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Fujiike DT, Santos LL, Silveira de Andrade L, Meneses GC, Martins AMC, Libório AB. Endothelium-related biomarkers, hyperphosphatemia and mortality in hemodialysis patients: a moderation analysis. J Nephrol 2024:10.1007/s40620-024-02033-3. [PMID: 39085573 DOI: 10.1007/s40620-024-02033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024]
Affiliation(s)
| | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Internal Medicine, Medical School, Federal University of Ceará, Fortaleza, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Universidade de Fortaleza- UNIFOR, Fortaleza, Ceará, Brazil.
- Medical Course, Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil.
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Miyazaki S, Kitamura M, Hayashida M, Tamaki A, Tomura H, Yamaguchi K, Nishino T, Funakoshi S. Survival and cognitive deterioration in elderly patients undergoing hemodialysis. Geriatr Gerontol Int 2023; 23:111-116. [PMID: 36608644 DOI: 10.1111/ggi.14531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
AIM This study aimed to elucidate the 5-year changes in the cognitive function of elderly patients undergoing hemodialysis and its association with survival and related factors. METHODS Cognitive function in patients aged ≥65 years undergoing hemodialysis at the Nagasaki Renal Center was assessed using the Mini-Mental State Examination (MMSE) in 2016. Patients were subsequently classified into normal, mild cognitive impairment (MCI) and suspected dementia groups according to their scores; MMSE was conducted at 30 and 60 months thereafter. The patients were followed until 2021. The association between survival and patient backgrounds was analyzed. RESULTS Of the 181 patients, 168 completed follow-up and were classified into normal (n = 71, 42.3%), MCI (n = 44, 26.1%), and suspected dementia (n = 53, 31.5%) groups. Multivariable logistic regression analysis showed that age, female sex, and geriatric nutritional risk index were associated with MMSE scores <24. The 5-year survival rates were 60.6%, 40.9%, and 22.6% in the normal, MCI and suspected dementia groups, respectively. With some exceptions, MMSE results tended to decline during the observation period. A multivariate Cox proportional hazards model showed that age (hazard ratio [HR], 1.04; P = 0.007), dialysis vintage (HR, 0.96; P = 0.04), male sex (HR, 1.77; P = 0.02), geriatric nutritional risk index (HR, 0.94; P < 0.001) and MMSE score (HR, 0.96; P = 0.01) were independent risk factors for patient survival. CONCLUSIONS Cognitive impairment in patients undergoing hemodialysis was associated with age and nutritional status. Patients with cognitive impairment had a poor prognosis. Geriatr Gerontol Int 2023; 23: 111-116.
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Affiliation(s)
| | - Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Akira Tamaki
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideyuki Tomura
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosei Yamaguchi
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Yu H, Zhang C, Cai Y, Wu N, Duan K, Bo W, Liu Y, Xu Z. Abnormal regional homogeneity and amplitude of low frequency fluctuation in chronic kidney patients with and without dialysis. Front Neurosci 2022; 16. [PMID: 36483180 PMCID: PMC9723135 DOI: 10.3389/fnins.2022.1064813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
PurposeThe study characterizes regional homogeneity (ReHo) and amplitude of low frequency fluctuations (ALFF) in abnormal regions of brain in patients of chronic kidney disease (CKD).Materials and methodsA total of 64 patients of CKD were divided into 26 cases of non-dialysis-dependent chronic kidney disease (NDD-CKD), and 38 cases of dialysis-dependent chronic kidney disease (DD-CKD). A total of 43 healthy controls (normal control, NC) were also included. All subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI). ALFF and ReHo data was processed for monitoring the differences in spontaneous brain activity between the three groups. ALFF and ReHo values of extracted differential brain regions were correlated to the clinical data and cognitive scores of CKD patients.ResultsNon-dialysis-dependent group has increased ALFF levels in 13 brain regions while that of DD group in 28 brain regions as compared with NC group. ReHo values are altered in six brain regions of DD group. ALFF is correlated with urea nitrogen and ReHo with urea nitrogen and creatinine. DD group has altered ReHo in two brain regions compared with NDD group. The differences are located in basal ganglia, cerebellar, and hippocampus regions.ConclusionAbnormal activity in basal ganglia, cerebellar, and hippocampal regions may be involved in the cognitive decline of CKD patients. This link can provide theoretical basis for understanding the cognitive decline.
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Niu W, Yang X, Yan H, Yu Z, Li Z, Lin X, Gu L, Ni Z, Fang W. Peritoneal Protein Clearance Is Associated With Cardiovascular Events but Not Mortality in Peritoneal Dialysis Patients. Front Med (Lausanne) 2022; 9:748934. [PMID: 35721057 PMCID: PMC9201446 DOI: 10.3389/fmed.2022.748934] [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: 07/28/2021] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Association of peritoneal protein clearance (Pcl) with outcomes in patients with peritoneal dialysis (PD) is uncertain. Thus, we aimed to investigate its impact on cardiovascular events and all-cause mortality in patients with PD and factors associated with Pcl. Methods Prevalent patients with PD from January 2014 to April 2015 in the center of Renji Hospital were enrolled. At the time of enrollment, serum and dialysate samples were collected to detect biochemical parameters and Angiopoietin-2-Tie2 system cytokines. Mass transfer area coefficient of creatinine (MTACcr) and Pcl were calculated. Patients were dichotomized into two groups by the median Pcl level (68.5 ml/day) and were followed up prospectively until the end of the study (1 October 2018). Results A total of 318 patients with PD [51.2% men, mean age 56.7 ± 14.3 y, median PD duration 31.5 (12.1–57.2) months] were enrolled. Among them, 25.7% were comorbid with diabetes and 28.6% had a history of cardiovascular disease (CVD). After being followed up for up to 43.9 (24.2–50.3) months, 63 had developed cardiovascular events, and 81 patients were died. Among them, the high Pcl group had occurred 39 cardiovascular events and 51 deaths, and the low Pcl group had 24 cardiovascular events and 30 deaths. Kaplan-Meier analysis showed that both the occurrence of cardiovascular events and all-cause mortality were increased in patients with high Pcl. However, after adjusting for important confounders and serum Angiopoietin-2 (Angpt-2) level, Pcl was still an independent risk factor for cardiovascular events [hazard ratio (HR) = 1.006 (1.000–1.012), p = 0.038] but not mortality. On multivariate regression analysis, serum albumin, MTACcr, and body mass index (BMI) were found to be independently associated with Pcl. Conclusion High Pcl is an independent risk factor for cardiovascular events but not all-cause mortality. The prediction of cardiovascular events by Pcl was independent of serum Angpt-2.
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Affiliation(s)
- Wei Niu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxiao Yang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhenyuan Li
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinghui Lin
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Leyi Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Olczyk P, Kusztal M, Gołębiowski T, Letachowicz K, Krajewska M. Cognitive Impairment in End Stage Renal Disease Patients Undergoing Hemodialysis: Markers and Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042389. [PMID: 35206577 PMCID: PMC8877881 DOI: 10.3390/ijerph19042389] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Abstract
(1) Background: Cognitive impairment (CI) is common in chronic kidney disease (CKD) and patients treated with hemodialysis. (2) Methods: The systematic review was prepared following the PRISMA statement (2013). The biomedical electronic databases MEDLINE and SCOPUS were searched. (3) Results: out of 1093 studies, only 30, which met problem and population criteria, were included in this review. The risk factors for CI can be divided into three groups: traditional risk factors (present in the general population), factors related to dialysis sessions, and nontraditional risk factors occurring more frequently in the HD group. (4) Conclusions: the methods of counteracting CI effective in the general population should also be effective in HD patients. However, there is a need to develop unique anti-CI approaches targeting specific HD risk factors, i.e., modified hemodialysis parameters stabilizing cerebral saturation and blood flow.
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Wang H, Huang L, Wu G, Li J, Liu L, Zhang T, Zhu J, Zhang X, Shen W, Chai C, Xia S. Regional cerebral gray matter atrophy is associated with cognitive impairment in hemodialysis patients: a cross-sectional and longitudinal voxel-based morphological MRI study. Brain Imaging Behav 2022; 16:1284-1293. [PMID: 34993881 DOI: 10.1007/s11682-021-00602-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/19/2022]
Abstract
This study aimed to explore gray matter volume (GMV) changes in patients undergoing hemodialysis and assess the clinical risk factors associated with GMV changes and the relationship between GMV changes and neuropsychologic test results. Eighty-eight hemodialysis patients and 76 healthy controls (HCs) were recruited in this study. Fifty patients underwent follow-up examinations (follow-up duration: 1.75 ± 0.55 years), including magnetic resonance imaging, blood biochemical, and neuropsychologic testing. Changes in GMV between the patients and HCs were assessed. Longitudinal GMV changes were also explored in the patients. The clinical risk factors associated with longitudinal GMV changes and the correlations between longitudinal GMV changes and neuropsychologic test results were analyzed in the patients. Patients undergoing hemodialysis had diffusely decreased GMV compared with HCs (with age, sex, and total intracranial volume [TIV] as covariates, P<0.001, voxel-wise threshold false discovery rate [FDR] corrected). Compared with patients at baseline, regional decreased GMV were found in patients at follow-up (with age and TIV as covariates, P<0.05, voxel-wise threshold FDR corrected). Increased serum urea concentrations, parathyroid hormone levels, and hemodialysis duration were independent risk factors for decreased GMV in patients undergoing hemodialysis (all P<0.05, FDR corrected). Patients undergoing hemodialysis had lower mini-mental state examination (MMSE) (27[26, 29]) and Montreal cognitive assessment (MoCA) (22[19.5, 24.0]) scores than those of the HCs (30[29, 30] and 28[26.9, 29]) (all P<0.05). The MMSE scores of the patients at follow-up (26[25, 28.5]) were lower than those of patients at baseline (28[25, 29.5]) (P=0.02). The decreased left caudate volumes were positively correlated with reduced MMSE scores in hemodialysis patients (rs=0.437, P=0.033). Patients undergoing hemodialysis had noticeable GM atrophy over time, related to cognitive impairments.
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Affiliation(s)
- Huiying Wang
- The School of Medicine, Nankai University, Tianjin, 300071, China
| | - Lixiang Huang
- Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China
| | - Gemuer Wu
- The School of Medicine, Nankai University, Tianjin, 300071, China
| | - Jinping Li
- Department of Hemodialysis, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China
| | - Lei Liu
- Department of Radiology, Hebei Petrochina Central Hospital, Langfang, 065000, China
| | - Tong Zhang
- First Central Clinical College, Medical University of Tianjin, Tianjin, 300070, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, 100102, China
| | - Xianchang Zhang
- MR Collaboration, Siemens Healthineers Ltd., Beijing, 100102, China
| | - Wen Shen
- Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China
| | - Chao Chai
- Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China.
| | - Shuang Xia
- Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, 300192, China.
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Gomes CAM, de Carvalho Borges BM, Lemos LO, de Medeiros CMMF, de Lima PR, Meneses GC, Martins AC, de Melo Bezerra Cavalcante CT, Cavalcante MB, Libório AB. Baseline endothelial-related biomarkers in hemodialysis patients and risk of developing severe SARS-Cov-2 infection. J Nephrol 2021; 34:971-974. [PMID: 34279811 PMCID: PMC8287842 DOI: 10.1007/s40620-021-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Cícero Abdon Malheiro Gomes
- Medical Sciences Postgraduate Program, Universidade de Fortaleza, UNIFOR, Avenida Abolição, 4043 Ap 1203, Fortaleza, Ceara, 60165-082, Brazil
| | | | | | | | - Paula Roberta de Lima
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Gdayllon Cavalcante Meneses
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alice Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Universidade de Fortaleza, UNIFOR, Avenida Abolição, 4043 Ap 1203, Fortaleza, Ceara, 60165-082, Brazil.
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Bijkerk R, Kallenberg MH, Zijlstra LE, van den Berg BM, de Bresser J, Hammer S, Bron EE, Achterberg H, van Buchem MA, Berkhout-Byrne NC, Bos WJW, van Heemst D, Rabelink TJ, van Zonneveld AJ, van Buren M, Mooijaart S. Circulating angiopoietin-2 and angiogenic microRNAs associate with cerebral small vessel disease and cognitive decline in older patients reaching end stage renal disease. Nephrol Dial Transplant 2020; 37:498-506. [PMID: 33355649 DOI: 10.1093/ndt/gfaa370] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of end-stage renal disease (ESRD) is increasing worldwide, with the majority of new ESRD cases diagnosed in patients aged >60 years. These older patients are at increased risk for impaired cognitive functioning, potentially through cerebral small vessel disease (SVD). Novel markers of vascular integrity may be of clinical value for identifying patients at high risk for cognitive impairment. METHODS We aimed to associate the levels of Angiopoietin-2 (Ang-2), asymmetric dimethylarginine (ADMA), and a selection of eight circulating angiogenic miRNAs with SVD and cognitive impairment in older patients reaching ESRD that did not initiate renal replacement therapy yet (n = 129; mean age 75.3 years; mean eGFR 16.4 mL/min). We assessed brain MRI changes of SVD (white matter hyperintensity volume, microbleeds and presence of lacunes) and measures of cognition in domains of memory, psychomotor speed and executive function, comprised in a neuropsychological test battery. RESULTS Older patients reaching ESRD showed an unfavorable angiogenic profile, as indicated by aberrant levels of Ang-2 and five angiogenic miRNAs (miR-27a, miR-126, miR-132, miR-223, miR-326), compared to healthy persons and patients with diabetic nephropathy. Moreover, Ang-2 associated with SVD and with the domains of psychomotor speed and executive function, while miR-223 and miR-29a associated with memory function. CONCLUSIONS Taken together, these novel angiogenic markers might serve to identify older patients with ESRD at risk of cognitive decline, as well as give insight into the underlying (vascular) pathophysiology.
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Affiliation(s)
- Roel Bijkerk
- Department of Internal Medicine (Nephrology).,Einthoven Laboratory for Vascular and Regenerative Medicine
| | - Marije H Kallenberg
- Department of Internal Medicine (Nephrology).,Department of Internal Medicine (Gerontology and Geriatrics)
| | - Laurien E Zijlstra
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernard M van den Berg
- Department of Internal Medicine (Nephrology).,Einthoven Laboratory for Vascular and Regenerative Medicine
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Esther E Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Hakim Achterberg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology).,Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Ton J Rabelink
- Department of Internal Medicine (Nephrology).,Einthoven Laboratory for Vascular and Regenerative Medicine
| | - Anton Jan van Zonneveld
- Department of Internal Medicine (Nephrology).,Einthoven Laboratory for Vascular and Regenerative Medicine
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology).,Department of Nephrology, HAGA Hospital, The Hague, The Netherlands
| | - Simon Mooijaart
- Department of Internal Medicine (Gerontology and Geriatrics).,Institute of Evidence-Based Medicine in Old Age, Leiden, The Netherlands
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