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Han S, Jia M, Yuan W, Wang Y, Lu Y, Xu Y, Shang L. The association between peripheral eosinophil count and chronic kidney disease: evidence from NHANES 1999-2018. Ren Fail 2024; 46:2319324. [PMID: 38390735 PMCID: PMC10896169 DOI: 10.1080/0886022x.2024.2319324] [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: 08/07/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Renal impairment has been previously linked to peripheral eosinophil count (PEC), prompting an investigation into its potential relationship with chronic kidney disease (CKD). This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) to comprehensively explore the association between PEC and CKD. METHODS Survey-weighted generalized multivariate linear regression was employed to evaluate the associations between PEC, urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR), with meticulous adjustment for potential covariates. To assess non-linear correlations, a restricted cubic spline analysis was conducted. Sensitivity analysis was performed to test the stability of results. RESULTS The study included a total of 9224 participants with non-dialysis CKD. In the multivariate linear regression model, after comprehensive adjustment for potential covariates, PEC showed a negative association with eGFR (β per 100 cells/uL increase in PEC, -0.71; 95% CI, -1.04, -0.37), while demonstrating a positive trend with UACR (β per 100 cells/uL increase in PEC, 10.21; 95% CI, 1.37, 19.06). The restrictive cubic spline curve analysis suggested that these associations occurred within the range of 0 to 400 cells/uL for PEC. Sensitivity analysis supported the stability of the observed results. CONCLUSIONS Circulating eosinophil levels are negatively correlated with eGFR and demonstrate a positive trend with UACR, when PEC falls within the range of less than 400 cells/uL among adults with CKD. Further research is warranted to validate these findings.
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Affiliation(s)
- Shisheng Han
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Meng Jia
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenli Yuan
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Wang
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Lu
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanqiu Xu
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li Shang
- Institute of Science, Technology and Humanities, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Afsar B, Afsar RE. Hypersensitive Reactions During Hemodialysis Treatment: What Do We Need to Know? Semin Dial 2024; 37:189-199. [PMID: 38433728 DOI: 10.1111/sdi.13197] [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: 11/22/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Kidney replacement therapies (KRTs) including hemodialysis (HD) are one of the treatment options for most of the patients with end-stage kidney disease. Although HD is vital for these patients, it is not hundred percent physiological, and various adverse events including hypersensitivity reactions may occur. Fortunately, these reactions are rare in total and less when compared to previous decades, but it is still very important for at least two reasons: First, the number of patients receiving kidney replacement treatment is increasing globally; and the cumulative number of these reactions may be substantial. Second, although most of these reactions are mild, some of them may be very severe and even lead to mortality. Thus, it is very important to have basic knowledge and skills to diagnose and treat these reactions. Hypersensitivity reactions can occur at any component of dialysis machinery (access, extracorporeal circuit, medications, etc.). The most important preventive measure is to avoid the allergen. However, even with very specific test, sometimes the allergen cannot be found. In mild conditions, HD can be contained with non-specific treatment (topical creams, antihistaminics, corticosteroids). In more severe conditions, treatment must be stopped immediately, blood should not be returned to patient, drugs must be stopped, and rules of general emergency treatment must be followed.
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Affiliation(s)
- Baris Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Rengin Elsurer Afsar
- Department of Nephrology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
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Asmara IGY, Agustriadi IGNO, Sujaya IM, Thalib SS, Lestari R, Fatrullah SP, Widiasari KSR, Ajmala IE. Eosinopenia as a prognostic factor of mortality for COVID-19 in end-stage kidney disease patients. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:273-279. [PMID: 38807735 PMCID: PMC11129073 DOI: 10.22088/cjim.15.2.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/30/2023] [Accepted: 06/26/2023] [Indexed: 05/30/2024]
Abstract
Background The unique role of eosinophil in coronavirus disease 2019 (COVID-19) patients has been shown in several studies, but its role in end-stage kidney disease (ESKD) patients who contracted COVID-19 is less reported. This study investigated eosinopenia's predictive value as a mortality marker in ESKD patients with COVID-19. Methods It is a retrospective study of ESKD patients who contracted COVID-19 between May 2020 and October 2021 in West Nusa Tenggara General Hospital, Indonesia. Comparative analysis was carried out between the death dan survival group. Logistic regression analysis was done to investigate the role of eosinopenia on the outcome after controlling other significant variables. Results The analyses included one hundred fifteen confirmed COVID-19 in ESKD patients. The average age was 50, 53% of patients were males, 41% were newly diagnosed with ESKD, and the mortality rate was 25.2%. This study's prevalence of eosinopenia, high neutrophil-to-lymphocyte ratio (NLR), and high C-reactive protein (CRP) in the nonsurvivors was 51.4%, 39.3%, and 30.8%, respectively. Diastolic blood pressure <90 mmHg (P=0.004), respiratory rate >22 x/minutes (P=0.011), oxygen saturation <93% (P=0.008), NLR >6 (p<0.001), eosinophil count <0.01 x103/uL (p<0.001), CRP >20 mg/L (P=0.047), and isolation hemodialysis (HD) therapy (p<0.001) were independently associated with mortality of COVID-19 in ESKD patients. However, on multivariate logistic regression analysis, eosinopenia (P=0.019) and HD (P=0.001) were risk factors that remained significant prognostic mortality factors. Conclusion Eosinopenia was common in ESKD patients with COVID-19, particularly in the death group. Eosinopenia at admission and HD during hospitalization were risk factors for COVID-19 mortality in ESKD patients.
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Affiliation(s)
- I Gede Yasa Asmara
- Department of Internal Medicine, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - I Gusti Ngurah Ommy Agustriadi
- Department of Internal Medicine, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - I Made Sujaya
- Department of Internal Medicine, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Salim Said Thalib
- Department of Internal Medicine, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Rina Lestari
- Department of Pulmonology, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Suryani Padua Fatrullah
- Department of Pulmonology, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Komang Sri Rahayu Widiasari
- Department of Pulmonology, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Indana Eva Ajmala
- Department of Pulmonology, Faculty of Medicine, University of Mataram - West Nusa Tenggara General Hospital, Mataram, Indonesia
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Talal S, Mona K, Karem A, Yaniv L, Reut HM, Ariel S, Moran AK, Harel E, Campisi-Pinto S, Mahmoud AA, Raul C, David T, Gil BS, Idan C. Neutrophil degranulation and severely impaired extracellular trap formation at the basis of susceptibility to infections of hemodialysis patients. BMC Med 2022; 20:364. [PMID: 36284314 PMCID: PMC9597999 DOI: 10.1186/s12916-022-02564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic kidney disease patients are at increased risk of mortality with cardiovascular diseases and infections as the two leading causes of death for end-stage kidney disease treated with hemodialysis (HD). Mortality from bacterial infections in HD patients is estimated to be 100-1000 times higher than in the healthy population. METHODS We comprehensively characterized highly pure circulating neutrophils from HD and healthy donors. RESULTS Protein levels and transcriptome of HD patients' neutrophils indicated massive neutrophil degranulation with a dramatic reduction in reactive oxygen species (ROS) production during an oxidative burst and defective oxidative cellular signaling. Moreover, HD neutrophils exhibit severely impaired ability to generate extracellular NET formation (NETosis) in NADPH oxidase-dependent or independent pathways, reflecting their loss of capacity to kill extracellular bacteria. Ectopic hydrogen peroxidase (H2O2) or recombinant human SOD-1 (rSOD-1) partly restores and improves the extent of HD dysfunctional neutrophil NET formation. CONCLUSIONS Our report is one of the first singular examples of severe and chronic impairment of NET formation leading to substantial clinical susceptibility to bacteremia that most likely results from the metabolic and environmental milieu typical to HD patients and not by common human genetic deficiencies. In this manner, aberrant gene expression and differential exocytosis of distinct granule populations could reflect the chronic defect in neutrophil functionality and their diminished ability to induce NETosis. Therefore, our findings suggest that targeting NETosis in HD patients may reduce infections, minimize their severity, and decrease the mortality rate from infections in this patient population.
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Affiliation(s)
- Salti Talal
- Oncology & Hematology Division, Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Khoury Mona
- Oncology & Hematology Division, Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Awad Karem
- Nephrology Department, Emek Medical Center, Afula, Israel
| | | | | | - Shemesh Ariel
- Biomedical Core Facility, Bruce Rappaport Faculty of Medicine Technion-Israel, Haifa, Israel
| | | | - Eitam Harel
- Emek Medical Center, Clinical Laboratories, Clalit, Afula, Israel
| | | | - Abu-Amna Mahmoud
- Oncology & Hematology Division, Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Colodner Raul
- Emek Medical Center, Clinical Laboratories, Clalit, Afula, Israel
| | - Tovbin David
- Nephrology Department, Emek Medical Center, Afula, Israel
| | - Bar-Sela Gil
- Oncology & Hematology Division, Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel.
| | - Cohen Idan
- Oncology & Hematology Division, Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.
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Ohashi N, Sakao Y, Sato T, Ishigaki S, Isobe S, Fujikura T, Kato A, Yasuda H. Characteristics of adrenal insufficiency in hemodialysis patients. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00337-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Adrenal insufficiency causes abnormal subjective symptoms such as general fatigue, signs such as hypotension, and abnormalities such as hypoglycemia and leads to poor prognosis. However, all these are also observed in hemodialysis (HD) patients without adrenal insufficiency. The morphology of the adrenal glands in HD patients with adrenal insufficiency is unclear. Therefore, this study was performed to clarify the characteristics of adrenal insufficiency in HD patients.
Methods
Seventeen HD patients who had abnormal subjective symptoms and test results indicating adrenal insufficiency and whose serum cortisol levels were less than 18 μg/dL were recruited.
Results
Seven HD patients were diagnosed with adrenal insufficiency. No significant differences were found about abnormal subjective symptoms and images between patients with and without adrenal insufficiency. The levels of serum cortisol and serum cholinesterase were significantly lower in patients with adrenal insufficiency than in those without adrenal insufficiency. A plasma cortisol level of 8.45 μg/dL showed the highest sensitivity and specificity in the receiver operating characteristic curve. The serum cortisol levels were significantly and negatively associated with the plasma ferritin levels in patients with adrenal insufficiency. Multiple linear regression analyses revealed that the serum cortisol levels showed a significant negative association with the plasma ferritin levels after adjustments.
Conclusions
It is difficult to infer adrenal insufficiency in HD patients by subjective symptoms and images of the adrenal glands. Adrenal insufficiency correlates with nutritional and inflammatory status, and the levels of serum cholinesterase and plasma ferritin might reflect their corresponding status.
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Yang J, Fan J, Fan L, Yi C, Lin J, Mao H, Yang X, Wang X. Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients. Int Arch Allergy Immunol 2020; 181:765-773. [PMID: 32694251 DOI: 10.1159/000509085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Eosinophilia (eosinophil fraction of leukocytes >5%), an indicative parameter for bioincompatibility in various circumstances, is well established in hemodialysis. However, change in eosinophil count (EOC) and its association with death-censored technique failure among peritoneal dialysis (PD) patients remain unclear. METHODS We compared eosinophils before and after PD initiation among 1,432 eligible continuous ambulatory PD patients regularly followed up in our PD center during 2007-2018. Risk factors of early-stage eosinophilia were examined by the logistic regression test. The relationship of early-stage eosinophilia and EOC with death-censored technique failure was examined using the Cox proportional hazards model for overall patients and for men and women separately. RESULTS After PD initiation, the EOC and percentage of patients with eosinophilia were significantly increased compared with baseline. Being male (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.55-3.31; p < 0.001) and higher EOC at baseline (100 cells/μL increase, OR: 1.62; 95% CI: 1.45-1.82; p < 0.001) were risk factors of early-stage eosinophilia after PD initiation. During follow-up, 204 death-censored technique failures were recorded. In fully adjusted models, each with 100 cells/μL increase in EOC, the adjusted hazard ratios (HRs) of technique failure were 1.11 (95% CI: 1.03-1.20; p = 0.009) in the whole cohort, 1.29 (95% CI: 1.10-1.51; p = 0.002) in women, and 1.07 (95% CI: 0.97-1.17; p = 0.196) in men. Eosinophilia was significantly associated with the risk of technique failure for women (HR: 2.24; 95% CI: 1.07-4.70; p = 0.033), which was especially significant for women aged <55 years (HR: 7.61; 95% CI: 1.88-30.90; p = 0.005). CONCLUSION EOC was increased significantly after PD initiation, and increased numbers of eosinophils were associated with higher death-censored technique failure in PD patients, especially women.
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Affiliation(s)
- Jiayi Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jinjin Fan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Li Fan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, .,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China,
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