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Effect of citric-acid dialysate on the QTC-interval. Sci Rep 2021; 11:9909. [PMID: 33972581 PMCID: PMC8110800 DOI: 10.1038/s41598-021-89083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
Lower dialysate calcium (dCa) concentration and dialysate citric-acidification may positively affect calcification propensity in serum of haemodialysis (HD) patients. However, the accompanying lower ionized blood calcium concentration may lead to a prolonged cardiac action potential, which is possibly pro-arrhythmic. The aim of this study is to investigate the influence of citric-acid dialysate on the QT-interval corrected for heart rate (QTc) compared to conventional dialysate with different dCa concentrations. We conducted a four-week multicentre, randomized cross-over trial. In week one and three patients received acetic-acid dialysate with a dCa of 1.50 mmol/l (A1.5), in week two and four acetic-acid dialysate with a dCa of 1.25 mmol/l (A1.25) or citric-acid dialysate (1.0 mmol/l) with a dCa of 1.50 mmol/l (C1.5) depending on randomization. Patients had continuous ECG monitoring during one session in week one, two and four. The data of 13 patients were available for analysis. Results showed a significant though limited increase of QTc with C1.5 (from 427 to 444 ms (start to end); p = 0.007) and with A1.25 (from 431 to 449 ms; p < 0.001), but not with A1.5 (from 439 to 443 ms; p = 0.13). In conclusion, we found that the use of C1.5 or A1.25 is associated with a significant prolongation of QTc which was however relatively limited.
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Govoni M, Muscari C, Bonafè F, Morselli PG, Cortesi M, Dallari D, Giordano E. A brief very-low oxygen tension regimen is sufficient for the early chondrogenic commitment of human adipose-derived mesenchymal stem cells. Adv Med Sci 2021; 66:98-104. [PMID: 33461101 DOI: 10.1016/j.advms.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects exerted over chondrogenic commitment of human adipose-derived mesenchymal stem cells (ADSCs) by a very low oxygen tension (<1% pO2). MATERIALS/METHODS Cell morphology, mRNA levels of chondrocyte-specific marker genes and the involvement of p38 MAPK signalling were monitored in human ADSCs under a very low oxygen tension. RESULTS Cell morphology was significantly changed after two days of hypoxic preconditioning when they featured as elongated spindle-shaped cells. SRY-box containing gene 9, aggrecan and collagen type II mRNA levels were enhanced under severe hypoxic culture conditions. Moreover, the inhibition of p38 MAPK resulted in a substantial reduction in transcription of the above-mentioned specific genes, proving the pivotal role of this pathway in the transcriptional regulation of chondrogenesis. CONCLUSIONS Here, we propose a protocol showing the early commitment of stem cells towards the chondrogenic phenotype in only 2 days of culture via a very low hypoxic environment, in the absence of growth factors added in the culture medium.
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Zarkasi KA, Jen-Kit T, Jubri Z. Molecular Understanding of the Cardiomodulation in Myocardial Infarction and the Mechanism of Vitamin E Protections. Mini Rev Med Chem 2019; 19:1407-1426. [DOI: 10.2174/1389557519666190130164334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/10/2018] [Accepted: 01/12/2019] [Indexed: 12/13/2022]
Abstract
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Myocardial infarction is a major cause of deaths globally. Modulation of several molecular
mechanisms occurs during the initial stages of myocardial ischemia prior to permanent cardiac tissue
damage, which involves both pathogenic as well as survival pathways in the cardiomyocyte. Currently,
there is increasing evidence regarding the cardioprotective role of vitamin E in alleviating the disease.
This fat-soluble vitamin does not only act as a powerful antioxidant; but it also has the ability to regulate
several intracellular signalling pathways including HIF-1, PPAR-γ, Nrf-2, and NF-κB that influence
the expression of a number of genes and their protein products. Essentially, it inhibits the molecular
progression of tissue damage and preserves myocardial tissue viability. This review aims to summarize
the molecular understanding of the cardiomodulation in myocardial infarction as well as the
mechanism of vitamin E protection.
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Affiliation(s)
- Khairul Anwar Zarkasi
- Department of Biochemistry, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Tan Jen-Kit
- Department of Biochemistry, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Zakiah Jubri
- Department of Biochemistry, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
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Mercadal L, Franck JE, Metzger M, Yuan W, Kolko A, Monnet E, Hannedouche T, Jacquelinet C, Stengel B. Improved survival associated with acetate-free haemodialysis in elderly: a registry-based study. Nephrol Dial Transplant 2015; 30:1560-8. [DOI: 10.1093/ndt/gfv248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 05/12/2015] [Indexed: 11/13/2022] Open
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Saikumar JH, Kovesdy CP. Bicarbonate Therapy in End-Stage Renal Disease: Current Practice Trends and Implications. Semin Dial 2015; 28:370-6. [PMID: 25845518 DOI: 10.1111/sdi.12373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Management of metabolic acidosis covers the entire spectrum from oral bicarbonate therapy and dietary modifications in chronic kidney disease to delivery of high doses of bicarbonate-based dialysate during maintenance haemodialysis (MHD). Due to the gradual depletion of the body's buffers and rapid repletion during MHD, many potential problems arise as a result of our current treatment paradigms. Several studies have given rise to conflicting data about the adverse effects of our current practice patterns in MHD. In this review, we will describe the pathophysiology and consequences of metabolic acidosis and its therapy in CKD and ESRD, and discuss current evidence supporting a more individualized approach for bicarbonate therapy in MHD.
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Affiliation(s)
- Jagannath H Saikumar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.,Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
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Tiranathanagul K, Tangvoraphonkchai K, Srisawat N, Susantitaphong P, Tungsanga K, Praditpornsilpa K, Eiam-Ong S. Acute intradialytic cardiac function and inflammatory cytokine changes during high-efficiency online hemodiafiltration with acetate-free and standard dialysis solutions. Ther Apher Dial 2014; 19:250-8. [PMID: 25545821 DOI: 10.1111/1744-9987.12271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/01/2014] [Indexed: 11/28/2022]
Abstract
Acetate in standard acetate-containing bicarbonate (AC) dialysis fluid could induce peripheral vasodilatation, suppression of myocardial function, and inflammatory cytokine production, resulting in intradialytic hypotension in conventional hemodialysis (HD) patients. Online hemodiafiltration (HDF) provides superior hemodynamic stability over HD. The potentially additive hemodynamic benefits of the novel acetate-free bicarbonate (AF) dialysis fluid in online HDF have never been explored before. The present randomized, double-blind, crossover study was conducted in 22 online HDF patients to investigate the impact of AF dialysis fluid on hemodynamic and cytokine changes compared with AC dialysis fluid in online HDF. The results demonstrated the comparable changes of arterial pressure between AF and AC online HDF. During the study periods, the incidences of composite intradialytic hypotension and other adverse events were not different. The baseline and hourly changes of cardiac index, cardiac output, and peripheral vascular resistance during dialysis were comparable (P=0.534, 0.199, and 0.641, respectively). The percent reductions of NT-proBNP and cTnT were not significantly different (72.6 ± 12.3 vs. 72.6 ± 12.8%, P=0.99 and 35.2 ± 12.8 vs. 36.7 ± 12.0%, P=0.51). The changes of all pro-inflammatory cytokines (IL-2β, IL-6, IL-8, and TNF-α) and anti-inflammatory cytokine (IL-10) during dialysis were comparable between both groups. In conclusion, AF dialysis solution does not offer additional hemodynamic benefit for stable online HDF patients. The hemodynamic stability provided by online HDF might protect the adverse effects of acetate.
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Affiliation(s)
- Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamonwan Tangvoraphonkchai
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Unarokov ZM, Mukhoedova TV, Shuvaeva OV. Comparison of sustained low-efficiency dialysis with acetate-free and acetate-containing bicarbonate dialysate in unstable patients. Artif Organs 2014; 38:883-8. [PMID: 24393008 DOI: 10.1111/aor.12251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This work is focused on the problem of maintenance of intradialytic hemodynamic safety in unstable patients with acute kidney injury (AKI). A hypothesis that "small" quantities of acetate in standard bicarbonate dialysate can cause pronounced acetatemia and exacerbate cardiovascular instability was tested. In this prospective randomized study, a group of patients with AKI after cardiac surgery was treated with sustained low-efficiency dialysis with either acetate-containing bicarbonate dialysate or acetate-free dialysate, where acetate is replaced by hydrochloric acid. It was demonstrated that application of acetate-containing bicarbonate dialysate results in blood acetate levels up to 12 times the normal level. Additionally, it is associated with a 3.8-fold-increased risk of hemodynamic complications in comparison with acetate-free dialysate. The choice of acetate-free or acetate-containing bicarbonate dialysate does not influence adequacy of correction of the acid-base and electrolyte content of blood.
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Affiliation(s)
- Zaur M Unarokov
- Department of Anesthesiology and Critical Care, Academician E.N. Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
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Kuragano T, Kida A, Furuta M, Yahiro M, Kitamura R, Otaki Y, Nonoguchi H, Matsumoto A, Nakanishi T. Effects of Acetate-Free Citrate-Containing Dialysate on Metabolic Acidosis, Anemia, and Malnutrition in Hemodialysis Patients. Artif Organs 2011; 36:282-90. [PMID: 21954915 DOI: 10.1111/j.1525-1594.2011.01349.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Takahiro Kuragano
- Department of Internal Medicine Division of Kidney and Dialysis, Hyogo College of Medicine Seishoukai Aoi Hospital, Nishinomiya, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan.
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Matsuyama K, Tomo T, Kadota JI. Acetate-free blood purification can impact improved nutritional status in hemodialysis patients. J Artif Organs 2011; 14:112-9. [DOI: 10.1007/s10047-010-0551-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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Calò LA, Naso A, Davis PA, Pagnin E, Corradini R, Tommasi A, Sereni L, Ragazzi E. Hemodiafiltration With Online Regeneration of Ultrafiltrate: Effect on Heme-Oxygenase-1 and Inducible Subunit of Nitric Oxide Synthase and Implication for Oxidative Stress and Inflammation. Artif Organs 2010; 35:183-7. [DOI: 10.1111/j.1525-1594.2010.01045.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Case of a Maintenance Hemodialysis Patient in Whom a Change of Sensitivity to Acetate Was Suspected. ASAIO J 2010; 56:488-90. [PMID: 20811173 DOI: 10.1097/mat.0b013e3181f11e9d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bolasco P, Ghezzi PM, Serra A, Corazza L, Fundoni GF, Pistis R, Gazzanelli L, Piras A, Accalai G, Calvisi L, Carpentieri E, Contu R, Grussu S, Mattana G, Pinna M, Scalas MR, Sulis E. Effects of acetate-free haemodiafiltration (HDF) with endogenous reinfusion (HFR) on cardiac troponin levels. Nephrol Dial Transplant 2010; 26:258-63. [PMID: 20601367 DOI: 10.1093/ndt/gfq359] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Haemofiltrate reinfusion (HFR) is a form of haemodiafiltration (HDF) in which replacement fluid is constituted by ultrafiltrate from the patient 'regenerated' through a cartridge containing hydrophobic styrene resin. Bicarbonate-based dialysis solutions (DS) used in routine haemodialysis and HDF contain small quantities of acetate (3-5 mMol/L) as stabilizing agent, one of the major causes of intradialytic hypotension. Acetate-free (AF) DS have recently been made available, substituting acetate with hydrochloric acid. Cardiac troponin (cTnT) constitutes an appreciable marker of myocardial damage and cardiac hypertrophy, and correlates with left ventricular mass. METHODS The aim of this study was to assess the impact of the presence or lack of acetate in DS on cTnT levels in patients treated with HFR and to evaluate outcome of intra-session cardiovascular stability. Twenty-five patients devoid of major cardiovascular comorbidity were randomized and treated with AF HFR for 3 months. The same patients were subsequently treated by means of HFR with DS containing 3 mMol/L acetate for 3 months and finally with AF HFR for a further 3 months. Prior and subsequent to each treatment period, samples were collected for cTnT measurement. RESULTS A significant decrease was observed in cTnT levels throughout the first session of AF HFR (1.32 ± 0.35-1.12 ± 0.31 ng/mL, P < 0.05) with a subsequent rise being registered during HFR with acetate-containing DS (1.12 ± 0.31-1.28 ± 0.37 ng/mL, P < 0.05) and a further drop from 1.28 ± 0.37 to 1.21 ± 0.35 ng/mL in the last AF HFR period. During HFR with acetate-containing DS, a significant drop in systolic and diastolic arterial pressure was observed in conjunction with a higher heart rate at the end of the session. CONCLUSION We observed an increase in cTnT during HFR with acetate and drops manifested during HFR without acetate; it may therefore be concluded that the drop in cTnT level, significantly correlated with lack of acetate, is indicative of improvement of cardiac microvascular function.
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