiency or dysregulation of iron homeostasis, leading to tissue hypoxia. Coexistence of anemia and MS or its components has been reported in the literature. The term "rubrometabolic syndrome" acts as a unifying entity linking the importance of blood in health and anemia in MS; it justifies two principles - redness of blood and low-grade inflammation. Chronic low-grade inflammation in MS affects iron metabolism leading to anemia. Tissue hypoxia that results from the anemic condition seems to be a major causative factor for the exacerbation of several microvascular and macrovascular components of T2DM, which include diabetic neuropathy, nephropathy, retinopathy, and cardiovascular complications. In obesity, anemia leads to malabsorption of micronutrients and can complicate the management of the condition by bariatric surgery. Anemia interferes with the diagnosis and management of T2DM, obesity, dyslipidemia, or hypertension due to its effect on pathological tests as well as medications. Since anemia in MS is multifaceted, the management of anemia is challenging as overcorrection of anemia with erythropoietin-stimulating agents can cause detrimental effects. These limitations necessitate availability of an effective and safe therapy that can maintain and elevate the hemoglobin levels along with maintaining the physiological balance of other systems. This review discusses the physiological links between anemia and MS along with diagnosis and management strategies in patients with coexistence of anemia and MS.
Collapse
Affiliation(s)
| | - Ankia Coetzee
- Division of Endocrinology, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joel R Saldaña
- Resultados Medicos, Desarrollo e Investigación, SC, Boulevard Valle de San Javier, Pachuca Hidalgo, Mexico City, Mexico
| | - Gary Kilov
- University of Melbourne, Launceston, Australia
| |
Collapse
|
6
|
Papadopoulos KI, Papadopoulou A, Aw TC. Beauty and the beast: host microRNA-155 versus SARS-CoV-2. Hum Cell 2023; 36:908-922. [PMID: 36847920 PMCID: PMC9969954 DOI: 10.1007/s13577-023-00867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/29/2023] [Indexed: 02/28/2023]
Abstract
Severe acute respiratory coronavirus 2 (SARS-CoV-2) infection in the young and healthy usually results in an asymptomatic or mild viral syndrome, possibly through an erythropoietin (EPO)-dependent, protective evolutionary landscape. In the old and in the presence of co-morbidities, however, a potentially lethal coronavirus disease 2019 (COVID-19) cytokine storm, through unrestrained renin-angiotensin aldosterone system (RAAS) hyperactivity, has been described. Multifunctional microRNA-155 (miR-155) elevation in malaria, dengue virus (DENV), the thalassemias, and SARS-CoV-1/2, plays critical antiviral and cardiovascular roles through its targeted translational repression of over 140 genes. In the present review, we propose a plausible miR-155-dependent mechanism whereby the translational repression of AGRT1, Arginase-2 and Ets-1, reshapes RAAS towards Angiotensin II (Ang II) type 2 (AT2R)-mediated balanced, tolerable, and SARS-CoV-2-protective cardiovascular phenotypes. In addition, it enhances EPO secretion and endothelial nitric oxide synthase activation and substrate availability, and negates proinflammatory Ang II effects. Disrupted miR-155 repression of AT1R + 1166C-allele, significantly associated with adverse cardiovascular and COVID-19 outcomes, manifests its decisive role in RAAS modulation. BACH1 and SOCS1 repression creates an anti-inflammatory and cytoprotective milieu, robustly inducing antiviral interferons. MiR-155 dysregulation in the elderly, and in comorbidities, allows unimpeded RAAS hyperactivity to progress towards a particularly aggressive COVID-19 course. Elevated miR-155 in thalassemia plausibly engenders a favorable cardiovascular profile and protection against malaria, DENV, and SARS-CoV-2. MiR-155 modulating pharmaceutical approaches could offer novel therapeutic options in COVID-19.
Collapse
Affiliation(s)
- K. I. Papadopoulos
- THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Bangkok, 10310 Thailand
| | - A. Papadopoulou
- Occupational and Environmental Health Services, Feelgood Lund, Ideon Science Park, Scheelevägen 17, 223 63 Lund, Sweden
| | - T. C. Aw
- grid.413815.a0000 0004 0469 9373Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
- grid.4280.e0000 0001 2180 6431Department of Medicine, National University of Singapore, Singapore, 119228 Singapore
| |
Collapse
|
7
|
Genetic Polymorphism in Angiotensinogen and Its Association with Cardiometabolic Diseases. Metabolites 2022; 12:metabo12121291. [PMID: 36557328 PMCID: PMC9785123 DOI: 10.3390/metabo12121291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Angiotensinogen (AGT) is one of the most significant enzymes of the renin-angiotensin-aldosterone system (RAAS) which is involved in the regulation and maintenance of blood pressure. AGT is involved in the production of angiotensin I which is then converted into angiotensin II that leads to renal homeostasis. However, various genetic polymorphisms in AGT have been discovered in recent times which have shown an association with various diseases. Genetic polymorphism increases the level of circulating AGT in blood which exaggerates the effects produced by AGT. The associated diseases occur due to various effects produced by increased AGT levels. Several cardiovascular diseases including myocardial infarction, coronary heart disease, heart failure, hypertrophy, etc. are associated with AGT polymorphism. Other diseases such as depression, obesity, diabetic nephropathy, pre-eclampsia, and liver injury are also associated with some variants of AGT gene. The most common variants of AGT polymorphism are M235T and T174M. The two variants are associated with many diseases. Some other variants such as G-217A, A-6G, A-20C and G-152A, are also present but they are not as significant as that of M235T and T174M variants. These variants increase the level of circulating AGT and are associated with prevalence of different diseases. These diseases occur through various pathological pathways, but the initial reason remains the same, i.e., increased level of AGT in the blood. In this article, we have majorly focused on how genetic polymorphism of different variants of AGT gene is associated with the prevalence of different diseases.
Collapse
|
8
|
Vizcarra-Vizcarra CA, Chávez-Velázquez E, Asato-Higa C, Hurtado-Aréstegui A. Treatment of Focal and Segmental Glomerulosclerosis Secondary to High Altitude Polycythemia with Acetazolamide. High Alt Med Biol 2022; 23:286-290. [PMID: 35394893 DOI: 10.1089/ham.2021.0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vizcarra-Vizcarra, Cristhian A., Eduardo Chávez-Velázquez, Carmen Asato-Higa, and Abdías Hurtado-Aréstegui. Treatment of focal and segmental glomerulosclerosis secondary to high altitude polycythemia with acetazolamide. High Alt Med Biol 00:000-000, 2022.-Focal segmental glomerulosclerosis (FSGS) is a morphological pattern, caused by glomerular injury and is the leading cause of nephrotic syndrome in adults. We present the case of a 59-year-old female patient, resident of a high-altitude city (3,824 m), who had polycythemia and nephrotic syndrome. A renal biopsy was performed, and the findings were compatible with FSGS. The patient received phlebotomy 500 ml three times, which reduced, partially, the hemoglobin concentration. However, she had refractory proteinuria, despite the use of enalapril and spironolactone. We observed that proteinuria worsened with the increase in hemoglobin levels. So, she was treated with acetazolamide 250 mg bid for 4 months, which reduced proteinuria and hemoglobin. During the coronavirus disease 2019 (COVID-19) pandemic, the patient did not take acetazolamide and again, she had an increase in hemoglobin and proteinuria levels. We conclude that acetazolamide may be an effective treatment in FSGS due to high altitude polycythemia.
Collapse
Affiliation(s)
- Cristhian A Vizcarra-Vizcarra
- Nephrology Division, Honorio Delgado Regional Hospital, Arequipa, Peru
- Faculty of Medicine, San Agustin National University, Arequipa, Peru
| | - Eduardo Chávez-Velázquez
- Nephrology Division, Honorio Delgado Regional Hospital, Arequipa, Peru
- Faculty of Medicine, San Agustin National University, Arequipa, Peru
| | | | - Abdías Hurtado-Aréstegui
- Nephrology Division, Arzobispo Loayza National Hospital, Lima, Peru
- Faculty of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| |
Collapse
|
9
|
Vlahakos V, Marathias K, Lionaki S, Loukides S, Zakynthinos S, Vlahakos D. The Paradigm Shift from Polycythemia to Anemia in COPD: The Critical Role of the Renin-Angiotensin System Inhibitors. Expert Rev Respir Med 2022; 16:391-398. [PMID: 35212601 DOI: 10.1080/17476348.2022.2045958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Although polycythemia has been considered a common adverse event in COPD, anemia is reported more often and has gained more importance than polycythemia over the last thirty years. AREAS COVERED Factors considered to be associated with the development of anemia in COPD have included: Aging and kidney dysfunction with erythropoietin deficiency and bone marrow suppression due to uremic toxins; heart failure (HF), which is often encountered in COPD and is accompanied by anemia in one third of the cases; Low-grade chronic inflammation, which can directly suppresses the bone marrow and diminish iron absorption and utilization via increased hepcidin levels; long-term oxygen therapy (LTOT), which ameliorates chronic hypoxia, and most important, RAS inhibitors, which are widely used for the co-morbidities associated with COPD (hypertension, HF, CKD, diabetes) and have previously been shown to lower hematocrit values or cause anemia in various clinical conditions. EXPERT OPINION Introduction of LTOT in COPD and especially the established use of RAS inhibitors form the basis for the shift from polycythemia to anemia in COPD. Interestingly, when the SGLT2 inhibitors are introduced for cardiorenal protection in COPD, one could anticipate correction of anemia or even reemergence of polycythemia, since this new class of drugs can augment erythropoietin secretion and increase hematocrit values.
Collapse
Affiliation(s)
- Vassilios Vlahakos
- 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos General Hospital, Athens, Greece
| | - Katerina Marathias
- Department of Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Sofia Lionaki
- 2nd Department of Medicine, Renal Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Spyros Zakynthinos
- 1 Department of Intensive Care Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos General Hospital, Athens, Greece
| | - Demetrios Vlahakos
- 2 Department of Medicine, Renal Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| |
Collapse
|
10
|
Song HY, Wei CM, Zhou WX, Hu HF, Wan QJ. Association between admission hemoglobin level and prognosis in patients with type 2 diabetes mellitus. World J Diabetes 2021; 12:1917-1927. [PMID: 34888016 PMCID: PMC8613662 DOI: 10.4239/wjd.v12.i11.1917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/18/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anaemia is common in patients with chronic kidney disease (CKD) and is a major risk factor that contributes to mortality in such patients. Type 2 diabetes mellitus (T2DM) is one of the leading causes of CKD. The association between admission hemoglobin levels and renal damage in patients with T2DM remains unclear.
AIM To evaluate the relationship between admission hemoglobin levels and prognosis in patients with T2DM.
METHODS We performed a retrospective analysis of 265 consecutive patients presenting with T2DM between 2011 and 2015. The composite endpoint was end-stage renal disease or a 50% reduction in the estimated glomerular filtration rate.
RESULTS In multivariable-adjusted Cox proportional hazards models (adjusting for demographic factors, traditional risk factors, lipids), the adjusted hazard ratios (HRs) for the highest and middle tertiles compared to the lowest tertile of hemoglobin were 0.82 (95%CI: 0.11-6.26, P = 0.8457) and 0.28 (95%CI: 0.09-0.85, P = 0.0246), respectively. However, after further adjustment for glycaemia control, hemoglobin was positively related to the risk of the composite endpoint (HR: 1.05, 95%CI: 0.14-8.09, P = 0.9602) when the highest tertile was compared to the lowest tertile of hemoglobin. We found a U-shaped relationship between hemoglobin levels and the composite endpoint. The curve tended to reach the lowest level at an optimal hemoglobin level.
CONCLUSION Among patients with T2DM, a U-shaped relationship was observed between hemoglobin levels and renal damage. A lower admission hemoglobin level (hemoglobin < 13.3 g/dL) is an independent predictor of renal damage.
Collapse
Affiliation(s)
- Hai-Ying Song
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen 518035, Guangdong Province, China
| | - Cui-Mei Wei
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen 518035, Guangdong Province, China
| | - Wen-Xiong Zhou
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen 518035, Guangdong Province, China
| | - Hao-Fei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen 518035, Guangdong Province, China
| | - Qi-Jun Wan
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen 518035, Guangdong Province, China
| |
Collapse
|
11
|
Hamdan Almaeen A, Mostafa-Hedeab G. Haematological Indicators of Response to Erythropoietin Therapy in Chronic Renal Failure Patients on Haemodialysis: Impact of Angiotensin-Converting Enzyme rs4343 Gene Polymorphism. Pharmgenomics Pers Med 2021; 14:1055-1068. [PMID: 34483678 PMCID: PMC8408344 DOI: 10.2147/pgpm.s311181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This is the first cross-sectional study studying the changes in haematological indicators of the response to recombinant human erythropoietin (rHuEPO) therapy in chronic renal failure (CRF) patients on haemodialysis (HD) stratified according to ACE G2350A (rs4343) gene polymorphism. DESIGN An observational cross-sectional study. SETTING Nephrology department and Biochemistry and molecular biology department, faculty of medicine, Cairo University. PATIENTS A total of 256 CRF patients on HD for at least six months (162 male and 103 female) and 160 healthy subjects (122 male and 38 female) were recruited in the current study after signing a consent form. ACE G2350A (rs4343) Insertion/Deletion (I/D) was tested, the association between ACE G2350A (RS4343) gene polymorphisms and patients response to rHuEpo was evaluated. RESULTS ACE G2350A (rs4343) I/D was the most prevalent genotype, while I/I genotype was the lowest prevalent among patient or control subjects included in the study. D allele is the most prevalent allele, either among patients or the control group. Hemoglobin (Hb) level in patients with I/I and Deletion/Deletion (D/D) genotype was significantly higher compared to those with I/D genotype (P = 0.012 and P = 0.005, respectively). Serum iron in the I/D genotype was significantly higher than those with either I/I or D/D genotype (P = 0.045 and P = 0.018, respectively). Angiotensin-converting enzyme (ACE) content, total leukocytic count (TLC), and soluble erythropoietin receptor (sEpoR) were independent predictors of Hb level. The ACE gene, TLC, and serum iron were the independent factors that may affect the Haematocrit (Hct) level. ACE G2350A (rs4343) gene polymorphisms may affect the HD patient's responses to rHuEPOs. CONCLUSION In HD patients, screening for ACE G2350A (rs4343) gene polymorphisms before rHuEpo administration may help predict patient response.
Collapse
Affiliation(s)
| | - Gomaa Mostafa-Hedeab
- Pharmacology Department, Health Sciences Research Unit, Medical College, Jouf University, Sakaka, Kingdom of Saudi Arabia
- Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| |
Collapse
|
12
|
Cheng AP, Cheng MP, Gu W, Sesing Lenz J, Hsu E, Schurr E, Bourque G, Bourgey M, Ritz J, Marty FM, Chiu CY, Vinh DC, De Vlaminck I. Cell-free DNA tissues of origin by methylation profiling reveals significant cell, tissue, and organ-specific injury related to COVID-19 severity. MED 2021; 2:411-422.e5. [PMID: 33521749 PMCID: PMC7836424 DOI: 10.1016/j.medj.2021.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) primarily affects the lungs, but evidence of systemic disease with multi-organ involvement is emerging. Here, we developed a blood test to broadly quantify cell-, tissue-, and organ-specific injury due to COVID-19. METHODS Our test leverages genome-wide methylation profiling of circulating cell-free DNA in plasma. We assessed the utility of this test to identify subjects with severe disease in two independent, longitudinal cohorts of hospitalized patients. Cell-free DNA profiling was performed on 104 plasma samples from 33 COVID-19 patients and compared to samples from patients with other viral infections and healthy controls. FINDINGS We found evidence of injury to the lung and liver and involvement of red blood cell progenitors associated with severe COVID-19. The concentration of cell-free DNA correlated with the World Health Organization (WHO) ordinal scale for disease progression and was significantly increased in patients requiring intubation. CONCLUSIONS This study points to the utility of cell-free DNA as an analyte to monitor and study COVID-19. FUNDING This work was supported by NIH grants 1DP2AI138242 (to I.D.V.), R01AI146165 (to I.D.V., M.P.C., F.M.M., and J.R.), 1R01AI151059 (to I.D.V.), K08-CA230156 (to W.G.), and R33-AI129455 to C.Y.C., a Synergy award from the Rainin Foundation (to I.D.V.), a SARS-CoV-2 seed grant at Cornell (to I.D.V.), a National Sciences and Engineering Research Council of Canada fellowship PGS-D3 (to A.P.C.), and a Burroughs-Wellcome CAMS Award (to W.G.). D.C.V. is supported by a Fonds de la Recherche en Sante du Quebec Clinical Research Scholar Junior 2 award. C.Y.C. is supported by the California Initiative to Advance Precision Medicine, and the Charles and Helen Schwab Foundation.
Collapse
Affiliation(s)
| | | | - Wei Gu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Joan Sesing Lenz
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Elaine Hsu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erwin Schurr
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Guillaume Bourque
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Canadian Centre for Computational Genomics, Montreal, QC, Canada
| | - Mathieu Bourgey
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Canadian Centre for Computational Genomics, Montreal, QC, Canada
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Francisco M Marty
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Donald C Vinh
- McGill University Health Center, Montreal, QC, Canada
| | - Iwijn De Vlaminck
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| |
Collapse
|
13
|
Hammad R, Eldosoky MAER, Fouad SH, Elgendy A, Tawfeik AM, Alboraie M, Abdelmaksoud MF. Circulating cell-free DNA, peripheral lymphocyte subsets alterations and neutrophil lymphocyte ratio in assessment of COVID-19 severity. Innate Immun 2021; 27:240-250. [PMID: 33646058 PMCID: PMC8054149 DOI: 10.1177/1753425921995577] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cell destruction results in plasma accumulation of cell-free DNA (cfDNA). Dynamic changes in circulating lymphocytes are features of COVID-19. We aimed to investigate if cfDNA level can serve in stratification of COVID-19 patients, and if cfDNA level is associated with alterations in lymphocyte subsets and neutrophil-to-lymphocyte ratio (NLR). This cross-sectional comparative study enrolled 64 SARS-CoV-2-positive patients. Patients were subdivided to severe and non-severe groups. Plasma cfDNA concentration was determined by real-time quantitative PCR. Lymphocyte subsets were assessed by flow cytometry. There was significant increase in cfDNA among severe cases when compared with non-severe cases. cfDNA showed positive correlation with NLR and inverse correlation with T cell percentage. cfDNA positively correlated with ferritin and C-reactive protein. The output data of performed ROC curves to differentiate severe from non-severe cases revealed that cfDNA at cut-off ≥17.31 ng/µl and AUC of 0.96 yielded (93%) sensitivity and (73%) specificity. In summary, excessive release of cfDNA can serve as sensitive COVID-19 severity predictor. There is an association between cfDNA up-regulation and NLR up-regulation and T cell percentage down-regulation. cfDNA level can be used in stratification and personalized monitoring strategies in COVID-19 patients.
Collapse
Affiliation(s)
- Reham Hammad
- Clinical Pathology Department, Faculty of Medicine (for Girls), Al-Azhar University, Egypt
| | | | - Shaimaa Hani Fouad
- Internal Medicine Allergy and Clinical Immunology, Ain-Shams University, Egypt
| | - Abdelaleem Elgendy
- Clinical Pathology Department, Faculty of Medicine (for Boys), Al-Azhar University, Egypt
| | - Amany M Tawfeik
- Microbiology and Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Egypt
| | | | | |
Collapse
|
14
|
Pavlidis G, Papageorgiou SG, Bazani E, Bouchla A, Glezou E, Gkontopoulos K, Thomopoulos T, Pappa V, Vlahakos DV. Discontinuation of the renin-angiotensin system inhibitors improves erythropoiesis in patients with lower-risk myelodysplastic syndromes. Ther Adv Hematol 2021; 12:2040620720958299. [PMID: 33489062 PMCID: PMC7809530 DOI: 10.1177/2040620720958299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/20/2020] [Indexed: 11/15/2022] Open
Abstract
Renin–angiotensin system (RAS) blockade by angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) has been related to anemia in various situations. We aimed to investigate whether discontinuation of RAS inhibitors improves erythropoiesis in patients with lower-risk myelodysplastic syndromes (LR-MDSs). Seventy-four patients with LR-MDS were divided into three groups matched for gender and age. Group A consisted of 20 hypertensive patients who discontinued RAS inhibitors and received alternative medications. Group B consisted of 26 patients who continued to receive ACEi/ARB and Group C included 28 patients (50% hypertensive) never exposed to ACEi/ARB. Half of the patients in each group were under treatment with recombinant human erythropoietin (rHuEPO). Data were collected at baseline and after 3, 6 and 12 months. Group A showed a significant increase in hemoglobin from 10.4 ± 1g/dL at baseline to 12.6 ± 1.2 g/dL after 12 months (p = 0.035) and in hematocrit (31.4 ± 3% versus 37.9 ± 4%, p = 0.002). Incident anemia decreased from 100% at baseline to 60% at 12 months (p = 0.043) despite a concomitant dose reduction in rHuEPO by 18% (p = 0.035). No changes in hemoglobin and hematocrit were observed in both Group B and Group C. In the subset of patients not treated with rHuEPO, improvement of erythropoiesis was found only in Group A, as measured by changes in hemoglobin (11.5 ± 1 g/dL versus 12.4 ± 1.3 g/dL, p = 0.041) and hematocrit (34.5 ± 3% versus 37.1 ± 4%, p = 0.038) after 12 months. In contrast, Group B and Group C decreased hemoglobin and hematocrit after 12 months (p < 0.05). In conclusion, discontinuation of ACEi/ARB in LR-MDS patients is followed by a significant recovery of erythropoiesis after 12 months.
Collapse
Affiliation(s)
- George Pavlidis
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Sotirios G Papageorgiou
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", 1 Rimini St., Haidari, Athens, 12462, Greece
| | - Efthimia Bazani
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Anthi Bouchla
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Eirini Glezou
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Konstantinos Gkontopoulos
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Thomas Thomopoulos
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Vasiliki Pappa
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| | - Demetrios V Vlahakos
- 2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece
| |
Collapse
|
15
|
Malyszko J, Basak G, Batko K, Capasso G, Capasso A, Drozd-Sokolowska J, Krzanowska K, Kulicki P, Matuszkiewicz-Rowinska J, Soler MJ, Sprangers B, Malyszko J. Haematological disorders following kidney transplantation. Nephrol Dial Transplant 2020; 37:409-420. [PMID: 33150431 DOI: 10.1093/ndt/gfaa219] [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: 12/29/2019] [Indexed: 01/19/2023] Open
Abstract
Transplantation offers cure for some haematological cancers, end-stage organ failure, but at the cost of long-term complications. Renal transplantation is the best-known kidney replacement therapy and it can prolong end-stage renal disease patient lives for decades. However, patients after renal transplantation are at a higher risk of developing different complications connected not only with surgical procedure but also with immunosuppressive treatment, chronic kidney disease progression and rejection processes. Various blood disorders can develop in post-transplant patients ranging from relatively benign anaemia through cytopenias to therapy-related myelodysplasia and acute myeloid leukaemia (AML) and post-transplant lymphoproliferative disorders followed by a rare and fatal condition of thrombotic microangiopathy and haemophagocytic syndrome. So far literature mainly focused on the post-transplant lymphoproliferative disease. In this review, a variety of haematological problems after transplantation ranging from rare disorders such as myelodysplasia and AML to relatively common conditions such as anaemia and iron deficiency are presented with up-to-date diagnosis and management.
Collapse
Affiliation(s)
| | - Grzegorz Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Batko
- Department of Nephrology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Giavambatista Capasso
- Department of Translational Medical Sciences, University Luigi Vanvitelli, Naples, Italy
| | - Anna Capasso
- Department of Oncology, Livestrong Cancer Institutes, Dell Medical School, The University of Texas, Austin, TX, USA
| | - Joanna Drozd-Sokolowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krzanowska
- Department of Nephrology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Pawel Kulicki
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Maria Jose Soler
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ben Sprangers
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Molecular Immunology, Rega Institute, Katholieke Universiteit Leuven, Belgium.,Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Jacek Malyszko
- 1st Department of Nephrology and Transplantology, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
16
|
Cheng AP, Cheng MP, Gu W, Lenz JS, Hsu E, Schurr E, Bourque G, Bourgey M, Ritz J, Marty F, Chiu CY, Vinh DC, Vlaminck ID. Cell-Free DNA in Blood Reveals Significant Cell, Tissue and Organ Specific injury and Predicts COVID-19 Severity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.07.27.20163188. [PMID: 32766608 PMCID: PMC7402071 DOI: 10.1101/2020.07.27.20163188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
COVID-19 primarily affects the lungs, but evidence of systemic disease with multi-organ involvement is emerging. Here, we developed a blood test to broadly quantify cell, tissue, and organ specific injury due to COVID-19, using genome-wide methylation profiling of circulating cell-free DNA in plasma. We assessed the utility of this test to identify subjects with severe disease in two independent, longitudinal cohorts of hospitalized patients. Cell-free DNA profiling was performed on 104 plasma samples from 33 COVID-19 patients and compared to samples from patients with other viral infections and healthy controls. We found evidence of injury to the lung and liver and involvement of red blood cell progenitors associated with severe COVID-19. The concentration of cfDNA correlated with the WHO ordinal scale for disease progression and was significantly increased in patients requiring intubation. This study points to the utility of cell-free DNA as an analyte to monitor and study COVID-19.
Collapse
Affiliation(s)
| | | | - Wei Gu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
- UCSF-Abbot Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Joan Sesing Lenz
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Elaine Hsu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Erwin Schurr
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Guillaume Bourque
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Mathieu Bourgey
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical school, Boston, MA, USA
| | - Francisco Marty
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA, USA
| | - Charles Y. Chiu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
- UCSF-Abbot Viral Diagnostics and Discovery Center, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | | | - Iwijn De Vlaminck
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| |
Collapse
|
17
|
Xie T, Chen C, Peng Z, Brown BC, Reisz JA, Xu P, Zhou Z, Song A, Zhang Y, Bogdanov MV, Kellems RE, D'Alessandro A, Zhang W, Xia Y. Erythrocyte Metabolic Reprogramming by Sphingosine 1-Phosphate in Chronic Kidney Disease and Therapies. Circ Res 2020; 127:360-375. [PMID: 32284030 DOI: 10.1161/circresaha.119.316298] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
RATIONALE Hypoxia promotes renal damage and progression of chronic kidney disease (CKD). The erythrocyte is the only cell type for oxygen (O2) delivery. Sphingosine 1-phosphate (S1P)-a highly enriched biolipid in erythrocytes-is recently reported to be induced under high altitude in normal humans to enhance O2 delivery. However, nothing is known about erythrocyte S1P in CKD. OBJECTIVE To investigate the function and metabolic basis of erythrocyte S1P in CKD with a goal to explore potential therapeutics. METHODS AND RESULTS Using erythrocyte-specific SphK1 (sphingosine kinase 1; the only enzyme to produce S1P in erythrocytes) knockout mice (eSphK1-/-) in an experimental model of hypertensive CKD with Ang II (angiotensin II) infusion, we found severe renal hypoxia, hypertension, proteinuria, and fibrosis in Ang II-infused eSphk1-/- mice compared with controls. Untargeted metabolomics profiling and in vivo U-13C6 isotopically labeled glucose flux analysis revealed that SphK1 is required for channeling glucose metabolism toward glycolysis versus pentose phosphate pathway, resulting in enhanced erythroid-specific Rapoport-Luebering shunt in Ang II-infused mice. Mechanistically, increased erythrocyte S1P functioning intracellularly activates AMPK (AMP-activated protein kinase) 1α and BPGM (bisphosphoglycerate mutase) by reducing ceramide/S1P ratio and inhibiting PP2A (protein phosphatase 2A), leading to increased 2,3-bisphosphoglycerate (an erythrocyte-specific metabolite negatively regulating Hb [hemoglobin]-O2-binding affinity) production and thus more O2 delivery to counteract kidney hypoxia and progression to CKD. Preclinical studies revealed that an AMPK agonist or a PP2A inhibitor rescued the severe CKD phenotype in Ang II-infused eSphK1-/- mice and prevented development of CKD in the control mice by inducing 2,3-bisphosphoglycerate production and thus enhancing renal oxygenation. Translational research validated mouse findings in erythrocytes of hypertensive CKD patients and cultured human erythrocytes. CONCLUSIONS Our study elucidates the beneficial role of eSphk1-S1P in hypertensive CKD by channeling glucose metabolism toward Rapoport-Luebering shunt and inducing 2,3-bisphosphoglycerate production and O2 delivery via a PP2A-AMPK1α signaling pathway. These findings reveal the metabolic and molecular basis of erythrocyte S1P in CKD and new therapeutic avenues.
Collapse
Affiliation(s)
- Tingting Xie
- From the Rheumatology and Immunology (T.X.), Xiangya Hospital, Central South University, Changsha, Hunan, China.,Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston
| | - Changhan Chen
- Otolaryngology Head and Neck Surgery (C.C.), Xiangya Hospital, Central South University, Changsha, Hunan, China.,Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston
| | - Zhangzhe Peng
- Nephrology (Z.P.), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Benjamin C Brown
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora (B.C.B., J.A.R., A.D.)
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora (B.C.B., J.A.R., A.D.)
| | - Ping Xu
- Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston
| | - Zhen Zhou
- Division of Medical Genetics, Department of Internal Medicine (Z.Z.), University of Texas McGovern Medical School at Houston
| | - Anren Song
- Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston
| | - Yujin Zhang
- Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston
| | - Mikhail V Bogdanov
- Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston
| | - Rodney E Kellems
- Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston.,MDAnderson-UTHealth Graduate School of Biomedical Science, Houston, TX (R.E.K., Y.X.)
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora (B.C.B., J.A.R., A.D.)
| | - Weiru Zhang
- General Medicine (W.Z.), Xiangya Hospital, Central South University, Changsha, Hunan, China.,Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston
| | - Yang Xia
- Biochemistry and Molecular Biology (T.X., C.C., P.X., A.S., Y.Z., M.V.B., R.E.K., W.Z., Y.X.), University of Texas McGovern Medical School at Houston.,MDAnderson-UTHealth Graduate School of Biomedical Science, Houston, TX (R.E.K., Y.X.)
| |
Collapse
|
18
|
Ohki K, Wakui H, Uneda K, Azushima K, Haruhara K, Kinguchi S, Urate S, Yamada T, Yamaji T, Kobayashi R, Kanaoka T, Minegishi S, Ishigami T, Fujikawa T, Toya Y, Tamura K. Effects of Erythropoietin-Stimulating Agents on Blood Pressure in Patients with Non-Dialysis CKD and Renal Anemia. KIDNEY DISEASES (BASEL, SWITZERLAND) 2020; 6:299-308. [PMID: 32903814 PMCID: PMC7445655 DOI: 10.1159/000507396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Erythropoietin-stimulating agents (ESAs) are used to treat renal anemia in patients with non-dialysis CKD, but this can lead to increases in blood pressure (BP). OBJECTIVE We investigated the effects of continuous erythropoietin receptor activator (CERA) and darbepoetin alfa (DA) on office/ambulatory BP in 36 patients with non-dialysis CKD and renal anemia who did not receive ESA treatment. METHODS Participants were randomly assigned to CERA or DA, and received ESA treatment for 24 weeks. ESA doses were adjusted to maintain hemoglobin (Hb) at 10-12 g/dL. Primary outcomes were office/ambulatory BP after 24 weeks of ESA treatment. Hb levels were within the target range at 24 weeks. RESULTS Office/ambulatory BP, renal function, and other parameters were not significantly different between groups. However, we could not exclude the possibility that differences may exist because our sample size was small. Therefore, we also performed analysis of all of the data that were compiled from the groups of per-protocol population. Although office/ambulatory BP profiles had not worsened after 24 weeks of ESA treatment, more than half of the patients required an increase in the antihypertensive agent dose. CONCLUSIONS CERA and DA may have similar effects on BP profiles in patients with non-dialysis CKD and renal anemia. ESA treatment often requires increases in the doses of antihypertensive agents.
Collapse
Affiliation(s)
| | - Hiromichi Wakui
- *Dr. Hiromichi Wakui, Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004 (Japan),
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Effects of recreational scuba diving on erythropoiesis-"normobaric oxygen paradox" or "plasma volume regulation" as a trigger for erythropoietin? Eur J Appl Physiol 2020; 120:1689-1697. [PMID: 32488585 DOI: 10.1007/s00421-020-04395-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Previous studies have shown an increase in erythrocyte lipid peroxidation and a decrease in red blood cell (RBC) count, hemoglobin, and hematocrit after only one recreational scuba diving session. The aim of this study was to examine the effect of repetitive scuba diving on RBC parameters and erythropoiesis. METHODS Divers (N = 14) conducted one dive per week over 5 weeks at a depth of 20-30 m for 30 min. For measuring RBC parameters, erythropoietin, iron, and ferritin, blood samples were collected before and after the first, third, and fifth dive. RESULTS Between pre- and post-dive results, a statistically significant increase in RBC count, hemoglobin, hematocrit, mean corpuscular volume (MCV), RBC distribution width (RDW), iron, and ferritin was observed. Analysis of the results between the first, third, and fifth dive showed that the erythropoietin increase at the third (pre-dive p = 0.009; post-dive p = 0.004) and fifth dive (pre-dive p < 0.001; post-dive p = 0.003) was not accompanied by changes in RBC count, hemoglobin, iron, and ferritin. In parallel, a continuous increase in hematocrit, MCV, and RDW was observed, whereas mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) decreased. CONCLUSIONS Changes in RBC indices and EPO elevation indicate that the occasional switch from hyperoxia to normoxia or mechanisms for plasma volume regulation may be a step in the maintenance of erythropoiesis.
Collapse
|
20
|
Brière M, Diedisheim M, Dehghani L, Dubois-Laforgue D, Larger E. Anaemia and its risk factors and association with treatments in patients with diabetes: A cross-sectional study. DIABETES & METABOLISM 2020; 47:101164. [PMID: 32461154 DOI: 10.1016/j.diabet.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anaemia is frequently seen in patients with diabetes and the main cause is renal failure. At all stages of renal failure, however, the prevalence of anaemia is higher in diabetes patients than expected for their glomerular filtration rate, suggesting that causes of anaemia other than renal failure are at work. The present cross-sectional study was conducted to investigate the possible iatrogenic causes of anaemia in patients with diabetes. SUBJECTS AND METHODS This was a hospital-based cross-sectional study of all patients who had biological and clinical data covering a 2-year period. All had been in contact with the diabetes department either as outpatients or as inpatients mostly for educational purposes. Clinical factors, including type of diabetes, known diabetes complications, treatments received and biological data, were reviewed for their possible involvement in anaemia. RESULTS A total of 4145 consecutive patients were included. Anaemia was observed in 1065 (25.7%) of them. Patients with anaemia were more frequently women and those with longer durations of diabetes. Haemoglobin concentrations were decreased, and prevalence of anaemia was increased at all stages of renal failure, already at stage 2, KDIGO classification. Anaemia patients were more frequently taking insulin, antiplatelet agents and renin-angiotensin system blockers (RASBs). After exclusion of patients with specific causes of anaemia, logistic regression analysis of all parameters correlated with anaemia on univariate analysis revealed that anaemia was associated with gender, antiplatelet agents and RASBs. CONCLUSION This study has confirmed that anaemia is frequently seen in diabetes patients and strongly associated with renal failure (already at stage 2). Our observations highlight the adjuvant role of drugs, particularly RASBs, in the risk of anaemia in patients with diabetes.
Collapse
Affiliation(s)
- M Brière
- Service de diabétologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Diedisheim
- Service de diabétologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Dehghani
- Service de diabétologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - D Dubois-Laforgue
- Service de diabétologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - E Larger
- Service de diabétologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| |
Collapse
|
21
|
Papagiannopoulos-Vatopaidinos IE, Papagiannopoulou M, Sideris V. Dry Fasting Physiology: Responses to Hypovolemia and Hypertonicity. Complement Med Res 2020; 27:242-251. [PMID: 31958788 DOI: 10.1159/000505201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to provide a deeper insight into dry fasting (DF) physiology. DESIGN Ten participants performed DF for 5 consecutive days. METHODS The following parameters were monitored daily: cortisol, aldosterone, high-sensitivity C-reactive protein (CRP), erythropoietin, albumin, uric acid, and vitamin C in serum; vasopressin (ADH), adrenocorticotropic hormone (ACTH), renin, angiotensin II, and total antioxidant capacity (TAC) in plasma; hematocrit and erythrocytes in whole blood; osmolality, noradrenaline, dopamine, adrenaline, Na+, and K+ in 24-h urine; waist circumference and body, urine, and stool weight. RESULTS The following parameters increased: ADH (60 ± 11%), ACTH (176 ± 34%), cortisol (495 ± 75%), urine osmolality (20 ± 4%), CRP (167 ± 77%), renin (315 ± 63%), angiotensin II (74 ± 21%), aldosterone (61 ± 21%), TAC (80.4 ± 17%), uric acid (103 ± 19%), albumin (18.4 ± 2.4%), erythrocytes (13.4 ± 2.2%), hematocrit (11 ± 1.8%), and the excretion of noradrenaline (40.3 ± 10%) and dopamine (17 ± 5%). The following parameters decreased: waist circumference (8.20 ± 0.61 cm), body weight (7.010 ± 0.3 kg), erythropoietin (65 ± 18%), and the excretion of adrenaline (38 ± 4%) and Na+ (60 ± 16%). The excretion of K+ remained unchanged. Vitamin C decreased, showing a half-life of 4.8 ± 0.7 days. The percent ratios of lost weight components were: urine (52.2 ± 3.7%), insensible water loss (32.2 ± 1.4%), stool (5 ± 0.3%), and respiratory gases, i.e., expired CO2 - incorporated O2 (10.6 ± 5.4%). CONCLUSION The mechanisms underlying the hypertonicity and hypovolemia compensation and the ratio analysis of lost weight components were presented. DF demonstrated short-term antioxidant, anti-ischemic, immune-stimulating, anti-edematous, and anti-inflammatory effects. The results may have an impact on developing new concepts for the treatment of edema, obesity, and inflammatory and ischemic diseases.
Collapse
Affiliation(s)
| | - Maria Papagiannopoulou
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vassilis Sideris
- Hellenic Pasteur Institute, Athens, Greece.,Alexandra Hospital, Athens, Greece
| |
Collapse
|
22
|
Hasanin AH, Mohamed RH. Telmisartan alone or in combination with etanercept improves anemia associated with rheumatoid arthritis in rats: a possible role of anti-inflammatory and reno-protective effects. Pharmacol Rep 2020; 72:379-388. [PMID: 32048253 DOI: 10.1007/s43440-019-00033-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/21/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are conflicting data regarding angiotensin receptor blockers (ARBs) induced anemia and its beneficial anti-inflammatory effect in rheumatoid arthritis. The aim of the present study was to investigate the effect of telmisartan administration either alone or in combination with etanercept on anemia of chronic inflammatory diseases in a model of rheumatoid arthritis in rats. METHODS Rheumatoid arthritis (RA) was induced by Freund's Complete Adjuvant (FCA; 1 mg/0.1 ml paraffin oil), injected subcutaneously on days 0, 30 and 40. Rats with RA received dimethyl sulfoxide (DMSO), etanercept (0.3 mg/kg 3 times/week; sc), telmisartan (1.5 mg/kg/day; orally) or combination of etanercept and telmisartan. Arthritis parameters (footpad circumference change and paw volume change), erythrocyte indices (hemoglobin, mean corpuscular volume and mean corpuscular hemoglobin level changes), iron profile (serum iron and serum ferritin), serum levels of erythropoietin (EPO), hepcidin, tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 were evaluated, along with measuring serum urea and creatinine levels. RESULTS All treated groups showed improvement of the measured parameters in comparison to RA-control subgroup. Telmisartan either alone or in combination with etanercept significantly improved arthritis and erythrocyte indices. Telmisartan showed significant increase in EPO and decrease in hepcidin compared to etanercept. Combination group showed significant improvement in serum iron, ferritin, EPO, hepcidin, TNF-α, IL-6, urea and creatinine, compared to etanercept. Telmisartan either alone or in combination, but not etanercept alone, significantly decreased creatinine level. CONCLUSION Telmisartan improved anemia and arthritis parameters and showed anti-inflammatory and reno-protective effects, in a rat model of rheumatoid arthritis.
Collapse
Affiliation(s)
- Amany H Hasanin
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt
| | - Reham Hussein Mohamed
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt.
| |
Collapse
|
23
|
Iron Overload in Renal Transplant Patients: The Role of Hepcidin and Erythropoietin. Transplant Proc 2020; 52:169-174. [DOI: 10.1016/j.transproceed.2019.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/18/2019] [Indexed: 12/29/2022]
|
24
|
Inhibition of the renin-angiotensin system in the cardiorenal syndrome with anaemia: a double-edged sword. J Hypertens 2019; 37:2145-2153. [PMID: 31490340 DOI: 10.1097/hjh.0000000000002111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
: The term 'cardiorenal syndrome' (CRS) was introduced to describe problems related to the simultaneous existence of heart and renal insufficiency. The prevalence of anaemia in CRS is high and increases the risk of hospitalizations and death. Renin-angiotensin system (RAS) inhibition is the cornerstone therapy in cardiovascular and renal medicine. As angiotensin II regulates both glomerular filtration rate (GFR) and erythropoiesis, RAS inhibition can further deteriorate renal function and lower hematocrit or cause anaemia in patients with heart failure. The aim of this review is to explore the relationship among CRS, anemia and administration of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) and summarize the evidence suggesting that RAS inhibition may be considered an iatrogenic cause of deterioration of CRS with anemia. It should be emphasized however, that RAS inhibition reduces mortality in both groups with and without worsening of renal function, and therefore, no patient with CRS should be denied an ACEi or ARB trial without careful evaluation.
Collapse
|
25
|
Lee KH, Park E, Choi HJ, Kang HG, Ha IS, Cheong HI, Park YS, Cho H, Han KH, Kim SH, Cho MH, Lee JH, Shin JI. Anemia and Iron Deficiency in Children with Chronic Kidney Disease (CKD): Data from the Know-Ped CKD Study. J Clin Med 2019; 8:jcm8020152. [PMID: 30700016 PMCID: PMC6406575 DOI: 10.3390/jcm8020152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/16/2022] Open
Abstract
Children with chronic kidney disease (CKD) are at high risk of anemia, an important risk factor for cardiovascular disease and poor quality of life. The present study used baseline data from the Korean cohort study for Outcome in patients With Pediatric Chronic Kidney Disease (KNOW-PedCKD). A Total of 437 patients was included in the analyses excluding missing data. The characteristics of patients with and without anemia and those of patients with and without iron deficiency were compared. Logistic regression analysis and Pearson correlation were conducted to evaluate associated risk factors and correlations in children with CKD. Anemia in children with CKD was associated with older age, low body weight and body mass index (BMI) z-score, birth age, preceding glomerulonephritis, decreased estimated glomerular filtration rate (eGFR), low levels of serum albumin and calcium, high levels of serum intact parathyroid hormone (iPTH), and serum phosphorus. Anemia was correlated positively with changes in the BMI z-score, body weight, and serum albumin and cholesterol levels, but correlated negatively with serum calcium, iPTH, ferritin levels, and transferrin saturation. Iron deficiency in children with CKD was associated with young age, low hemoglobin and serum ferritin levels, high BMI z-scores, and low levels of serum iPTH. This is the first nationwide cohort study of anemia in Korean children with CKD and the first prospective pediatric CKD cohort study in Asia. The study results demonstrated that anemia and iron deficiency are affected by various factors, including age, BMI, and levels of serum iPTH. To improve the retrospective outcome of affected children, it is important to understand the effect of each of these factors and to attempt an early intervention to prevent anemia and iron deficiency by regular measurement of these parameters in children at risk.
Collapse
Affiliation(s)
- Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea.
- Division of Pediatric Nephrology, Severance Children's Hospital, Seoul 03722, Korea.
| | - Eujin Park
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea.
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University Children's Hospital & Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital & Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital & Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital & Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul 05505, Korea.
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Kyoung Hee Han
- Department of Pediatrics, Jeju National University School of Medicine, Jeju 63241, Korea.
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan 50612, Korea.
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu 41404, Korea.
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul 05505, Korea.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 03722, Korea.
- Division of Pediatric Nephrology, Severance Children's Hospital, Seoul 03722, Korea.
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea.
| |
Collapse
|
26
|
Liu L, Zhang Y, Fu F, Zhuo L, Wang Y, Li W. Long-term clinical spectrum and circulating RAS evaluation of anephric patients undergoing hemodialysis: A report of four cases and literature review. J Renin Angiotensin Aldosterone Syst 2019; 19:1470320318799904. [PMID: 30264674 PMCID: PMC6166312 DOI: 10.1177/1470320318799904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Bilateral nephrectomy leads to a short-term reduction in blood pressure. This
is mainly due to a sharp change in the circulating renin-angiotensin system
(RAS), but data on the long-term outcomes of their clinical status and
further changes in circulating RAS are rare. Materials and methods: We enrolled four Chinese patients who had both of their kidneys removed two
(1), six (1) and eight (2) years prior to this study, respectively. Their
clinical data were collected retrospectively and circulating RAS was
evaluated by radioimmunoassay. Results: Hypotension after surgery occurred in two patients who suffered thrombosis of
the arteriovenous fistula, but no life-threatening complications occurred.
The average hemoglobin level was 103.3±12.3 g/l. Two patients without
hemorrhage received intravenous erythropoietin (EPO) of 4500–8000 iu/week.
Extremely low plasma renin activity (PRA) of 0.08±0.03 ng/ml (normal range
0.93–6.56 ng/ml) showed in the patients. Surprisingly, plasma angiotensin II
concentration (71.37±8.28 pg/ml) and aldosterone level
(0.17±0.02 ng/mlng/ml) were within the normal range. Conclusions: The four anephric individuals did not suffer life-threatening complications
while their hypotension gradually subsided and their EPO dosage was
relatively low. Although their PRA level was extremely low, they produced
normal levels of angiotensin II and aldosterone in plasma, which indicates
the kidney-independent mechanism of angiotensin II production likely
compensated in the long term.
Collapse
Affiliation(s)
- Lin Liu
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yumei Zhang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, PR China
| | - Fangting Fu
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, PR China
| | - Li Zhuo
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yamei Wang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, PR China
| | - Wenge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, PR China
| |
Collapse
|
27
|
Fludrocortisone stimulates erythropoietin production in the intercalated cells of the collecting ducts. Biochem Biophys Res Commun 2018; 503:3121-3127. [PMID: 30146260 DOI: 10.1016/j.bbrc.2018.08.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 01/08/2023]
Abstract
Erythropoietin has been thought to be secreted to plasma soon after the production because of the difficulty of Western blot analysis and immunohistochemistry. We established the new methods of Western blot analysis and immunohistochemistry. Using the new methods, we investigated the effects of aldosterone and fludrocortisone, an analogue of aldosterone on erythropoietin mRNA and protein production by the kidneys. Aldosterone stimulated Epo and HIF2α mRNA expressions in tubule suspensions and microdissected medullary thick ascending limbs and outer medullary collecting ducts. Western blot analysis showed a recombinant erythropoietin at 34-45 kDa and kidney erythropoietin at 36-40 and 42 kDa, both of which shifted to 22 kDa by deglycosylation. Erythropoietin protein expression was observed in the nephrons but not in the interstitial cells in control condition. Fludrocortisone stimulated erythropoietin mRNA and protein expressions in the distal nephrons, particularly in the intercalated cells of the collecting ducts. These data show that erythropoietin is produced by the nephrons by the regulation of renin-angiotensin-aldosterone system and not by the renal interstitial cells in control condition.
Collapse
|
28
|
Zou Z, Zhuang Y, Liu L, Shen B, Xu J, Jiang W, Luo Z, Teng J, Wang C, Ding X. Role of elevated red cell distribution width on acute kidney injury patients after cardiac surgery. BMC Cardiovasc Disord 2018; 18:166. [PMID: 30107786 PMCID: PMC6092813 DOI: 10.1186/s12872-018-0903-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
Background The aim of the study was to explore associations between elevated red cell distribution width (RDW) and acute kidney injury (AKI) in patients undergoing cardiac surgery (CS-AKI). Methods Preoperative, intraoperative and postoperative data of 10,274 patients undergoing cardiac surgery, including demographic data, were prospectively collected from January 2009 to December 2014. Propensity score matching was used on the basis of clinical characteristics and preoperative variables. An elevated RDW was defined as the difference between RDW 24 h after cardiac surgery and the latest RDW before cardiac surgery. Results A total of 10,274 patients were included in the unmatched cohort, and 3146 patients in the propensity-matched cohort. In the unmatched cohort, the overall CS-AKI incidence was 32.8% (n = 3365) with a hospital mortality of 5.5% (n = 185). In the propensity-matched cohort, the elevated RDW in AKI patients was higher than in patients without AKI (0.3% (0.0%, 0.7%) vs 0.5% (0.1, 1.1%), P < 0.001) and the elevated RDW incidences were 0.4% (0.1%, 0.9%), 0.6% (0.2%, 1.1%) and 1.1% (0.3%, 2.1%) in stage 1, 2 and 3 AKI patients (P < 0.001). Among propensity-matched patients with CS-AKI, the level of elevated RDW in non-survivors was higher than in survivors [1.2% (0.5%, 2.3%) vs 0.5% (0.1%, 1.0%), P < 0.001] and a 0.1% increase in elevated RDW was associated with a 0.24% higher risk of within-hospital mortality in patients with CS-AKI. Estimating the receiver-operating characteristic (ROC) area under the curve (AUC) showed that an elevated RDW had moderate discriminative power for AKI development (AUC = 0.605, 95% CI, 0.586–0.625; P < 0.001) and hospital mortality (AUC = 0.716, 95% CI, 0.640–0.764; P < 0.001) in the propensity-matched cohort. Conclusions An elevated RDW might be an independent prognostic factor for the severity and poor prognosis of CS-AKI.
Collapse
Affiliation(s)
- Zhouping Zou
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, 200032, China
| | - Yamin Zhuang
- Department of Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China
| | - Lan Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, 200032, China
| | - Jiarui Xu
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, 200032, China
| | - Wuhua Jiang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, 200032, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China
| | - Jie Teng
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Medical Center of Kidney, No 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Institute for Kidney and Dialysis, No 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, 200032, China. .,Hemodialysis Quality of Control Center of Shanghai, No 180 Fenglin Road, Shanghai, 200032, China. .,Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, No 668 Jinhu Road, Xiamen, 361015, Fujian, China.
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Medical Center of Kidney, No 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Institute for Kidney and Dialysis, No 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, 200032, China. .,Hemodialysis Quality of Control Center of Shanghai, No 180 Fenglin Road, Shanghai, 200032, China. .,Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, No 668 Jinhu Road, Xiamen, 361015, Fujian, China.
| |
Collapse
|
29
|
Cernaro V, Coppolino G, Visconti L, Rivoli L, Lacquaniti A, Santoro D, Buemi A, Loddo S, Buemi M. Erythropoiesis and chronic kidney disease-related anemia: From physiology to new therapeutic advancements. Med Res Rev 2018; 39:427-460. [PMID: 30084153 DOI: 10.1002/med.21527] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 12/19/2022]
Abstract
Erythropoiesis is triggered by hypoxia and is strictly regulated by hormones, growth factors, cytokines, and vitamins to ensure an adequate oxygen delivery to all body cells. Abnormalities in one or more of these factors may induce different kinds of anemia requiring different treatments. A key player in red blood cell production is erythropoietin. It is a glycoprotein hormone, mainly produced by the kidneys, that promotes erythroid progenitor cell survival and differentiation in the bone marrow and regulates iron metabolism. A deficit in erythropoietin synthesis is the main cause of the normochromic normocytic anemia frequently observed in patients with progressive chronic kidney disease. The present review summarizes the most recent findings about each step of the erythropoietic process, going from the renal oxygen sensing system to the cascade of events induced by erythropoietin through its own receptor in the bone marrow. The paper also describes the new class of drugs designed to stabilize the hypoxia-inducible factor by inhibiting prolyl hydroxylase, with a discussion about their metabolism, disposition, efficacy, and safety. According to many trials, these drugs seem able to simulate tissue hypoxia and then stimulate erythropoiesis in patients affected by renal impairment. In conclusion, the in-depth investigation of all events involved in erythropoiesis is crucial to understand anemia pathophysiology and to identify new therapeutic strategies, in an attempt to overcome the potential side effects of the commonly used erythropoiesis-stimulating agents.
Collapse
Affiliation(s)
- Valeria Cernaro
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Coppolino
- Nephrology and Dialysis Unit, Department of Internal Medicine, "Pugliese-Ciaccio" Hospital of Catanzaro, Catanzaro, Italy
| | - Luca Visconti
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Laura Rivoli
- Unit of Nephrology, Department of Internal Medicine, Chivasso Hospital, Turin, Italy
| | - Antonio Lacquaniti
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Santoro
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antoine Buemi
- Surgery and Abdominal Transplantation Division, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain, Brussels, Belgium
| | - Saverio Loddo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Buemi
- Chair of Nephrology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| |
Collapse
|
30
|
Valent P, Büsche G, Theurl I, Uras IZ, Germing U, Stauder R, Sotlar K, Füreder W, Bettelheim P, Pfeilstöcker M, Oberbauer R, Sperr WR, Geissler K, Schwaller J, Moriggl R, Béné MC, Jäger U, Horny HP, Hermine O. Normal and pathological erythropoiesis in adults: from gene regulation to targeted treatment concepts. Haematologica 2018; 103:1593-1603. [PMID: 30076180 PMCID: PMC6165792 DOI: 10.3324/haematol.2018.192518] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022] Open
Abstract
Pathological erythropoiesis with consequent anemia is a leading cause of symptomatic morbidity in internal medicine. The etiologies of anemia are complex and include reactive as well as neoplastic conditions. Clonal expansion of erythroid cells in the bone marrow may result in peripheral erythrocytosis and polycythemia but can also result in anemia when clonal cells are dysplastic and have a maturation arrest that leads to apoptosis and hinders migration, a constellation typically seen in the myelodysplastic syndromes. Rarely, clonal expansion of immature erythroid blasts results in a clinical picture resembling erythroid leukemia. Although several mechanisms underlying normal and abnormal erythropoiesis and the pathogenesis of related disorders have been deciphered in recent years, little is known about specific markers and targets through which prognosis and therapy could be improved in anemic or polycythemic patients. In order to discuss new markers, targets and novel therapeutic approaches in erythroid disorders and the related pathologies, a workshop was organized in Vienna in April 2017. The outcomes of this workshop are summarized in this review, which includes a discussion of new diagnostic and prognostic markers, the updated WHO classification, and an overview of new drugs used to stimulate or to interfere with erythropoiesis in various neoplastic and reactive conditions. The use and usefulness of established and novel erythropoiesis-stimulating agents for various indications, including myelodysplastic syndromes and other neoplasms, are also discussed.
Collapse
Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria .,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Guntram Büsche
- Institute of Pathology, Medizinische Hochschule Hannover, Germany
| | - Igor Theurl
- Department of Internal Medicine II, Medical University Innsbruck, Austria
| | - Iris Z Uras
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine, Vienna, Austria
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - Reinhard Stauder
- Department of Internal Medicine V, Medical University Innsbruck, Austria
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Austria
| | - Wolfgang Füreder
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
| | - Peter Bettelheim
- First Department of Internal Medicine, Elisabethinen Hospital, Linz, Austria
| | - Michael Pfeilstöcker
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria.,3Medical Department, Hanusch Hospital, Vienna, Austria
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Klaus Geissler
- 5Medical Department for Hematology and Oncology, Hospital Hietzing, Vienna, Austria
| | - Jürg Schwaller
- Department of Biomedicine, University Children's Hospital Basel, Switzerland
| | - Richard Moriggl
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Biomedical Science, Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
| | - Marie C Béné
- Hematology Biology, University Hospital, Nantes, France
| | - Ulrich Jäger
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilian University, Munich, Germany
| | - Olivier Hermine
- Imagine Institute, INSERM U 1163, CNRS 8654, Université Paris Descartes, Sorbonne, Paris Cité, France
| |
Collapse
|
31
|
Unal A, Ata S, Karakurkcu C, Ciraci MZ, Kocyigit I, Sipahioglu MH, B Tokgoz, Oymak O. Does Renal Tubular Injury-Induced Local Tissue Hypoxia Involve Post-Transplantation Erythrocytosis? Transplant Proc 2018; 49:1930-1934. [PMID: 28923650 DOI: 10.1016/j.transproceed.2017.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The pathogenesis of post-transplantation erythrocytosis (PTE) is not well understood and appears to be multifactorial. Our hypothesis in this study was that several factors, including toxicity of calcineurin inhibitor, immunologic factors, and chronic allograft nephropathy, can trigger local tissue hypoxia in peritubular interstitium, which is where production of erythropoietin (EPO) takes place. This local interstitial tissue hypoxia can cause an increase in renal EPO production, which induces the development of PTE. METHODS This cross-sectional study included 15 renal transplant recipients, in whom polycythemia developed after kidney transplantation, with elevated hematocrit level to >51%. Forty-eight age- and gender-matched renal transplant recipients with normal hematocrit level were included as the renal transplant control group. In addition, 13 age- and gender-matched healthy subjects were also included as the healthy control group. We used urine hypoxia-inducible factor-2 alpha (HIF-2α) levels to evaluate whether there is local tissue hypoxia in renal allograft. HIF-2α levels were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). Serum EPO and insulin-like growth factor-1 (IGF-1) levels were also measured. RESULTS HIF-2α levels were significantly lower in the polycythemia group than the other two groups, but there was no significant difference between the healthy control group and the renal transplant control group with regard to HIF-2α levels. There was no significant difference among the 3 study groups in terms of levels of serum EPO and IGF-1. CONCLUSION Local tissue hypoxia in renal allograft does not seem to play an important role in the development of PTE.
Collapse
Affiliation(s)
- A Unal
- Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey.
| | - S Ata
- Department of Internal Medicine, Erciyes University Medical School, Kayseri, Turkey
| | - C Karakurkcu
- Department of Biochemistry, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - M Z Ciraci
- Department of Biochemistry, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - I Kocyigit
- Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey
| | - M H Sipahioglu
- Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey
| | - B Tokgoz
- Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey
| | - O Oymak
- Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey
| |
Collapse
|
32
|
Circulating Fibroblast Growth Factor-23 Levels are Associated with an Increased Risk of Anemia Development in Patients with Nondialysis Chronic Kidney Disease. Sci Rep 2018; 8:7294. [PMID: 29740119 PMCID: PMC5940871 DOI: 10.1038/s41598-018-25439-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/13/2018] [Indexed: 12/26/2022] Open
Abstract
Fibroblast growth factor-23 (FGF23) is an established biomarker of adverse outcomes in patients with chronic kidney disease (CKD). Several cross-sectional studies have suggested a possible association between FGF23 and anemia in these patients. In this large-scale prospective cohort study, we investigated this relationship and examined whether high FGF23 levels increase the risk of incident anemia. This prospective longitudinal study included 2,089 patients from the KoreaN cohort study for Outcome in patients With CKD. Anemia was defined as hemoglobin level <13.0 g/dl (men) and <12.0 g/dl (women). Log-transformed FGF23 significantly correlated with hepcidin but inversely correlated with iron profiles and hemoglobin. Multivariate logistic regression showed that log-transformed FGF23 was independently associated with anemia (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.04–1.24, P = 0.01). Among 1,164 patients without anemia at baseline, 295 (25.3%) developed anemia during a median follow-up of 21 months. In fully adjusted multivariable Cox models, the risk of anemia development was significantly higher in the third (hazard ratio [HR], 1.66; 95% CI, 1.11–2.47; P = 0.01) and fourth (HR, 1.84; 95% CI, 1.23–2.76; P = 0.001) than in the first FGF23 quartile. In conclusion, high serum FGF23 levels were associated with an increased risk for anemia in patients with nondialysis CKD.
Collapse
|
33
|
Sahay M, Kalra S, Badani R, Bantwal G, Bhoraskar A, Das AK, Dhorepatil B, Ghosh S, Jeloka T, Khandelwal D, Latif ZA, Nadkar M, Pathan MF, Saboo B, Sahay R, Shimjee S, Shrestha D, Siyan A, Talukdar SH, Tiwaskar M, Unnikrishnan AG. Diabetes and Anemia: International Diabetes Federation (IDF) - Southeast Asian Region (SEAR) position statement. Diabetes Metab Syndr 2017; 11 Suppl 2:S685-S695. [PMID: 28483426 DOI: 10.1016/j.dsx.2017.04.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
Anemia is often associated with diabetes mellitus and is known to intensify the risk of developing diabetes-related microvascular and macrovascular complications. There is paucity in understanding of co-existence of these conditions, especially in Southeast Asian countries. Iron and/or erythropoietin deficiencies are the major causes of anemia in diabetes, and diabetic kidney disease plays a key role. Patients with diabetes need to be screened for anemia along with other risk factors and anemia should be corrected appropriately to improve overall clinical outcomes. This position statement aims to provide a comprehensive overview and an algorithm for appropriate management of anemia in patients with diabetes.
Collapse
Affiliation(s)
| | | | | | | | | | - A K Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | | | | | | | | | - Milind Nadkar
- Seth G.S. Medical College & KEM Hospital, Mumbai, India
| | | | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, India
| | | | | | | | - Ali Siyan
- Maldivian Diabetes Society, Male, Maldives
| | | | | | | |
Collapse
|
34
|
Louw EH, Chothia MY. Residual renal function in chronic dialysis is not associated with reduced erythropoietin-stimulating agent dose requirements: a cross-sectional study. BMC Nephrol 2017; 18:336. [PMID: 29178879 PMCID: PMC5702117 DOI: 10.1186/s12882-017-0752-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaemia is a very common problem in patients with end-stage kidney disease (ESKD) and the use of erythropoietin-stimulating agents (ESA) has revolutionised its treatment. Residual renal function (RRF) is associated with a reduction in ESA resistance and mortality in chronic dialysis. The primary aim was to establish whether RRF has an association with ESA dose requirements in ESKD patients receiving chronic dialysis. METHODS A single center, cross-sectional study involving 100 chronic dialysis patients was conducted from December 2015 to May 2016. Participants were divided into two groups depending on presence of RRF, which was defined as a 24-h urine sample volume of ≥ 100 ml. Erythropoietin resistance index [ERI = total weekly ESA dose (IU)/weight (kg)/haemoglobin concentration (g/dL] was used as a measure of ESA dose requirements. RESULTS There was no difference in ERI between those with RRF as compared to those without (9.5 versus 11.0, respectively; P = 0.45). Also, ERI did not differ between those receiving haemodialysis as compared with peritoneal dialysis (10.8 versus 10.2, respectively; P = 0.84) or in those using renin-angiotensin system (RAS) blockers as compared with no RAS blocker use (11.6 versus 9.2, respectively; P = 0.10). Lower ERI was evident for those with cystic kidney disease as compared to those with other causes of ESKD (6.9 versus 16.5, respectively; P = 0.32) although this did not reach statistical significance. Higher ERI was found in those with evidence of systemic inflammation as compared to those without (16.5 versus 9.5, respectively; P = 0.003). CONCLUSIONS There was no association between RRF and ESA dose requirements, irrespective of dialysis modality, RAS blocker use, primary renal disease or hyperparathyroidism.
Collapse
Affiliation(s)
- Elizabeth Helene Louw
- Divisions of General Medicine and Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, 7505, South Africa
| | - Mogamat-Yazied Chothia
- Divisions of General Medicine and Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, 7505, South Africa.
| |
Collapse
|
35
|
Stević N, Stefanović N, Veličković - Radovanović R, Apostolović B, Paunović K, Cvetković M, Virijević D, Cvetković T. T HE INFLUENCE OF ACE INHIBITORS TREATMENT ON ANEMIA PARAMETERS IN PATIENTS ON MAINTENANCE HEMODIALYSIS. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
36
|
Xu XP, He HL, Hu SL, Han JB, Huang LL, Xu JY, Xie JF, Liu AR, Yang Y, Qiu HB. Ang II-AT2R increases mesenchymal stem cell migration by signaling through the FAK and RhoA/Cdc42 pathways in vitro. Stem Cell Res Ther 2017; 8:164. [PMID: 28697804 PMCID: PMC5506621 DOI: 10.1186/s13287-017-0617-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Mesenchymal stem cells (MSCs) migrate via the bloodstream to sites of injury and are possibly attracted by inflammatory factors. As a proinflammatory mediator, angiotensin II (Ang II) reportedly enhances the migration of various cell types by signaling via the Ang II receptor in vitro. However, few studies have focused on the effects of Ang II on MSC migration and the underlying mechanisms. Methods Human bone marrow MSCs migration was measured using wound healing and Boyden chamber migration assays after treatments with different concentrations of Ang II, an AT1R antagonist (Losartan), and/or an AT2R antagonist (PD-123319). To exclude the effect of proliferation on MSC migration, we measured MSC proliferation after stimulation with the same concentration of Ang II. Additionally, we employed the focal adhesion kinase (FAK) inhibitor PF-573228, RhoA inhibitor C3 transferase, Rac1 inhibitor NSC23766, or Cdc42 inhibitor ML141 to investigate the role of cell adhesion proteins and the Rho-GTPase protein family (RhoA, Rac1, and Cdc42) in Ang II-mediated MSC migration. Cell adhesion proteins (FAK, Talin, and Vinculin) were detected by western blot analysis. The Rho-GTPase family protein activities were assessed by G-LISA and F-actin levels, which reflect actin cytoskeletal organization, were detected by using immunofluorescence. Results Human bone marrow MSCs constitutively expressed AT1R and AT2R. Additionally, Ang II increased MSC migration in an AT2R-dependent manner. Notably, Ang II-enhanced migration was not mediated by Ang II-mediated cell proliferation. Interestingly, Ang II-enhanced migration was mediated by FAK activation, which was critical for the formation of focal contacts, as evidenced by increased Talin and Vinculin expression. Moreover, RhoA and Cdc42 were activated by FAK to increase cytoskeletal organization, thus promoting cell contraction. Furthermore, FAK, Talin, and Vinculin activation and F-actin reorganization in response to Ang II were prevented by PD-123319 but not Losartan, indicating that FAK activation and F-actin reorganization were downstream of AT2R. Conclusions These data indicate that Ang II-AT2R regulates human bone marrow MSC migration by signaling through the FAK and RhoA/Cdc42 pathways. This study provides insights into the mechanisms by which MSCs home to injury sites and will enable the rational design of targeted therapies to improve MSC engraftment.
Collapse
Affiliation(s)
- Xiu-Ping Xu
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Hong-Li He
- Department of Critical Care Medicine, Affiliated Hospital of University of Electronic Science and Technology of China & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China
| | - Shu-Ling Hu
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Ji-Bin Han
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Li-Li Huang
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Jing-Yuan Xu
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Jian-Feng Xie
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Ai-Ran Liu
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Yi Yang
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Hai-Bo Qiu
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
| |
Collapse
|
37
|
Abstract
The renin-angiotensin system (RAS) is a key regulator of blood pressure and blood volume homeostasis. The RAS is primarily comprised of the precursor protein angiotensinogen and the two proteases, renin and angiotensin-converting enzyme (ACE). Angiotensin I (Ang I) is derived from angiotensinogen by renin, but appears to have no biological activity. In contrast, angiotensin II (Ang II) that has a variety of biological functions in the cells is converted from Ang I through removal of two-C-terminal residues by ACE. The physiological effects of Ang II are due to Ang II signaling through specific receptor binding, resulting in muscle contraction leading to increased blood pressure and volume. To modulate RAS, three classes of drugs have been developed: (1) renin inhibitors to prevent angiotensinogen conversion to Ang I, (2) ACE inhibitors, to prevent Ang I processing to Ang II and (3) angiotensin receptor blockers, to inhibit Ang II signaling through its receptor. Studies using the RAS inhibitors and Ang II demonstrated that RAS signaling mediates actions of Ang II in the regulation of proliferation and differentiation of specific hematopoietic cell types, especially in the red blood cell lineage. Accumulating evidence indicates that RAS regulates EPO, an essential mediator of red cell production, for human anemia and erythropoiesis in vivo and in vitro. The regulation of EPO expression by Ang II may be responsible for maintaining red blood cell homeostasis. This review highlights the biological roles of RAS for blood cell and EPO homeostasis through Ang II signaling. The molecular mechanism for Ang II-induced EPO production of the cell or tissue type-specific expression is discussed.
Collapse
Affiliation(s)
- Yong-Chul Kim
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Ognoon Mungunsukh
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Regina M Day
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
| |
Collapse
|
38
|
Zhou XY, Chen HL, Ni SS. Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism. J Crit Care 2016; 37:197-201. [PMID: 27969570 DOI: 10.1016/j.jcrc.2016.09.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/16/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of the study was to investigate red cell distribution width (RDW) in predicting 30-day mortality in patients with pulmonary embolism (PE). METHODS A single-center, retrospective study design was used between January 1, 2014, and February 1, 2016. The primary end point was 30-day mortality after admission. The RDW predicting value was assessed by receiver operating characteristic curves and area under the curve. RESULTS A total of 309 patients with PE were included. The 30-day mortality was 14.9% (46/309). The mean RDW level was 13.9%±0.6% (range, 10.7%-21.9%) at admission. The 30-day mortality was higher in the high-RDW-level group compared with the normal-RDW-level group (12.5% vs 23.5%, χ2=5.140, P=.023), with an odds ratio of 2.164 (95% confidence interval [CI], 1.019-4.450). Logistic regression showed that presence of shock, RDW level, and simplified pulmonary embolism severity index (sPESI) were independent risk factors for 30-day mortality in patients with PE. After adjustment by these risk factors, the adjusted odds ratio was 1.439 (95% CI, 1.024-2.116). The area under the curve for RDW predicting the 30-day mortality was 0.6646 (95% CI, 0.5585-0.7518). The cutoff was 16%. The Youden index for RDW and sPESI was 0.400 and 0.453, respectively. When adding RDW into sPESI, the modified sPESI showed highest prediction accuracy, with Youden index 0.499. CONCLUSIONS Our results suggested that the RDW is a simple and useful indicator in predicting 30-day mortality in patients with PE. However, this conclusion showed be confirmed by prospective study with large sample.
Collapse
Affiliation(s)
- Xiao-Yu Zhou
- Department of Respiratory Diseases, the Affiliated Hospital of Nantong University
| | | | - Song-Shi Ni
- Department of Respiratory Diseases, the Affiliated Hospital of Nantong University.
| |
Collapse
|
39
|
Bamgbola OF. Spectrum of anemia after kidney transplantation: pathophysiology and therapeutic implications. Clin Transplant 2016; 30:1185-1194. [DOI: 10.1111/ctr.12813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Oluwatoyin F. Bamgbola
- Division of Pediatric Nephrology; Downstate Medical Center; State University of New York; Brooklyn NY USA
| |
Collapse
|
40
|
Loutradis C, Skodra A, Georgianos P, Tolika P, Alexandrou D, Avdelidou A, Sarafidis PA. Diabetes mellitus increases the prevalence of anemia in patients with chronic kidney disease: A nested case-control study. World J Nephrol 2016; 5:358-366. [PMID: 27458564 PMCID: PMC4936342 DOI: 10.5527/wjn.v5.i4.358] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/01/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare anemia prevalence between matched chronic kidney disease (CKD) patients with and without diabetes mellitus (DM) and to assess factors associated with anemia development.
METHODS: This is a nested case-control study of 184 type-2 diabetic and 184 non-diabetic CKD patients from a prospectively assembled database of a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate (eGFR). Prevalence of anemia (hemoglobin: Men: < 13 g/dL, women: < 12 g/dL and/or use of recombinant erythropoietin) was examined in comparison, in the total population and by CKD Stage. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with anemia.
RESULTS: The total prevalence of anemia was higher in diabetics (47.8% vs 33.2%, P = 0.004). Accordingly, prevalence was higher in diabetics in CKD Stage 3 (53.5% vs 33.1%, P < 0.001) and particularly in Stage 3a (60.4% vs 26.4%, P < 0.001), whereas it was non-significantly higher in Stage 4 (61.3% vs 48.4%; P = 0.307). Serum ferritin was higher in diabetics in total and in CKD stages, while serum iron was similar between groups. In multivariate analyses, DM (OR = 2.206, 95%CI: 1.196-4.069), CKD Stages 3a, 3b, 4 (Stage 4: OR = 12.169, 95%CI: 3.783-39.147) and serum iron (OR = 0.976, 95%CI: 0.968-0.985 per mg/dL increase) were independently associated with anemia.
CONCLUSION: Prevalence of anemia progressively increases with advancing stages of CKD and is higher in diabetic than matched non-diabetic CKD patients and diabetes is independently associated with anemia occurrence. Detection and treatment of anemia in diabetic CKD patients should be performed earlier than non-diabetic counterparts.
Collapse
|
41
|
Han SY, Oh SW, Hong JW, Yi SY, Noh JH, Lee HR, Kim DJ. Association of Estimated Glomerular Filtration Rate with Hemoglobin Level in Korean Adults: The 2010-2012 Korea National Health and Nutrition Examination Survey. PLoS One 2016; 11:e0150029. [PMID: 27128634 PMCID: PMC4851309 DOI: 10.1371/journal.pone.0150029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/08/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Little is known about anemia in patients with early renal dysfunction. We aimed to investigate the association of hemoglobin level and anemia prevalence with estimated glomerular filtration rate (eGFR) decline using a nation-wide representative sample of the adult Korean population. METHODS In total, 17,373 participants (7,296 men; weighted n = 18,330,187; mean age, 44.2±0.3 years; 9,886 women, weighted n = 18,317,454; mean age, 46.9±0.3 years) were included. eGFR was divided into 5 groups: Group 1, ≥105; Group 2, 90-104; 75-89; Group 4, 60-74; and Group 5, <60 mL/min/1.73m2. RESULTS The weighted anemia prevalence rates were 2.6% in men and 12.8% in women. In men, the weighted hemoglobin level increased with a decrease in eGFR; this value peaked at an eGFR of 60-89 mL/min/1.73m2 and decreased thereafter at an eGFR of <60 mL/min/1.73m2 (15.19±0.03, 15.35±0.03, 15.53±0.03, 15.52±0.06, and 14.90±0.12 g/dL from Groups 1 to 5) after adjustment for age, college graduation, cancer history, current smoking, waist circumference, serum cholesterol level, serum triglyceride level, and diastolic blood pressure. In women, the weighted hemoglobin level increased with a decrease in eGFR; this value peaked with an eGFR of 75-89 mL/min/1.73m2 and decreased thereafter (12.90±0.03, 13.08±0.02, 13.20±0.04, 13.14±0.05, and 12.47±0.11 g/dL from Groups 1 to 5) after adjustment for menstruation, pregnancy, estrogen replacement, and the above-mentioned variables. In both sexes, the weighted prevalence of anemia with an eGFR of 60-104 mL/min/1.73m2 was significantly lower than that with an eGFR of ≥105 mL/min/1.73m2 (men, 3.2±0.4%, 1.9±0.3%, 1.8±0.3%, 2.0±0.9%, and 18.1±3.1%; women, 14.0±0.8%, 11.2±0.7%, 10.5±1.0%, 13.2±1.6%, and 32.3±3.2% from Groups 1 to 5). CONCLUSIONS We noted a compensatory increase in the hemoglobin level with a minor decline in kidney function (in the range of eGFR ≥60 mL/min/1.73m2) prior to a marked decrease in hemoglobin level with severe renal dysfunction.
Collapse
Affiliation(s)
- Sang Youb Han
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Se Won Oh
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Jae Won Hong
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Seong Yoon Yi
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Hye Ran Lee
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| |
Collapse
|
42
|
Tsai MH, Leu JG, Fang YW, Liou HH. High Fibroblast Growth Factor 23 Levels Associated With Low Hemoglobin Levels in Patients With Chronic Kidney Disease Stages 3 and 4. Medicine (Baltimore) 2016; 95:e3049. [PMID: 26986127 PMCID: PMC4839908 DOI: 10.1097/md.0000000000003049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In chronic kidney disease (CKD), decreased erythropoietin production, low serum active vitamin D levels, and high renin-angiotensin-aldosterone activities had been regarded as major causes of renal anemia. At present, no clinical data are available to elucidate the association between renal anemia and fibroblast growth factor 23 (FGF23) levels in CKD. This study aimed to access whether FGF23 is involved in the pathogenesis of renal anemia. This cross-sectional observational study included 53 stable outpatients with CKD stages 3 and 4. Our primary predictor was serum FGF23 levels and outcome was hemoglobin levels. Measurements contained hemoglobin, FGF23, 25-hydroxyvitamin D, intact parathyroid hormone, plasma renin, serum aldosterone, HbA1C levels, lipid and iron profiles, and serum and urine electrolytes. Mean age of our patients was 66.4 ± 12.8 (SD) years, mean estimated glomerular filtration rate 33.5 ± 13.9 mL/min/1.73 m, median FGF23 level 200 (25th-75th percentile, 124-303) pg/mL, vitamin D level 19.5 (25th-75th percentile, 14.0-25.9) ng/mL, and hemoglobin level 12.7 (25th-75th percentile, 10.7-13.75) g/dL. Even after adjusting multiple variables, lower hemoglobin levels correlated significantly with FGF23 levels that were higher than the median value (>200 pg/mL). Moreover, after adjusting for aldosterone, but not 25-hydroxyvitamin D, it decreased the association with FGF23 that higher than median level and hemoglobin levels. We also observed a significant decrease of hemoglobin level in the higher FGF23 group who had a diabetes history. High FGF23 levels were observed to be associated with low hemoglobin levels, which may be partially mediated through the effects of serum aldosterone levels in our patients with CKD stages 3 and 4. Furthermore, we also presumed that diabetes itself may have an impact on the loop among FGF23, hemoglobin, and aldosterone levels in these CKD patients.
Collapse
Affiliation(s)
- Ming-Hsien Tsai
- From the Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital (M-HT, J-GL, Y-WF); Fu-Jen Catholic University School of Medicine (Y-WF); Division of biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei (M-HT); and Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan (H-HL)
| | | | | | | |
Collapse
|
43
|
Taymez DG, Ucar E, Turkmen K, Ucar R, Afsar B, Gaipov A, Turk S. The Predictive Value of Platelet/Lymphocyte Ratio in Hemodialysis Patients With Erythropoietin Resistance. Ther Apher Dial 2016; 20:118-21. [DOI: 10.1111/1744-9987.12380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/03/2015] [Accepted: 10/01/2015] [Indexed: 12/20/2022]
Affiliation(s)
| | - Esma Ucar
- Department of Internal Medicine; Meram Faculty of Medicine, Necmettin Erbakan University; Konya Turkey
| | - Kultigin Turkmen
- Department of Nephrology; Meram Faculty of Medicine, Necmettin Erbakan University; Konya Turkey
| | - Ramazan Ucar
- Department of Internal Medicine; Meram Faculty of Medicine, Necmettin Erbakan University; Konya Turkey
| | - Baris Afsar
- Konya Numune State Hospital; Department of Nephrology; Konya Turkey
| | | | - Suleyman Turk
- Department of Nephrology; Selcuklu Faculty of Medicine, Selcuk University; Konya Turkey
| |
Collapse
|
44
|
Calò LA, Davis PA, Maiolino G, Pagnin E, Ravarotto V, Naso E, Carraro G, Naso A. Assessing the Relationship of Angiotensin II Type 1 Receptors with Erythropoietin in a Human Model of Endogenous Angiotensin II Type 1 Receptor Antagonism. Cardiorenal Med 2015; 6:16-24. [PMID: 27194993 DOI: 10.1159/000439183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/28/2015] [Indexed: 12/26/2022] Open
Abstract
HYPOTHESIS/INTRODUCTION Angiotensin II (Ang II) has been shown to control erythropoietin (EPO) synthesis as Ang II type 1 receptor (AT1R) blockers block Ang-II-induced EPO oversecretion. To further explore the involvement of AT1R in processes controlling EPO levels, plasma EPO and mononuclear cell NADPH oxidase 4 (NOX4) - a NOX family member involved in oxygen sensing, which is a process central to controlling EPO levels - were assessed in Bartter's/Gitelman's syndrome (BS/GS) patients, a human model of endogenous AT1R antagonism and healthy subjects. Heme oxygenase (HO)-1, antioxidant and anti-inflammatory factor related to NOX4 activation, and the relationship of EPO and NOX4 to HO-1 were also assessed. MATERIALS AND METHODS EPO was measured by chemiluminescent immunoassay, HO-1 by sandwich immunoassay and NOX4 protein expression by Western blot. RESULTS EPO was increased in BS/GS patients compared to healthy subjects (7.64 ± 2.47 vs. 5.23 ± 1.07 U/l; p = 0.025), whereas NOX4 did not differ between BS/GS and healthy subjects (1.76 ± 0.61 vs. 1.65 ± 0.54 densitometric units; p = n.s.), and HO-1 was increased in BS/GS patients compared to healthy subjects (9.58 ± 3.07 vs. 5.49 ± 1.04 ng/ml; p = 0.003). NOX4 positively correlated with HO-1 only in BS/GS patients; no correlation was found between EPO and either NOX4 or HO-1 in those two groups. CONCLUSIONS The effect of the renin-angiotensin system on EPO cannot be solely mediated by Ang II via AT1R signaling, but rather, EPO levels are also determined by a complex interrelated set of signals that involve AT2R, nitric oxide levels, NOX4 and HO-1 activity.
Collapse
Affiliation(s)
- Lorenzo A Calò
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Paul A Davis
- Department of Nutrition, University of California, Davis, Calif., USA
| | - Giuseppe Maiolino
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Elisa Pagnin
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Verdiana Ravarotto
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Elena Naso
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Gianni Carraro
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| | - Agostino Naso
- Department of Medicine, Nephrology and Hypertension, University of Padova, Padova, Italy
| |
Collapse
|
45
|
Erythropoiesis and Blood Pressure Are Regulated via AT1 Receptor by Distinctive Pathways. PLoS One 2015; 10:e0129484. [PMID: 26107632 PMCID: PMC4479565 DOI: 10.1371/journal.pone.0129484] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022] Open
Abstract
The renin–angiotensin system (RAS) plays a central role in blood pressure regulation. Although clinical and experimental studies have suggested that inhibition of RAS is associated with progression of anemia, little evidence is available to support this claim. Here we report that knockout mice that lack angiotensin II, including angiotensinogen and renin knockout mice, exhibit anemia. The anemia of angiotensinogen knockout mice was rescued by angiotensin II infusion, and rescue was completely blocked by simultaneous administration of AT1 receptor blocker. To genetically determine the responsible receptor subtype, we examined AT1a, AT1b, and AT2 knockout mice, but did not observe anemia in any of them. To investigate whether pharmacological AT1 receptor inhibition recapitulates the anemic phenotype, we administered AT1 receptor antagonist in hypotensive AT1a receptor knockout mice to inhibit the remaining AT1b receptor. In these animals, hematocrit levels barely decreased, but blood pressure further decreased to the level observed in angiotensinogen knockout mice. We then generated AT1a and AT1b double-knockout mice to completely ablate the AT1 receptors; the mice finally exhibited the anemic phenotype. These results provide clear evidence that although erythropoiesis and blood pressure are negatively controlled through the AT1 receptor inhibition in vivo, the pathways involved are complex and distinct, because erythropoiesis is more resistant to AT1 receptor inhibition than blood pressure control.
Collapse
|
46
|
An JN, Hwang JH, Lee JP, Chin HJ, Kim S, Kim DK, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Lim CS. The Decrement of Hemoglobin Concentration with Angiotensin II Receptor Blocker Treatment Is Correlated with the Reduction of Albuminuria in Non-Diabetic Hypertensive Patients: Post-Hoc Analysis of ESPECIAL Trial. PLoS One 2015; 10:e0128632. [PMID: 26098847 PMCID: PMC4476682 DOI: 10.1371/journal.pone.0128632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
Blockade of the renin-angiotensin-aldosterone system exhibits a renoprotective effect; however, blockade of this system may also decrease hemoglobin (Hb) and erythropoietin (EPO) levels. We evaluated the correlation between reduced albuminuria and decreased hemoglobin concentrations after treatment with an angiotensin II receptor blocker (ARB). Two hundred forty-five non-diabetic hypertensive participants with established albuminuria and relatively preserved renal function were treated with an ARB (40 mg/day olmesartan) for eight weeks. Subsequent changes in various clinical parameters, including Hb, EPO, and albuminuria, were analyzed following treatment. After the 8-week treatment with an ARB, Hb and EPO levels significantly decreased. Patients with a greater decrease in Hb exhibited a greater reduction in 24-hour urinary albumin excretion compared with patients with less of a decrease or no decrease in Hb, whereas no associations with a decline in renal function and EPO levels were noted. Multivariate logistic regression analysis demonstrated a correlation between the reduction of urine albumin excretion and the decrease in Hb levels (after natural logarithm transformation, adjusted odds ratio 1.76, 95% confidence interval 1.21-2.56, P = 0.003). Linear regression analysis also supported this positive correlation (Pearson correlation analysis; R = 0.24, P < 0.001). Decreased Hb concentrations following ARB treatment were positively correlated with reduced albuminuria in non-diabetic hypertensive patients, regardless of decreased blood pressure and EPO levels or renal function decline.
Collapse
Affiliation(s)
- Jung Nam An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Suhnggwon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Ho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Bum Soon Choi
- Department of Internal Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
47
|
Okada H, Suzue K, Imai T, Taniguchi T, Shimokawa C, Onishi R, Hirata J, Hisaeda H. A transient resistance to blood-stage malaria in interferon-γ-deficient mice through impaired production of the host cells preferred by malaria parasites. Front Microbiol 2015; 6:600. [PMID: 26136736 PMCID: PMC4470085 DOI: 10.3389/fmicb.2015.00600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/01/2015] [Indexed: 01/06/2023] Open
Abstract
IFN-γ plays both pathological and protective roles during blood-stage malaria. One of its pathological roles is its contribution to anemia by suppressing erythropoiesis. Here, to evaluate the effects of IFN-γ-mediated alterations in erythropoiesis on the course of malaria infection, mice deficient in IFN-γ (GKO) were infected with two strains of the rodent malaria parasite Plasmodium yoelii, 17XL (PyL) and 17XNL (PyNL), whose host cell ranges differ. Regardless of genotype, all mice infected with PyL, which can invade any erythrocyte, developed high parasitemia and died quickly. Although PyNL caused a transient non-lethal infection in wild-type (WT) mice, some GKO mice were unable to control the infection and died. However, GKO mice were resistant to the early phase of infection, showing an impaired increase in parasitemia compared with WT mice. This resistance in the GKO mice was associated with having significantly fewer reticulocytes, which are the preferred host cells for PyNL parasites, than the WT mice. Compared with the amount of reticulocytes in GKO mice during the early stages of infection, there was a significant increase in the amount of these cells at later stages, which coincided with the inability of these mice to control the infection. We found that the growth of PyNL parasites correlated with the amount of reticulocytes. Thus, the reduced number of reticulocytes in mice lacking IFN-γ appears to be responsible for the limited parasite growth. Notably, these differences in GKO mice were at least partially reversed when the mice were injected with exogenous IFN-γ. Additionally, an artificial induction of hemolytic anemia and an increase in reticulocytes by phenylhydrazine treatment in GKO mice completely abolished the lower parasitemia and resistance during early phase infection. These results suggest that IFN-γ may contribute to the early growth of PyNL parasites by increasing the amount of reticulocytes, presumably by enhancing erythropoiesis.
Collapse
Affiliation(s)
- Hiroko Okada
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| | - Kazutomo Suzue
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| | - Takashi Imai
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| | - Tomoyo Taniguchi
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| | - Chikako Shimokawa
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| | - Risa Onishi
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| | - Jun Hirata
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| | - Hajime Hisaeda
- Department of Parasitology, Graduate School of Medicine, Gunma University Maebashi, Japan
| |
Collapse
|
48
|
Pappa M, Dounousi E, Duni A, Katopodis K. Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy. Int Urol Nephrol 2015; 47:1365-72. [PMID: 26017902 DOI: 10.1007/s11255-015-1012-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/12/2015] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus (DM) is currently considered a modern global epidemic, and diabetic nephropathy (DN) is the most common cause of chronic kidney disease (CKD). Anemia is one of the most significant complications of CKD, and it is mainly attributed to insufficient erythropoietin (EPO) production. However, anemia develops earlier in the course of CKD among patients with DM, and the severity of anemia tends to be more marked in these patients compared to nondiabetic subjects, regardless of the stage of CKD. In this review, we focus on the "less known" complex interacting mechanisms which are involved in the pathophysiology of anemia associated with DN. Although the major cause of anemia in DN is considered to be an inappropriate response of the plasma EPO concentration to anemia, several other possible mechanisms have been suggested. Glomerular hyperfiltration, proteinuria, renal tubular dysfunction and interstitial fibrosis are among the main culprits. On the other hand, systemic effects such as chronic inflammation, autonomic neuropathy and the renin-angiotensin system are also involved. Finally, several medications are considered to aggravate anemia associated with DN. Since anemia is an important predictor of quality of life and is implicated in the increased burden of cardiovascular morbidity and mortality, further research is required to elucidate its pathogenesis in diabetic patients.
Collapse
Affiliation(s)
- M Pappa
- Department of Nephrology, General Hospital of Arta, Arta, Greece
| | | | | | | |
Collapse
|
49
|
Alves MT, Vilaça SS, Carvalho MDG, Fernandes AP, Dusse LMS, Gomes KB. Resistance of dialyzed patients to erythropoietin. Rev Bras Hematol Hemoter 2015; 37:190-7. [PMID: 26041422 PMCID: PMC4459468 DOI: 10.1016/j.bjhh.2015.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023] Open
Abstract
Resistance to recombinant human erythropoietin is a common condition in dialyzed patients with chronic kidney disease and is associated with more hospitalizations, increased mortality and frequent blood transfusions. The main cause of hyporesponsiveness to recombinant human erythropoietin in these patients is iron deficiency. However, a high proportion of patients does not respond to treatment, even to the use of intravenous iron, which indicates the presence of other important causes of resistance. In addition to the iron deficiency, the most common causes of resistance include inflammation, infection, malnutrition, inadequate dialysis, and hyperparathyroidism, although other factors may be associated. In the presence of adequate iron stores, other causes should be investigated and treated appropriately.
Collapse
Affiliation(s)
| | | | | | | | | | - Karina Braga Gomes
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| |
Collapse
|
50
|
Sarkar M, Rajta PN, Khatana J. Anemia in Chronic obstructive pulmonary disease: Prevalence, pathogenesis, and potential impact. Lung India 2015; 32:142-51. [PMID: 25814799 PMCID: PMC4372868 DOI: 10.4103/0970-2113.152626] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable lifestyle-related disease with high global prevalence. COPD is associated with significant morbidity and mortality worldwide. Comorbidities are important events in the natural history of the disease and have a negative effect on the morbidity and mortality of COPD patients. Cardiac diseases, lung cancer, osteoporosis, and depression are common comorbidities reported for COPD. Recently, anemia has been recognized as a frequent comorbidity in COPD patients. The prevalence of anemia in patients with COPD varies from 7.5% to 33%. Anemia of chronic disease (ACD) is probably the most common type of anemia associated with COPD. ACD is driven by COPD-mediated systemic inflammation. Anemia in COPD is associated with greater healthcare resource utilization, impaired quality of life, decreased survival, and a greater likelihood of hospitalization. We need large prospective studies to discern the association between anemia and COPD.
Collapse
Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Puja Negi Rajta
- Department of Physiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Jasmin Khatana
- Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| |
Collapse
|