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Badri S, Vahdat S, Seirafian S, Pourfarzam M, Gholipur-Shahraki T, Ataei S. Homocysteine-Lowering Interventions in Chronic Kidney Disease. J Res Pharm Pract 2021; 10:114-124. [PMID: 35198504 PMCID: PMC8809459 DOI: 10.4103/jrpp.jrpp_75_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/25/2021] [Indexed: 12/20/2022] Open
Abstract
The incidence of cardiovascular events and mortality is higher in patients with chronic kidney disease (CKD) compared to the general population. Homocysteine (Hcy) appears to be an independent risk factor for cardiovascular diseases in general populations and patients with CKD. Further, hyperhomocysteinemia can cause endothelial damage and increase the activity and production of coagulation factors, and its prevalence among patients with end-stage renal disease is approximately 85%-100%. Most treatments, which lower Hcy levels and have been considered in previous studies, include folic acid, B vitamins, omega-3 fatty acids, and N-acetylcysteine. However, the effect of therapies that can decrease Hcy levels and thus cardiovascular events in these patients is still unclear. The results are conflicting and require further investigation. To guide treatment decisions and improve patient outcomes, multiple databases were searched, including Web of Science, PubMed, and Medline to summarize the available evidence (i.e., clinical trial and meta-analyses) on Hcy-lowering interventions and cardiovascular events.
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Affiliation(s)
- Shirinsadat Badri
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Vahdat
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Seirafian
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Pourfarzam
- Department of Clinical Biochemistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahereh Gholipur-Shahraki
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Ataei
- Department of Clinical Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
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Mutual effect modification between adiponectin and HDL as risk factors of cardiovascular events in Type 2 diabetes individuals: a cohort study. Int Urol Nephrol 2021; 53:2583-2591. [PMID: 33674951 DOI: 10.1007/s11255-021-02828-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to assess whether high-density lipoprotein (HDL) cholesterol modifies the association between adiponectin and incident cardiovascular (CV) morbidity and mortality in Type 2 Diabetes Mellitus (T2DM) and vice versa. METHODS At baseline, 106 T2DM participants with various degrees of renal function were enrolled and followed up over a period of 7 years with fatal/nonfatal CV events as outcome. RESULTS During the follow-up, 49 participants experienced incident CV events (28 fatal, 21 nonfatal). On univariate Fine and Gray sub-hazard models, HDL cholesterol was a strong modifier of the association between adiponectin and CV outcomes both on crude (P = 0.011) and gender- and eGFR-adjusted models (P = 0.010). The protective effect for CV events portended by a fixed increase in adiponectin (1 μg/ml) was progressively higher across increasing values of HDL cholesterol. Moreover, plasma adiponectin also modified the protective effect of HDL on CV outcomes both in crude and multivariate analyses. We found a mutual effect modification between adiponectin and HDL as risk factors of CV events in participants with T2DM. CONCLUSION Our results are coherent with the hypothesis that HDL cholesterol might play a pivotal role in the interpretation of the association between adiponectin and the risk of adverse CV outcomes in this population.
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Yurtdaş M, Yaylali YT, Özdemir M. The role of monocyte to HDL ratio in predicting clinically significant carotid stenosis in patients with asymptomatic carotid artery disease. ACTA ACUST UNITED AC 2020; 66:1043-1048. [PMID: 32935796 DOI: 10.1590/1806-9282.66.8.1043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/26/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Monocyte count to HDL-C Ratio (MHR) and Fibrinogen to Albumin Ratio (FAR) have recently emerged as markers of inflammation in atherosclerotic diseases. Our goal was to investigate the relationships of MHR and FAR with the severity of carotid artery stenosis (CAS) in patients with asymptomatic carotid artery disease. METHODS This retrospective study consisted of 300 patients with asymptomatic CAS. Pre-angiographic MHR, FAR, and high-sensitive C-reactive protein (hsCRP) were measured. Carotid angiography was performed in patients with ≥50% stenosis on carotid ultrasonography. Patients were first split into 2 groups based on the degree of CAS and then tertiles (T) of MHR. RESULTS 96 patients had clinically insignificant CAS (<50%) (Group-1), and 204 patients had clinically significant CAS (≥50%) (Group-2). Group-2 had higher MHR, FAR, and hsCRP than group-1. Patients in T3 had higher MHR, FAR, and hsCRP than in T1 and T2. MHR, FAR, and hsCRP were correlated with each other (p<0.001, for all). MHR, FAR, and hsCRP were independent predictors of significant CAS. MHR better predicted a significant CAS than FAR and hsCRP (p<0.05). CONCLUSION Pre-angiographic MHR may be a better predictor than FAR and hsCRP in identifying a clinically significant carotid stenosis in patients with asymptomatic CAS. Patients with asymptomatic CAS and a high level of MHR should be followed-up closely to supervise risk-factor control and intensify treatment.
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Affiliation(s)
- Mustafa Yurtdaş
- Balıkesir Sevgi Hospital, Department of Cardiology, Balıkesir, Turkey
| | - Yalin Tolga Yaylali
- Pamukkale University, Faculty of Medicine, Department of Cardiology, Denizli, Turkey
| | - Mahmut Özdemir
- İstanbul Aydın University, Department of Cardiology, İstanbul, Turkey
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Liao KM, Kuo LT, Lu HY. Hospital costs and prognosis in end-stage renal disease patients receiving coronary artery bypass grafting. BMC Nephrol 2020; 21:333. [PMID: 32770957 PMCID: PMC7414285 DOI: 10.1186/s12882-020-01972-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/21/2020] [Indexed: 02/02/2023] Open
Abstract
Background Coronary artery disease is common in patients with end-stage renal disease (ESRD). Patients with ESRD are a high-risk group for cardiac surgery and have increased morbidity and mortality. Most studies comparing ESRD patients receiving coronary artery bypass grafting (CABG) or percutaneous coronary intervention have found that the long-term survival is good in ESRD patients after CABG. The aim of our study was to compare ESRD patients who underwent CABG with the general population who underwent CABG, in terms of prognosis and hospital costs. Methods This study analyzed data from the National Health Insurance Research Database in Taiwan for patients who were diagnosed with ESRD and received CABG (ICD-9-CM codes 585 or 586) between January 1, 2004, and December 31, 2009. The ESRD patients included in this study all received catastrophic illness cards with the major illness listed as ESRD from the Ministry of Health and Welfare in Taiwan. The control subjects were randomly selected patients without ESRD after propensity score matching with ESRD patients according to age, gender, and comorbidities at a 2:1 ratio from the same dataset. Results A total of 48 ESRD patients received CABG, and their mean age was 62.04 ± 10.04 years. Of these patients, 29.2% were aged ≥70 years, and 66.7% were male. ESRD patients had marginally higher intensive care unit (ICU) stays (11.06 vs 7.24 days) and significantly higher ICU costs (28,750 vs 17,990 New Taiwan Dollars (NTD)) than non-ESRD patients. Similarly, ESRD patients had significantly higher surgical costs (565,200 vs. 421,890 NTD), a higher perioperative mortality proportion (10.4% vs 2.1%) and a higher postoperative mortality proportion (33.3% vs 11.5%) than non-ESRD patients. Conclusions After CABG, ESRD patients had a higher risk of mortality than non-ESRD patients, and ICU and surgery costs were also higher among the ESRD patients than among patients without ESRD.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan.
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Gum Arabic ( Acacia Senegal) Augmented Total Antioxidant Capacity and Reduced C-Reactive Protein among Haemodialysis Patients in Phase II Trial. Int J Nephrol 2020; 2020:7214673. [PMID: 32328307 PMCID: PMC7171621 DOI: 10.1155/2020/7214673] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/27/2020] [Accepted: 02/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background Oxidative processes might increase in patients with end-stage renal disease (ESRD) according to the current literature. Oxidative stress (OS) is a risk factor of atherosclerosis and cardiovascular complications, which are major causes of mortality among ESRD patients. Haemodialysis (HD) is life-saving procedure, nevertheless it is an active chronic inflammatory status that could augment cardiovascular disease and increase mortality. Gum Arabic (GA) has been claimed to act as an antioxidant and anti-inflammatory agent in experimental studies and clinical trials. Therefore, we assumed GA supplementation among haemodialysis patients would reduce oxidative stress and consequently reduce the state of chronic inflammatory activation associated with haemodialysis. Methods Forty end-stage renal failure (ESRF) patients aged 18–80 years who were on regular haemodialysis in Arif Renal Center, Omdurman, Sudan, were recruited. All recruited patients met the inclusion criteria and signed informed consent prior to enrolment. The patients received 30 g/day of GA for 12 weeks. C-reactive protein (CRP) and complete blood count (CBC) were measured as baseline and monthly. Total antioxidant capacity (TAC) and oxidative stress marker malondialdehyde (MDA) levels were measured before and after GA intake. Ethical approval from the National Medicines and Poisons Board was obtained. Results Gum Arabic significantly augmented total antioxidant capacity level (P < 0.001) (95% CI, 0.408–0.625) and also attenuated oxidative marker MDA and C-reactive protein (P < 0.001). Conclusions GA has revealed potent antioxidative and anti-inflammatory properties in haemodialysis patients. Oral digestion of GA (30 g/day) decreased oxidative stress and inflammatory markers among haemodialysis patients. Trial registration. ClinicalTrials.gov Identifier: NCT03214692, registered 11 July 2017 (prospective registration).
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Paniagua R, Frías Y, De Jesús Ventura M, Rodríguez E, Hurtado ME, Alcántara G, Vázquez R, Ortiz R, Salcedo M, Rios ME, Kaji J, Amato D. C-Reactive Protein and Anti-Chlamydia Pneumoniae Antibodies as Risk Factors of Cardiovascular Death in Incident Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080302300207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti- Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD). Design Single-cohort, prospective observational study. Setting Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico. Patients A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied. Primary Outcome Mortality. Methods Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart. Results Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status. Conclusion These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Yolanda Frías
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Maria De Jesús Ventura
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Ernesto Rodríguez
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | | | | | - Roberto Vázquez
- Hospital General de Zona IMSS, Juárez, Chihuahua, Mexico City, México
| | - Ruth Ortiz
- Hospital General de Zona IMSS, Juárez, Chihuahua, Mexico City, México
| | - Mario Salcedo
- Hospital General de Zona IMSS, Durango, Durango, Mexico City, México
| | - Maria Elena Rios
- Hospital General de Zona IMSS, Durango, Durango, Mexico City, México
| | - Julio Kaji
- Hospital Regional 1° de Octubre, ISSSTE, Mexico City, México
| | - Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
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Stenvinkel P, Chung SH, Heimbürger O, Lindholm B. Malnutrition, Inflammation, and Atherosclerosis in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s27] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter Stenvinkel
- Department of Nephrology and Baxter Novum, Huddinge University Hospital, Stockholm, Sweden
| | - Sung Hee Chung
- Department of Nephrology and Baxter Novum, Huddinge University Hospital, Stockholm, Sweden
| | - Olof Heimbürger
- Department of Nephrology and Baxter Novum, Huddinge University Hospital, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Nephrology and Baxter Novum, Huddinge University Hospital, Stockholm, Sweden
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Pecoits–Filho R, Stenvinkel P, Wang AYM, Heimbürger O, Lindholm B. Chronic Inflammation in Peritoneal Dialysis: The Search for the Holy Grail? Perit Dial Int 2020. [DOI: 10.1177/089686080402400407] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mortality and morbidity in chronic kidney disease (CKD) patients are unacceptably high. The annual mortality rate due to cardiovascular disease (CVD) is approximately 9%, which, for the middle-aged person, is at least 10- to 20-fold higher than for the general population. Classic risk factors for CVD are highly prevalent in CKD patients, but they cannot fully account for the excessive rate of CVD in this population. Instead, it has become increasingly clear that nontraditional risk factors, such as systemic inflammation, may play a key role in the development of atherosclerosis. It is well established that inflammatory markers are very powerful predictors of high CVD morbidity and mortality not only in the general population, but particularly in CKD patients. Signs of a sustained low-grade inflammation, such as increased levels of C-reactive protein (CRP), are present in the majority of stage 5 CKD patients, even in patients in clinically stable condition, and they are also commonly observed after the initiation of dialysis therapy. Dialysis therapy — hemodialysis as well as peritoneal dialysis (PD) — may itself contribute to systemic inflammation. Local intraperitoneal inflammation can also occur in patients treated with PD. These local effects may result in a low-grade inflammation, caused by the bioincompatibility of conventional glucose-based dialysis fluids, to intense inflammation associated with peritonitis. Given these circumstances, it is reasonable to hypothesize that strategies aiming to reduce inflammation are potentially important and novel, and could serve to reduce CVD, thereby lowering morbidity and mortality in patients with CKD. In this review we provide information supporting the hypothesis that systemic inflammation is tightly linked to the most common complications of CKD patients, in particular those on PD, and that local inflammation in PD may contribute to various related complications. The aims of this review are to discuss the reasons that make inflammation an attractive target for intervention in CKD, the particular aspects of the inflammation–CVD axis during PD treatment that are likely involved, and possible means for the detection and management of chronic inflammation in PD patients.
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Affiliation(s)
- Roberto Pecoits–Filho
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
- Centro de Ciências Biológicas e da Saúde, Pontifícia Universidade Católica do Paraná, and Renal Diabetes and Hypertension Research Center of the ProRenal Foundation, Curitiba, Brazil
| | - Peter Stenvinkel
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Angela Yee-Moon Wang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Olof Heimbürger
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
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Achinger SG, Ayus JC. When the source of inflammation is hiding in plain sight: Failed kidney transplants, clotted arteriovenous grafts, and central venous catheters. Semin Dial 2018; 32:15-21. [PMID: 30032484 DOI: 10.1111/sdi.12739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiovascular mortality accounts for most deaths among hemodialysis patients and far exceeds the cardiovascular mortality rate of the general population. One important aspect of cardiovascular risk among dialysis patients is chronic inflammation. Iatrogenic sources of chronic inflammation in the form of failed renal allografts, old clotted arteriovenous grafts, and hemodialysis catheters play important, sometimes, unrecognized roles in this inflammatory state. There is ample observational evidence that these sources of inflammation are associated with hypoalbuminemia, erythropoetin-resistant anemia, and increased markers of chronic inflammation. In dialysis patients with chronic inflammation from potentially modifiable sources, causes should be sought and correction undertaken if possible. Allograft nephrectomy should be offered to patients with a chronic inflammatory state and a failed renal transplant. Unused, clotted AV grafts should be considered a likely source of chronic inflammation as well as infection and should be removed when evidence of infection is present on indium scanning. Catheter rates ought to be kept to a minimum for the many well-recognized reasons for their undesirability as well as for their potential to produce chronic inflammation with all of its ill effects.
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Affiliation(s)
| | - Juan Carlos Ayus
- Renal Consultants of Houston, Houston, TX, USA.,Department of Medicine, Division of Nephrology, University of California, Irvine, CA, USA
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10
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Arase H, Yamada S, Yotsueda R, Taniguchi M, Yoshida H, Tokumoto M, Nakano T, Tsuruya K, Kitazono T. Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort study. Atherosclerosis 2018; 275:115-123. [PMID: 29890446 DOI: 10.1016/j.atherosclerosis.2018.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. METHODS A total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine-Gray proportional subdistribution hazards model. RESULTS The modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals: Q1, 2.65 [1.69-4.25], Q2, 1.92 [1.27-2.94], and Q3, 1.31 [0.87-2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95% confidence intervals: Q1, 1.64 [1.04-2.61], Q2, 1.34 [0.91-2.00], and Q3, 1.04 [0.71-1.52]). The risk of stroke was not associated with the modified Cr index. CONCLUSIONS A lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.
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Affiliation(s)
- Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ryusuke Yotsueda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masatomo Taniguchi
- Fukuoka Renal Clinic, 4-6-20 Watanabe-dori, Chuo-ku, Fukuoka, 810-0004, Japan
| | - Hisako Yoshida
- Saga University Hospital, Clinical Research Center, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience). Diabetes Metab Syndr 2018; 12:91-97. [PMID: 28964721 DOI: 10.1016/j.dsx.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Inflammation and malnutrition play an important role in endothelial dysfunction, atherosclerosis and excessive cardiovascular morbidity and mortality in ESRD patients AIM OF THE STUDY: The primary objective is to determine the prevalence of inflammation, malnutrition and atherosclerosis in patients on maintenance haemodialysis. Secondary objective was to determine the association for atherosclerosis with inflammation and malnutrition. PATIENT AND METHODS One hundred and one adult patients with end stage renal disease on maintenance haemodialysis who are met with the exclusion criteria were enrolled in this cross sectional study from haemodialysis unit of Baghdad teaching hospital over the period of July/2015 - June 2016. All patients were thoroughly examined and many variables were evaluated (age, gender, blood pressure, diabetes mellitus, serum lipid profile, smoking habits, serum albumin, CRP, calcium, Phosphate, Parathyroid hormone and haemoglobin measurements). All patients underwent a carotid Doppler ultrasound study. RESULTS Atherosclerosis was present in 65.3%: 58.4% of patients had malnutrition and 43.6% had inflammation. The association for atherosclerosis and high CRP and low serum albumin is strong and independent of other atherosclerosis risk factors. There is significant inverse and independent correlation between CRP and albumin. CONCLUSION Inflammation (high serum CRP) and malnutrition (low serum albumin) in patients on haemodialysis are significantly associated with carotid atherosclerosis. Inflammation was more prevalent in the malnourished patients than in those with normal nutritional status.
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Affiliation(s)
- Ali Abdulmajid Dyab Allawi
- FRCP London, Assistant Professor Baghdad College of Medicine, University of Baghdad, Consultant Nephrologist and Transplant Physcian, Baghdad, Iraq.
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12
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Tanaka S, Ninomiya T, Taniguchi M, Tokumoto M, Masutani K, Ooboshi H, Kitazono T, Tsuruya K. Impact of blood urea nitrogen to creatinine ratio on mortality and morbidity in hemodialysis patients: The Q-Cohort Study. Sci Rep 2017; 7:14901. [PMID: 29097750 PMCID: PMC5668292 DOI: 10.1038/s41598-017-14205-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022] Open
Abstract
The association between blood urea nitrogen to creatinine ratio (UCR) and survival is uncertain in hemodialysis patients. We examined the influence of UCR on mortality and morbidity in hemodialysis patients. A total of 3,401 hemodialysis patients were prospectively followed for 4 years. The association between UCR with overall survival was analyzed using a Cox regression model. During a 4-year follow-up period, 545 patients died from any cause and 582 experienced MACE, 392 with coronary heart disease (CHD), 114 with infection-related death, 77 with hemorrhagic stroke, 141 with ischemic stroke, and 107 with cancer death. Every 1 increase in UCR level was significantly associated with an increased risk for all-cause mortality (hazard ratio [HR] 1.07; 95% confidence interval [CI] 1.03–1.12), CHD (HR 1.08; 95% CI 1.02–1.14), and infection-related death (HR 1.11; 95% CI 1.02–1.21). There was no evidence of a significant association between UCR and death from cancer, and incidence of stroke. A high UCR was significantly associated with an increased risk for all-cause mortality, infection-related death and incidence of CHD in hemodialysis patients.
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Affiliation(s)
- Shigeru Tanaka
- Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Masanori Tokumoto
- Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Kosuke Masutani
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroaki Ooboshi
- Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Wang WJ, Cheng MH, Lin JH, Weng CS. Effect of a rosmarinic acid supplemented hemodialysis fluid on inflammation of human vascular endothelial cells. Braz J Med Biol Res 2017; 50:e6145. [PMID: 29069222 PMCID: PMC5649864 DOI: 10.1590/1414-431x20176145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/15/2017] [Indexed: 12/23/2022] Open
Abstract
Chronic systemic inflammation and repetitive damage of vascular endothelia by incompatible dialysis system are probable causes of cardiovascular disease in patients on dialysis. The present study aimed to assess in vitro biocompatibility and anti-inflammatory effect of hemodialysis fluid supplemented with rosmarinic acid (RA) using human umbilical vein endothelial cells (HUVEC). HUVECs (5×106 cells/mL) were pre-exposed to 1 μg/mL of lipopolysaccharides (LPS) and incubated with RA-supplemented hemodialysis fluid (HDF). Cytotoxicity was assessed qualitatively by morphologic assessment and quantitatively by MTT assay. Expressions of proinflammatory mediators were assessed using quantitative real-time PCR and production of NO was quantified. Phosphorylation of AKT and nuclear localization of nuclear factor kappa B (NF-κB) were examined using western blotting. Exposure of HUVECs to RA-supplemented HDF had no influence on morphology and viability. Inhibition of proinflammatory mediator production in HUVECs by RA supplementation to HDF was significant in a dose-dependent manner. Exposure to RA-supplemented HDF resulted in a decrease in nitric oxide synthase expression and reduction of NO production in LPS-stimulated HUVECs. RA supplementation of HDF suppressed Akt activation in LPS-stimulated HUVECs. In addition, the level of cellular IκB was increased in parallel to a reduced nuclear translocation of NF-κB in LPS-induced endothelial cells. Our results suggest that RA-supplemented HDF is biocompatible and significantly suppressed inflammation induced in endothelial cells. In this respect, the use of HDF supplemented with RA could alleviate inflammation and improve long-term treatment of patients with renal failure on dialysis. Further clinical studies are required to confirm the effects.
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Affiliation(s)
- W-J. Wang
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - M-H. Cheng
- Department of Rehabilitation, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - J-H. Lin
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - C-S. Weng
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, Taiwan
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Noori N, Yan AT, Kiaii M, Rathe A, Goldstein MB, Bello O, Wald R. Nutritional status after conversion from conventional to in-centre nocturnal hemodialysis. Int Urol Nephrol 2017; 49:1453-1461. [PMID: 28456922 DOI: 10.1007/s11255-017-1595-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Recipients of conventional hemodialysis (CHD; 3-4 h/session, 3 times/week) experience volume expansion and nutritional impairment which may contribute to high mortality. Prolongation of sessions with in-centre nocturnal hemodialysis (INHD; 7-8 h/session, 3 times/week) may improve clinical outcomes by enhancement of ultrafiltration and uremic toxin removal. MATERIALS AND METHODS In this prospective cohort study, 56 adult patients who were receiving maintenance CHD for at least 90 days were assigned to CHD (patients who remained in CHD) and INHD (patients who switched to INHD) groups. Both groups were followed for 1 year divided into four 13-week quarters; post-dialysis weight and interdialytic weight gain (IDWG) were captured in each quarter. Repeated measures analysis of variance was used to calculate group main effect, time main effect or time-group interaction effect. RESULTS Conversion to INHD was associated with a mean (95% confidence interval) change in IDWG of 0.5 (0.08, 1.2) kg as compared to -0.3 (-0.9, 0.1) kg in the CHD group (p < 0.01). In the INHD group, post-dialysis weight (% of baseline pre-dialysis weight) decreased after conversion, reaching a nadir during the first 3 months (0.7%) and subsequently it gradually increased and returned to its baseline at the end of follow-up. A similar temporal trend was seen for serum creatinine but not serum N-terminal pro-brain natriuretic peptide (NT-proBNP) which is a marker of extracellular volume. The changes in serum albumin, prealbumin and hs-CRP were not different between the two groups. CONCLUSIONS Conversion to INHD was associated with greater IDWG and relatively stable body mass. We speculate that this gain in weight reflects an increase in lean body mass following the change in dialysis modality, which can be concluded from the parallel increase in serum creatinine and the lack of increase in NT-proBNP.
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Affiliation(s)
- Nazanin Noori
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada
| | - Andrew T Yan
- Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Andrea Rathe
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada
| | - Marc B Goldstein
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada.,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada
| | - Olugbenga Bello
- Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada. .,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada.
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Granata A, Clementi A, Virzì GM, Brocca A, de Cal M, Scarfia VR, Zanoli L, Ronco C, Corrao S, Malatino L. Cardiorenal syndrome type 4: From chronic kidney disease to cardiovascular impairment. Eur J Intern Med 2016; 30:1-6. [PMID: 26961461 DOI: 10.1016/j.ejim.2016.02.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/04/2016] [Accepted: 02/16/2016] [Indexed: 11/27/2022]
Abstract
Cardiorenal syndrome type 4 (CRS type 4), or chronic renocardiac syndrome, has been defined as "chronic abnormalities in renal function leading to cardiac disease" and recognizes the extreme burden of cardiovascular disease (CVD) risk in patients with chronic kidney disease (CKD). CKD is common and increasingly recognized as a risk factor for CVD. Even though the treatment for CVD has dramatically improved over the past decades, it still takes responsibility for up to 50% of deaths in CKD patients. For this reason, patients with CKD should be thoroughly evaluated for cardiovascular risk factors that require careful management, given the significant burden of CRS type 4 on the healthcare system. This review focuses on the most significant conventional and non-conventional CVD risk factors related to CKD.
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Affiliation(s)
- Antonio Granata
- Department of Nephrology and Dialysis, "San Giovanni di Dio" Hospital, Agrigento, Italy
| | - Anna Clementi
- Department of Nephrology and Dialysis, "San Giovanni di Dio" Hospital, Agrigento, Italy; International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; Department of Medicine, University of Padova Medical School, Padova, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | | | - Luca Zanoli
- Unit of Internal Medicine "A. Francaviglia", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Salvatore Corrao
- Internal Medicine Department, National Relevance Hospital Trust ARNAS "Civico, Di Cristina, Benfratelli", Palermo, Italy; Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M.), Di.Bi.M.I.S., University of Palermo, Palermo, Italy.
| | - Lorenzo Malatino
- Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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An intradialytic increase in serum interleukin-6 levels is associated with an increased mortality in hemodialysis patients. Int J Artif Organs 2015; 38:237-43. [PMID: 26044660 DOI: 10.5301/ijao.5000411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The inflammatory marker interleukin-6 (IL-6) increases early in the inflammatory cascade. The aim of this study was to evaluate whether an increase in serum IL-6 levels during a hemodialysis (HD) session is associated with mortality. METHODS 57 adult patients treated with HD for more than 1 month were prospectively studied over a 3-year follow-up period. Demographic and clinical data were collected and blood samples were drawn before and after a midweek HD session. Events of death and censoring were recorded. RESULTS During the 3-year follow-up, 50.8% of the patients died. In univariate Cox regression analysis, an increase in IL-6 levels during HD was associated with an increased mortality (HR 1.41 per pg/ml; 95% CI 1.06 to 1.88; P = .017). In multivariate Cox models, the only independent predictors of all-cause mortality were: an increase in IL-6 levels during dialysis (HR 1.46 per pg/ml; 95% CI 1.08 to 1.98; P = .014), higher baseline C-reactive protein (CRP) levels and older age. When predictors of an increase in serum IL-6 levels during HD were introduced into the model, mortality was still significantly associated with IL-6 elevation during dialysis (HR 1.47 per pg/ml, 95% CI 1.01 to 2.14; P = .045). CONCLUSIONS A rise in serum IL-6 levels during a single HD session is associated with a higher mortality among HD patients, independent of predialysis CRP or IL-6 levels. The results may imply the presence of an intradialytic inflammatory response that affects survival in HD patients.
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Unal A, Kavuncuoglu F, Duran M, Oguz F, Kocyigit I, Sipahioglu MH, Tokgoz B, Oymak O. Inflammation is associated to volume status in peritoneal dialysis patients. Ren Fail 2015; 37:935-40. [PMID: 25945604 DOI: 10.3109/0886022x.2015.1040337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
AIM The aim of this study is to investigate whether there is a relationship between inflammation and volume status in patients underwent peritoneal dialysis (PD). PATIENTS AND METHOD This cross-sectional study included 159 PD patients. The median duration of PD was 17 (range, 1-151) months. All patients were examined using bioelectrical impedance analysis to estimate the ratio of extracellular water to total body water (ECW/TBW), which was used to assess their volume status. The patients were categorized as having one of the following three volume statuses: hypervolemic (above +2 SD from the mean, which was obtained from healthy controls), normovolemic (between +2 SD and -2 SD), or hypovolemic (below -2 SD from the mean). Five patients with hypovolemia were excluded from the study. Fifty-six patients were hypervolemic whereas 98 patients were euvolemic. High-sensitive C-reactive protein (hs-CRP) levels were measured to evaluate inflammation in all patients. RESULTS hs-CRP value levels were significantly higher in hypervolemic patients compared with euvolemic patients [7.1 (3.1-44.0) mg/L vs. 4.3 (3.1-39.6), p: 0.015, respectively]. Left ventricular hypertrophy was more frequent in hypervolemic patients compared with euvolemic patients (53.6% vs. 30.6%, p: 0.004, respectively). ECW/TBW ratio positively correlated with hs-CRP (r: 0.166, p: 0.039). Gender, hs-CRP, and residual Kt/V urea were found to be independent risk factors for hypervolemia in multivariate analysis. CONCLUSION Inflammation is associated with hypervolemia in PD patients. Residual renal functions play an important role to maintain euvolemia in PD patients.
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Affiliation(s)
| | | | - Mustafa Duran
- b Department of Cardiology, Erciyes University Medical School , Kayseri , Turkey
| | - Fatih Oguz
- b Department of Cardiology, Erciyes University Medical School , Kayseri , Turkey
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Omrani HR, Rahimi M, Nikseresht K. The effect of selenium supplementation on acute phase reactants and thyroid function tests in hemodialysis patients. Nephrourol Mon 2015; 7:e24781. [PMID: 25883912 PMCID: PMC4393550 DOI: 10.5812/numonthly.24781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/17/2014] [Accepted: 11/29/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Selenium deficiency is a common problem in patients with chronic kidney disease (CKD). This micronutrient has anti-inflammatory and anti-oxidant effects. Selenium is also found in high concentrations in the thyroid gland. OBJECTIVES To determine the effect of selenium supplementation on thyroid function tests and acute phase reactants in hemodialysis patients. PATIENTS AND METHODS In this double-blinded randomized clinical in 3 months, 64 hemodialysis patients with selenium deficiency were divided into experimental (received selenium supplementation; 32 cases) or control group (received placebo; 32 cases). Erythrocyte sedimentation rate (ESR), ferritin, quantitative C-reactive protein (CRP) and thyroid function tests (TFTs) including thyroid stimulating hormone (TSH), T3 resin uptake (T3RU), and free T4 were measured before and after the intervention and compared between experimental and control groups. RESULTS At baseline, no significant difference was found between experimental and control groups regarding CRP, ESR and ferritin serum levels. Likewise, after intervention, no significant difference was found between experimental and control groups for CRP (14.77 ± 17.93 vs. 18.29 ± 21.56 mg/L), ESR (32.90 ± 32.62 vs. 33.91 ± 31.15 mm/h) and ferritin (528.6 ± 423.07 vs. 519.52 ± 345.59 ng/mL). At baseline, no significant difference was found between experimental and control groups regarding TFTs. Likewise, after intervention, no significant difference was found between experimental and control groups for TSH (3.7 ± 2.22 vs. 2.84 ± 1.88 µU/mL), free T4 (7.19 ± 1.98 vs. 7.02 ± 1.87 µg/dL) and T3RU (30.04 ± 2.28% vs. 29.2 ± 1.98%). CONCLUSIONS Oral selenium supplementation for three months did not have any significant effect on thyroid function tests or acute phase reactants.
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Affiliation(s)
- Hamid Reza Omrani
- Nephrology and Urology Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding author: Hamid Reza Omrani, Nephrology and Urology Research Center, Kermanshah University of Medical Sciences, P. O. Box: 6714-673159, Kermanshah, IR Iran. Tel: +98-8318362022, E-mail:
| | - Mehrali Rahimi
- Department of Internal Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Kanan Nikseresht
- Department of Internal Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
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Heidari B, Fazli MR, Misaeid MAG, Heidari P, Hakimi N, Zeraati AA. A linear relationship between serum high-sensitive C-reactive protein and hemoglobin in hemodialysis patients. Clin Exp Nephrol 2014; 19:725-31. [DOI: 10.1007/s10157-014-1048-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/22/2014] [Indexed: 02/06/2023]
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20
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Borrelli S, Minutolo R, De Nicola L, De Simone E, De Simone W, Zito B, Guastaferro P, Nigro F, Iulianiello G, Credendino O, Bassi A, Leone L, Capuano M, Auricchio MR, Conte G. Effect of hemodiafiltration with endogenous reinfusion on overt idiopathic chronic inflammation in maintenance hemodialysis patients: a multicenter longitudinal study. Hemodial Int 2014; 18:758-66. [PMID: 24865622 DOI: 10.1111/hdi.12178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic inflammation is widely diffuse in maintenance hemodialysis (MHD) patients and is associated with poor survival. Hemodiafiltration with endogenous reinfusion (HFR) is a dialysis technique, highly biocompatible, able to adsorb proinflammatory cytokines and to decrease amino acids and antioxidants loss. These features could be helpful in MHD patients affected by idiopathic chronic inflammation, but this issue remains to be elucidated. We performed a multicenter longitudinal study to assess the effect of the switching from bicarbonate HD to HFR in patients with serum C-reactive Protein (CRP) > 5 mg/L coupled with albumin <4.0 g/dL in the last 6 months. We enrolled 24/176 (14%) patients, of which 20 patients were assessed at 4 months and 18 completed the study. We excluded 11 patients with evident causes of inflammation. At baseline, serum levels of CRP (18.7[7.0-39.4] mg/L) and albumin (3.5[3.3-3.7] g/dL) were significantly correlated (r = -0.49; P = 0.028). The effect on CRP and albumin was almost evident in the first 4 months and remained stable until to eighth month. A strict correlation (R = -0.49; 0.040) between percentage change of CRP (-35%) and albumin (+14%) after 8 months of HFR. These effects were associated with the reduction of IL-6, IL-1β, and TNF-α and the increment of pre-albumin and leptin, whereas the serum levels of Branched Chain Amino Acid (BCAA) remained unchanged. In MHD patients affected by idiopathic chronic inflammation the switching from BHD to HFR is associated with improvement of inflammation. Whether these favorable effects may modify the outcomes of these high-risk patients needs to be confirmed by studies ad hoc.
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Morishita Y, Kusano E, Nagata D. Clinical Implication of the Renin-angiotensin-aldosterone Blockers in Chronic Kidney Disease Undergoing Hemodialysis. Open Cardiovasc Med J 2014; 8:6-11. [PMID: 24611082 PMCID: PMC3944431 DOI: 10.2174/1874192401408010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 01/01/2014] [Accepted: 01/05/2014] [Indexed: 11/22/2022] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) blockers have been widely used in chronic kidney disease patients undergoing hemodialysis; however, whether RAAS blockers have beneficial effects for cardiovascular disease in those patients has not been fully defined. This review focuses on the effects of RAAS blockers in chronic kidney disease undergoing hemodialysis for cardiovascular disease.
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Affiliation(s)
- Yoshiyuki Morishita
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Eiji Kusano
- Utsunomiya Social Insurance Hospital, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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de Jager DJ, Vervloet MG, Dekker FW. Noncardiovascular mortality in CKD: an epidemiological perspective. Nat Rev Nephrol 2014; 10:208-14. [DOI: 10.1038/nrneph.2014.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chen HC, Lim LM, Chang JM, Misra M. Save life and improve quality: report from the 5th Congress of International Society for Hemodialysis. Hemodial Int 2013; 18:163-71. [PMID: 23899054 DOI: 10.1111/hdi.12068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The 5th congress of International Society for Hemodialysis took place last August 3-5, 2012 at the Grand Hotel in Taipei and focused on "Save Life and Improve Quality." It attracted a total of 927 participants from 18 countries. The full spectrum of hemodialysis was covered with plenary lectures and symposiums delivered by experts from different subspecialties in nephrology starting from the history of hemodialysis, mineral bone disease, microinflammation and advanced techniques in hemodialysis. It was followed by critical care in nephrology, anemia, and nutrition in dialysis. Last but not the least, natural disasters and medical economics in hemodialysis were also discussed extensively. This special article will highlight the authentic contributions and innovative clinical presentations from the meeting.
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Affiliation(s)
- Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Wehmeyer MMH, Kshirsagar AV, Barros SP, Beck JD, Moss KL, Preisser JS, Offenbacher S. A randomized controlled trial of intensive periodontal therapy on metabolic and inflammatory markers in patients With ESRD: results of an exploratory study. Am J Kidney Dis 2013; 61:450-8. [PMID: 23261122 PMCID: PMC3578050 DOI: 10.1053/j.ajkd.2012.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 10/10/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Periodontitis is a novel risk factor for inflammation and cardiovascular disease in the dialysis population. Limited information exists about the impact of periodontal therapy in patients receiving dialysis. STUDY DESIGN Randomized controlled trial to assess feasibility and gather preliminary data. SETTING & PARTICIPANTS Dialysis patients with moderate/severe chronic periodontitis. INTERVENTION Intensive treatment, consisting of scaling and root planing, extraction of hopeless teeth, and placement of local-delivery antibiotics, was performed at the baseline visit for treatment-group patients and after study completion for control-group patients. OUTCOMES Outcomes were feasibility (screening, recruitment, enrollment, adverse events, and study withdrawal/completion), clinical periodontal parameters (probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index), and serum albumin and interleukin 6 levels at 3 and 6 months postintervention. RESULTS 342 dialysis patients were approached for participation: 53 were randomly assigned, with 26 participants assigned to immediate treatment and 27 assigned to a control arm for treatment after 6 months. 51 patients completed baseline appointments; 46 were available for 3-month follow-up, 45 were available for 6-month follow-up examinations, and 43 completed all visits. At 3 months, there was a statistically significant improvement for the treatment group compared to the control group for 3 periodontal parameters: mean probing depth (P = 0.008), extent of probing depth ≥4 mm (P = 0.02), and extent of gingival index ≥1 (P = 0.01). However, by 6 months, the difference between groups was no longer present for any variable except probing depth ≥4 mm (P = 0.04). There was no significant difference between groups for serum albumin or high-sensitivity interleukin 6 level at any time when adjusted for body mass index, diabetic status, and plaque index. LIMITATIONS Small sample size and relatively healthy population, imbalance in diabetes. CONCLUSIONS This small trial demonstrates successful cooperation between dentists and nephrologists and successful recruitment, treatment, and retention of dialysis patients with periodontitis. Larger studies with longer follow-up are needed to determine whether treatment can improve markers of inflammation and morbidity.
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Affiliation(s)
- Meggan M H Wehmeyer
- Department of Periodontics, University of Texas School of Dentistry at Houston, Houston, TX, USA.
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Morishita Y, Kusano E. Direct Renin inhibitor: aliskiren in chronic kidney disease. Nephrourol Mon 2012; 5:668-72. [PMID: 23577328 PMCID: PMC3614331 DOI: 10.5812/numonthly.3679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 12/12/2011] [Accepted: 12/18/2011] [Indexed: 02/07/2023] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of chronic kidney disease (CKD) progression and its increased complications such as hypertension (HT) and cardiovascular diseases (CVD). Previous studies suggested that aliskiren a direct renin inhibitor, blocks RAAS and may be effective for the management of CKD and its complications. This review focuses on the effects of aliskiren on CKD.
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Affiliation(s)
- Yoshiyuki Morishita
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
- Corresponding author: Yoshiyuki Morishita, Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-city, 329-0498, Tochigi, Japan. Tel.: + 81-285447346, Fax: +81-285444869, E-mail:
| | - Eiji Kusano
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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Deng J, Wu Q, Liao Y, Huo D, Yang Z. Effect of statins on chronic inflammation and nutrition status in renal dialysis patients: a systematic review and meta-analysis. Nephrology (Carlton) 2012; 17:545-51. [PMID: 22429568 DOI: 10.1111/j.1440-1797.2012.01597.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may have an adjunctive effect on chronic inflammation and nutrition status in renal dialysis patients. Therefore, we performed a systematic review of randomized controlled trials to assess the effect of statins on chronic inflammation and nutrition status in dialysis patients. METHODS The randomized controlled trials (RCTs) of statins versus placebo or no treatment for renal dialysis patients were searched from PubMed, EMbase and Cochran Central Register of Controlled Trials. We screened relevant studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by using the Cochrane Collaboration's Revman 5.1 software. RESULTS We identified nine trials including 3098 patients. Meta-analysis showed statins can significantly decrease the serum C-reactive protein (CRP) (SMD, -0.54; 95% confidence interval (CI), -1.04 to -0.05; P = 0.03) and high sensitivity CRP (hs-CRP) level (SMD, -0.72; 95% CI, -1.14 to -0.31; P = 0.0007) of dialysis patients compared with that of the control group. However, statins did not differ significantly from the control group in increasing the serum Alb level (SMD, -0.13; 95% CI, -0.42 to 0.15; P = 0.37). CONCLUSIONS Statins can improve the chronic inflammation status reflected by the decreasing of serum CRP and hs-CRP levels, whereas there is no conclusive evidence that it can improve the nutrition status. However, this result needs to be further confirmed in more high-quality randomized clinical trials.
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Affiliation(s)
- Jin Deng
- Department of Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Role of homocysteine in end-stage renal disease. Clin Biochem 2012; 45:1286-94. [PMID: 22683753 DOI: 10.1016/j.clinbiochem.2012.05.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 04/26/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022]
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Alsagaff MY, Thaha M, Aminuddin M, Yogiarto RM, Yogiantoro M, Tomino Y. Asymmetric dimethylarginine: a novel cardiovascular risk factor in end-stage renal disease. J Int Med Res 2012; 40:340-9. [PMID: 22429374 DOI: 10.1177/147323001204000135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This cross-sectional study explored the association between carotid intima-media thickness (CIMT) and the oxidative stress markers asymmetric dimethylarginine (ADMA) and homo cysteine in patients with end-stage renal disease who were on haemodialysis. METHODS A total of 30 patients undergoing chronic haemodialysis treatment were recruited to this study. Homocysteine and ADMA levels were determined using a fluorescence polarization immunoassay and an enzyme-linked immunosorbent assay, respectively. CIMT was measured as a marker of atherosclerosis using high-resolution ultrasonography and was performed after haemodialysis. RESULTS Significant positive correlations were found between CIMT and ADMA, and CIMT and duration of haemodialysis. Linear regression analysis showed that ADMA level and age were significant independent determinants of CIMT, whereas homo cysteine was not. CONCLUSIONS The relationship demonstrated between plasma ADMA and carotid artery thickening suggests that ADMA may be a novel marker of atherosclerosis in patients on haemodialysis.
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Affiliation(s)
- M Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Airlangga University School of Medicine, Jalan Mayjen Prof. Dr Moestopo 6-8, Surabaya 60118, Indonesia.
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Muhaisen RM, Sharif FA, Yassin MM. Risk factors of cardiovascular disease among children with chronic kidney disease in Gaza strip. J Cardiovasc Dis Res 2012; 3:91-8. [PMID: 22629024 PMCID: PMC3354476 DOI: 10.4103/0975-3583.95360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. Cardiovascular disease (CVD) is a major cause of mortality in patients with mild-to-moderate CKD and end-stage renal disease. There is accumulating evidence that the increase in CVD burden is present in CKD patients prior to dialysis, due both to conventional risk factors and kidney-specific disease. Detection and initiation of treatment for CVD risk factors at early stages of CKD should be effective in reducing CVD events before as well as after the onset of kidney failure. Materials and Methods: The study sample consisted of a total of 112 subjects aged ≤12 years: 60 CKD patients and 52 healthy control individuals. All subjects were investigated for a group of CVD risk factors such as: Hypertension, diabetes, dyslipidemia, physical inactivity, body mass index (BMI), family history of CVD, hypoalbuminemia, albuminuria, anemia, Ca x P product, and inflammation in terms of C-reactive protein (CRP). Results: Patients (40 males and 20 females) were categorized into four CKD stages (2, 3, 4, and 5) where, Stage 4 had the highest frequency, followed by Stages 3, 5 and 2. Evaluation of the patients indicated that they were shorter, had lower weight and had higher systolic and diastolic blood pressure as compared with control subjects. Frequency of physical inactivity among patients was two-fold higher than controls (50% vs. 25%). The patients showed significantly higher levels of cholesterol (163.6±39.8 vs. 141.8±24.2 mg/dL, P<0.0001), triglycerides (145.5±67.1 vs. 82.9±39.8 mg/dL, P<0.0001), low-density lipoprotein (92.6±31.9 vs. 72.5±19 mg/dL, P<</i>0.0001) and albumin/creatinine ratio (1792±3183 vs. 11.1±6.6 mg/g, P<0.0001). Moreover, the patients had lower levels of high-density lipoprotein (41.9±11.0 vs. 52.7±11.7 mg/dL, P<0.0001), hemoglobin (9.8±1.4 vs. 11.9±0.8 g/dL, P<0.0001) and albumin (4.6±0.6 vs. 4.8±0.2 g/dL, P=0.012). The CRP showed higher occurrence among patients (40% were positive for CRP). Calcium and phosphorus evaluation showed significantly lower calcium and higher phosphorus among patients. However, the difference in Ca X P product was not statistically significant. Conclusions: The study indicates that many of the CVD risk factors are associated with the different stages of CKD in children patients prior to dialysis, and that some of these factors are exacerbated as CKD progresses.
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Affiliation(s)
- Rafat M Muhaisen
- Human Resource Development (HRD), Ministry of Health, Gaza, Palestine
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Mallipattu SK, He JC, Uribarri J. Role of advanced glycation endproducts and potential therapeutic interventions in dialysis patients. Semin Dial 2012; 25:529-38. [PMID: 22548330 DOI: 10.1111/j.1525-139x.2012.01081.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
It has been nearly 100 years since the first published report of advanced glycation end products (AGEs) by the French chemist Maillard. Since then, our understanding of AGEs in diseased states has dramatically changed. Especially in the last 25 years, AGEs have been implicated in complications related to aging, neurodegenerative diseases, diabetes, and chronic kidney disease. Although AGE formation has been well characterized by both in vitro and in vivo studies, few prospective human studies exist demonstrating the role of AGEs in patients on chronic renal replacement therapy. As the prevalence of end-stage renal disease (ESRD) in the United States rises, it is essential to identify therapeutic strategies that either delay progression to ESRD or improve morbidity and mortality in this population. This article reviews the role of AGEs, especially those of dietary origin, in ESRD patients as well as potential therapeutic anti-AGE strategies in this population.
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Affiliation(s)
- Sandeep K Mallipattu
- Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA
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31
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Elshamaa MF, Sabry SM, El-Sonbaty MM, Elghoroury EA, Emara N, Raafat M, Kandil D, Elsaaid G. Adiponectin: an adipocyte-derived hormone, and its gene encoding in children with chronic kidney disease. BMC Res Notes 2012; 5:174. [PMID: 22471989 PMCID: PMC3403889 DOI: 10.1186/1756-0500-5-174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/03/2012] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of cardiovascular disease (CVD) and inflammation is high in patients with chronic kidney disease (CKD). Adiponectin (ADPN) is an adipocytokine that may have significant anti-inflammatory and anti-atherosclerotic effects. Low adiponectin levels have previously been found in patients with high risk for CVD. Methods On seventy eight advanced CKD (stages 4 and 5) pediatric patients undergoing maintenance hemodialysis( MHD) or conservative treatment (CT) the following parameters were studied: body mass index, left ventricular mass index(LVMI), serum adiponectin , cholesterol, HDL-cholesterol, high sensitivity C-reactive protein (hs CRP),interleukin 6(IL6) and single-nucleotide polymorphisms (SNPs) in the ADIPOQ gene at positions 45, and 276. Seventy age-and gender-matched healthy subjects served as control subjects. Results Markedly (P = 0.01) elevated plasma adiponectin levels were observed in CKD patients, especially CT patients, compared to control subjects. The wild type of ADIPOQ 45T > G (T) allele is the main gene for patients and controls. MHD and CT patients had significantly higher frequency of the TT genotypes of +276G > T gene (P = 0.04) compared with control subjects. A significant positive correlation was observed between plasma adiponectin and IL6 level, whereas negative correlations were found between adiponectin level, cholesterol, HDL cholesterol and hs CRP. In a stepwise backward multiple regression model only IL6 (P = 0.001) was independently associated with plasma adiponectin levels. The adiponectin gene the 276 GT+TT genotypes were associated with a higher level of adiponectin . Conclusions The present study demonstrated that ADPN is related to several metabolic and inflammatory CV risk factors in a manner consistent with the hypothesis that this protein might have a protective role against these factors. We observed an association between the +276G>T SNP in the adiponectin gene and CKD in children. Genetic variation of +276 gene seemed to have a positive impact on circulating adiponectin levels in CKD patients.
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Affiliation(s)
- Manal F Elshamaa
- Pediatric Department, National Research Centre, 33 El-Behous street, Dokki, PC:12311, Cairo, Egypt.
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Nusair MB, Rajpurohit N, Alpert MA. Chronic Inflammation and Coronary Atherosclerosis in Patients with End-Stage Renal Disease. Cardiorenal Med 2012; 2:117-124. [PMID: 22851960 DOI: 10.1159/000337082] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The key role of chronic inflammation in the pathogenesis of atherosclerosis has become increasingly apparent in recent years based on the results of experimental, epidemiologic and clinical studies. Coronary artery disease and its complications occur with disproportionately high frequency in patients with end-stage renal disease (ESRD) and contribute substantially to cardiovascular morbidity and mortality in this population. Traditional cardiovascular risk factors occur commonly in patients with ESRD. In addition, a variety of patient-related and dialysis-related factors unique to ESRD predispose to chronic inflammation and by doing so are thought to contribute to coronary atherosclerosis and its complications. These risk factors may serve as therapeutic targets and as such may offer the potential for altering the natural history of coronary atherosclerosis in ESRD.
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Affiliation(s)
- Maen B Nusair
- Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, Mo., USA
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Sezer S, Karakan S, Ozdemir N. Increased cardiac troponin T levels are related to inflammatory markers and various indices of renal function in chronic renal disease patients. Ren Fail 2012; 34:454-9. [PMID: 22320145 DOI: 10.3109/0886022x.2012.656562] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/OBJECTIVES Cardiovascular disease begins early in the course of chronic kidney disease (CKD), and the glomerular filtration rate (GFR) is an independent risk factor for it. There is little information on cardiac troponin concentrations in patients with CKD who have not commenced dialysis. Factors associated with this deleterious process are not completely understood, and we aimed to determine associated laboratory abnormalities of increased cardiac troponin T (cTnT) in patients with CKD. METHODS In this study, 104 patients (65 males and 39 females with mean age of 65 ± 15 years) were recruited. A detailed clinical history was recorded and routine biochemical variables and cTnT levels were measured. GFR was estimated (44.62 ± 14.38 mL/min/1.73 m(2)) using the modification of diet in renal disease study formula. RESULTS cTnT is correlated with blood urea (r = 0.262, p < 0.05), uric acid (r = 0.399, p < 0.001), blood phosphorus (r = 0.550, p < 0.001), triglyceride (r = 0.329, p = 0.011), C-reactive protein (CRP; r = 0.768, p < 0.001), renal resistive index (RRI; r = 0.412, p = 0.017), and GFR (r = -0.755, p = 0.011). On stepwise multiple regression analysis, increased CRP (≥12 mg/L), uric acid (≥5 mg/L), and RRI (≥0.70) were independent variables for increased cTnT status (r(2) = 0.053, p < 0.05). CONCLUSION Increased cTnT not only shows ongoing inflammation but also is a sensitive marker of functioning renal mass. It is strongly correlated with factors influencing the decline in renal function; thus, it can be used as a renal risk parameter.
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Affiliation(s)
- Siren Sezer
- Department of Nephrology, Baskent University, Ankara, Turkey
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Opalinska M, Stompor T, Pach D, Mikolajczak R, Fedak D, Krzanowski M, Rakowski T, Sowa-Staszczak A, Glowa B, Garnuszek P, Maurin M, Karczmarczyk U, Sulowicz W, Hubalewska-Dydejczyk A. Imaging of inflamed carotid artery atherosclerotic plaques with the use of 99mTc-HYNIC-IL-2 scintigraphy in end-stage renal disease patients. Eur J Nucl Med Mol Imaging 2012; 39:673-82. [PMID: 22237843 PMCID: PMC3315638 DOI: 10.1007/s00259-011-2026-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 12/04/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE Identification of vulnerable plaques remains crucial for better cardiovascular risk assessment. At least 20% of inflammatory cells within unstable (vulnerable) plaques comprise T lymphocytes, which contain receptors for interleukin-2 (IL-2); those receptors can be identified by scintigraphy with radiolabelled IL-2.The aim of this study was to identify the "inflamed" (vulnerable) plaques by scintigraphy using IL-2 labelled with (99m)Tc in the selected, high cardiovascular risk group of end-stage renal disease (ESRD) patients. METHODS A total of 28 patients (18 men, 10 women, aged 55.2 ± 9.6 years, 17 on peritoneal dialysis, 11 on haemodialysis) underwent common carotid artery (CCA) scintigraphy with the use of (99m)Tc-hydrazinonicotinamide (HYNIC)-IL-2. In all cases, ultrasound examination of the CCA was performed and levels of selected proinflammatory factors, atherogenic markers and calcium-phosphate balance parameters were measured. Finally, the target to non-target (T/nT) ratio of IL-2 uptake in atherosclerotic plaques with intima-media thickness (IMT), classic cardiovascular risk factors and concentrations of the measured factors were compared. RESULTS Increased (99m)Tc-HYNIC-IL-2 uptake in atherosclerotic plaques in 38/41 (91%) cases was detected. The median T/nT ratio of focal (99m)Tc-HYNIC-IL-2 uptake in atherosclerotic plaques was 2.35 (range 1.23-3.63). The mean IMT value on the side of plaques assessed by scintigraphy was 0.79 ± 0.18 mm (median 0.8, range 0.5-1.275). Correlations between T/nT ratio and homocysteine (R = 0.22, p = 0.037), apolipoprotein B (apoB) (R = 0.31, p = 0.008), apoB to apoA-I ratio (R = 0.29, p = 0.012) and triglyceride concentration (R = 0.26, p = 0.021) were detected. A lower T/nT ratio in patients with better parameters of nutritional status (haemoglobin, albumin, adiponectin) in comparison with patients with worse nutritional parameters (3.20 ± 0.5 vs 2.16 ± 0.68, p = 0.025) was revealed as well as a difference between values of T/nT ratio in groups of patients with values of apoB, soluble CD40 ligand and asymmetric dimethylarginine above and below median (3.18 ± 0.52 vs 2.16 ± 0.68, p = 0.031). No statistically significant association was found between T/nT ratio and mean value of either IMT or classic cardiovascular risk factors. CONCLUSION Scintigraphy with the use of (99m)Tc-HYNIC-IL-2 can be a tool for inflamed atherosclerotic (vulnerable) plaque visualization within CCA in ESRD patients. Quantitative results of carotid artery scintigraphy with (99m)Tc-HYNIC-IL-2 correlate with serum concentration of selected cardiovascular risk markers.
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Affiliation(s)
- Marta Opalinska
- Nuclear Medicine Unit, Department of Endocrinology, Jagiellonian University Medical School, ul. Kopernika 17, 31-501 Cracow, Poland
| | - Tomasz Stompor
- Department of Nephrology, Hypertensiology and Internal Medicine, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dorota Pach
- Nuclear Medicine Unit, Department of Endocrinology, Jagiellonian University Medical School, ul. Kopernika 17, 31-501 Cracow, Poland
| | - Renata Mikolajczak
- National Centre for Nuclear Research Radioisotope Centre POLATOM, Otwock, Poland
| | - Danuta Fedak
- Clinical Biochemistry, Jagiellonian University Medical School, Cracow, Poland
| | - Marcin Krzanowski
- Department of Nephrology, Jagiellonian University Medical School, Cracow, Poland
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical School, Cracow, Poland
| | - Anna Sowa-Staszczak
- Nuclear Medicine Unit, Department of Endocrinology, Jagiellonian University Medical School, ul. Kopernika 17, 31-501 Cracow, Poland
| | - Boguslaw Glowa
- Nuclear Medicine Unit, Department of Endocrinology, Jagiellonian University Medical School, ul. Kopernika 17, 31-501 Cracow, Poland
| | - Piotr Garnuszek
- National Centre for Nuclear Research Radioisotope Centre POLATOM, Otwock, Poland
| | - Michał Maurin
- National Centre for Nuclear Research Radioisotope Centre POLATOM, Otwock, Poland
| | - Urszula Karczmarczyk
- National Centre for Nuclear Research Radioisotope Centre POLATOM, Otwock, Poland
| | - Władysław Sulowicz
- Department of Nephrology, Jagiellonian University Medical School, Cracow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Nuclear Medicine Unit, Department of Endocrinology, Jagiellonian University Medical School, ul. Kopernika 17, 31-501 Cracow, Poland
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Abstract
Diabetes mellitus is the leading cause of end-stage renal disease (ESRD), accounting for 54% of all incident cases according to the US Renal Data System. These patients suffer an extremely high mortality rate due to the very high incidence of cardiovascular disease. A significant proportion of these patients already has established cardiovascular disease at the time of initiation of dialysis treatment. More importantly, as these patients develop progressive kidney dysfunction, they are not only subjected to traditional Framingham risk factors, but, more importantly, to a whole host of "kidney disease-related risk factors" that further accelerate the progression of cardiovascular disease and thus contribute to adverse cardiovascular outcomes. The present article provides an updated view on the multitude of traditional Framingham risk factors and kidney disease-related risk factors that diabetic ESRD patients are subjected to. A better understanding of the different cardiovascular risk factors will be fundamental to institute early detection programs, as well as to provide aggressive cardiovascular management of these patients.
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Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.
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Wasse H, Cardarelli F, De Staercke C, Hooper C, Veledar E, Guessous I. 25-hydroxyvitamin D concentration is inversely associated with serum MMP-9 in a cross-sectional study of African American ESRD patients. BMC Nephrol 2011; 12:24. [PMID: 21600051 PMCID: PMC3118225 DOI: 10.1186/1471-2369-12-24] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 05/22/2011] [Indexed: 12/01/2022] Open
Abstract
Background Circulating 25-hydroxyvitamin D [25(OH)D] concentration is inversely associated with peripheral arterial disease and hypertension. Vascular remodeling may play a role in this association, however, data relating vitamin D level to specific remodeling biomarkers among ESRD patients is sparse. We tested whether 25(OH)D concentration is associated with markers of vascular remodeling and inflammation in African American ESRD patients. Methods We conducted a cross-sectional study among ESRD patients receiving maintenance hemodialysis within Emory University-affiliated outpatient hemodialysis units. Demographic, clinical and dialysis treatment data were collected via direct patient interview and review of patients records at the time of enrollment, and each patient gave blood samples. Associations between 25(OH)D and biomarker concentrations were estimated in univariate analyses using Pearson's correlation coefficients and in multivariate analyses using linear regression models. 25(OH) D concentration was entered in multivariate linear regression models as a continuous variable and binary variable (<15 ng/ml and ≥15 ng/ml). Adjusted estimate concentrations of biomarkers were compared between 25(OH) D groups using analysis of variance (ANOVA). Finally, results were stratified by vascular access type. Results Among 91 patients, mean (standard deviation) 25(OH)D concentration was 18.8 (9.6) ng/ml, and was low (<15 ng/ml) in 43% of patients. In univariate analyses, low 25(OH) D was associated with lower serum calcium, higher serum phosphorus, and higher LDL concentrations. 25(OH) D concentration was inversely correlated with MMP-9 concentration (r = -0.29, p = 0.004). In multivariate analyses, MMP-9 concentration remained negatively associated with 25(OH) D concentration (P = 0.03) and anti-inflammatory IL-10 concentration positively correlated with 25(OH) D concentration (P = 0.04). Conclusions Plasma MMP-9 and circulating 25(OH) D concentrations are significantly and inversely associated among ESRD patients. This finding may suggest a potential mechanism by which low circulating 25(OH) D functions as a cardiovascular risk factor.
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Affiliation(s)
- Haimanot Wasse
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, USA
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Spoto B, Testa A, Parlongo RM, Tripepi G, Trischitta V, Mallamaci F, Zoccali C. Insulin resistance and left ventricular hypertrophy in end-stage renal disease: association between the ENPP1 gene and left ventricular concentric remodelling. Nephrol Dial Transplant 2011; 27:661-6. [DOI: 10.1093/ndt/gfr281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Terawaki H, Yokoyama K, Yamada Y, Maruyama Y, Iida R, Hanaoka K, Yamamoto H, Obata T, Hosoya T. Low-grade endotoxemia contributes to chronic inflammation in hemodialysis patients: examination with a novel lipopolysaccharide detection method. Ther Apher Dial 2011; 14:477-82. [PMID: 21175546 DOI: 10.1111/j.1744-9987.2010.00815.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Chronic inflammation has recently been proposed to play a major role in the development of cardiovascular disease and mortality among advanced chronic kidney disease (CKD) patients; however, why advanced CKD promotes chronic inflammation is still unclear. We hypothesized that a very low level of plasma endotoxin (lipopolysaccharide [LPS]) contributes to chronic inflammation in advanced CKD patients. We measured the plasma LPS levels using a novel LPS detection method (ESP method, a method for endotoxin detection using laser scattering photometry) concurrently with serum C-reactive protein (CRP) levels and various blood tests in 17 stable hemodialysis (HD) patients. As a result, the median LPS levels measured by the ESP method was 0.23 pg/mL (range, 0.01-3.89) (inflow, start of HD), 0.22 pg/mL (<0.01-9.97) (outflow, start of HD), 0.37 pg/mL (<0.01-7.42) (inflow, end of HD), and 1.07 pg/mL (<0.01-10.66) (dialysate), respectively; statistically significant differences were not detected between them. The predialysis median CRP level was 0.19 mg/dL (0.04-3.02). The logarithm of plasma LPS independently correlated with serum CRP (R = 0.595, P = 0.0103). In multiple (forward stepwise) regression analysis, in which CRP was determined to be the criterion variable, LPS (log), albumin, and the white blood cell count were adopted as independent explanatory variables (R = 0.401, -0.397 and 0.387, respectively). In conclusion, the present study revealed a significant relationship between LPS and CRP using the novel ESP method, and suggested that very low-grade endotoxemia is contributing to systemic inflammation in HD patients.
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Affiliation(s)
- Hiroyuki Terawaki
- Division of Kidney and Hypertension, and Department of Molecular Cell Biology, Institute of DNA Medicine, Jikei University School of Medicine, Tokyo, Japan.
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40
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Koeda Y, Nakamura M, Tanaka F, Onoda T, Itai K, Tanno K, Ohsawa M, Makita S, Ishibashi Y, Koyama T, Yoshida Y, Omama SI, Ogasawara K, Ogawa A, Kuribayashi T, Okayama A. Serum C-Reactive Protein Levels and Death and Cardiovascular Events in Mild to Moderate Chronic Kidney Disease. Int Heart J 2011; 52:180-4. [DOI: 10.1536/ihj.52.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yorihiko Koeda
- Department of Internal Medicine, Iwate Medical University
| | | | | | | | - Kazuyoshi Itai
- Department of Preventive Medicine, Iwate Medical University
| | - Kozo Tanno
- Department of Preventive Medicine, Iwate Medical University
| | - Masaki Ohsawa
- Department of Preventive Medicine, Iwate Medical University
| | - Shinji Makita
- Department of Internal Medicine, Iwate Medical University
| | | | | | - Yuki Yoshida
- Department of Neurosurgery, Iwate Medical University
| | | | | | - Akira Ogawa
- Department of Neurosurgery, Iwate Medical University
| | - Toru Kuribayashi
- Department of Health and Physical Education, Faculty of Education, Iwate University
| | - Akira Okayama
- The First Institute of Health Service, Japan Anti-tuberculosis Association
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Yilmaz R, Altun B, Ozer N, Hazirolan T, Turgan C. Impact of cytokine genotype on cardiovascular surrogate markers in hemodialysis patients. Ren Fail 2010; 32:806-16. [PMID: 20662694 DOI: 10.3109/0886022x.2010.494798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/AIMS Cytokine gene polymorphisms have been implicated as potential genetic risk factors for cardiovascular diseases (CVDs). Atherosclerosis and left ventricular hypertrophy (LVH) are surrogate markers for CVDs in uremic patients. The aim of this study was to assess the role of cytokine gene polymorphisms in carotid intima-media thickness (CIMT) and left ventricular mass index (LVMI) progression in nondiabetic hemodialysis (HD) patients. METHODS About 102 nondiabetic patients on maintenance HD were included in this study. Patients were followed up for 2 years. Genetic polymorphisms of TNF-alpha (-308 G/A, -238A/G) and IL-10 (-1082 A/G, -819 C/T, -592 A/C) were determined by polymerase chain reaction. Biochemical parameters and inflammatory markers and ambulatory blood pressure (BP) measurements were determined during the study period. CIMT and LVMI were also determined at baseline and after the first and second year. RESULTS Cardiovascular risk factors did not differ between TNF-alpha -308 high-/low-producer genotype groups. However, CIMT and LVMI progression were detected at higher levels in patients with high-producer genotypes (AA+AG) than in patients with the low-producer genotype (GG) during the study period. The TNF-alpha -308 G/A polymorphism was closely associated with C-reactive protein (CRP), a marker of systemic inflammation in the study population. Analysis also showed that the combination of high production of TNF-alpha and low production of IL-10 was associated with higher average IMT and LVMI progression and elevated average CRP levels compared with a combination of low production of TNF-alpha and high production of IL-10. CONCLUSION Polymorphisms in inflammatory genes may represent an additional factor affecting inflammation and CVD progression in nondiabetic HD patients.
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Affiliation(s)
- Rahmi Yilmaz
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Morishita Y, Hanawa S, Chinda J, Iimura O, Tsunematsu S, Kusano E. Effects of Aliskiren on blood pressure and the predictive biomarkers for cardiovascular disease in hemodialysis-dependent chronic kidney disease patients with hypertension. Hypertens Res 2010; 34:308-13. [DOI: 10.1038/hr.2010.238] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rebić D, Rasić S, Uncanin S, Dzemidzić J, Muslimović A, Catović A, Mujaković A. The influence of risk factors in remodelling carotid arteries in patients undergoing peritoneal dialysis. Bosn J Basic Med Sci 2010; 10 Suppl 1:S79-82. [PMID: 20433437 DOI: 10.17305/bjbms.2010.2654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Accelerated atherosclerosis and vascular calcification, with oxidative stress, endothelial dysfunction, and other factors causing the arterial stiffness, increases cardiovascular morbidity and mortality in patients on peritoneal dialysis. The aim of this paper is to assess changes in intima media thickness (IMT) at common carotid arteries (CCA) in patients with stable continuous ambulatory peritoneal dialysis (PD) and examine the relationship of these changes and other risk factors on the occurrence of atherosclerosis. The study was conducted on 35 stable PD patients (25 type 2 diabetic patients), aged 58.6 +/- 10.6 years. CCA-IMT was assessed using ultrasound B-mode technique, bilaterally. Other risk factors for the occurrence of atherosclerosis were monitored through regular laboratory control. One atheromatous plaque was found in 19 patients (54.3%). Among 25 type 2 diabetic patients, vascular calcifications were found in 80% patients. In all PD patients, CCA-IMT is 0.77 +/- 0.23, in PD patients with vascular calcifications CCA-IMT is 1.05 +/- 0.2 mm, while in group without vascular calcifications the value of this parameter is 0.56 +/- 0.09 (p<0.01 ). Significant differences were found between PD patients with and without vascular calcifications on CCA in patients age (p<0.001), as well as values of systolic blood pressure (p=0.001), serum phosphorus (p=0.017), product calcium and phosphorus (p=0.021), CRP (p=0.039), triglycerides (p<0.05) and lipoprotein (a) values (p=0.044). Our results suggest an important determination of common carotid arteries intima media thickness and its relation to other risk factors for the occurrence and progression of atherosclerosis in patients undergoing peritoneal dialysis.
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Affiliation(s)
- Damir Rebić
- Clinic for Nephrology, University of Sarajevo Clinics Centre, Bolnicka 25, Sarajevo, Bosnia and Herzegovina
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Demirci MS, Demirci C, Ozdogan O, Kircelli F, Akcicek F, Basci A, Ok E, Ozkahya M. Relations between malnutrition-inflammation-atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients. Nephrol Dial Transplant 2010; 26:1708-16. [DOI: 10.1093/ndt/gfq588] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Mutluay R, Konca C, Erten Y, Paşaoğlu H, Değer SM, Ağirgün C, Derici U, Arinsoy T, Sindel S. Predictive markers of asymptomatic atherosclerosis in end-stage renal disease patients. Ren Fail 2010; 32:448-54. [PMID: 20446782 DOI: 10.3109/08860221003658258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Uremia is associated with accelerated atherosclerosis and increased cardiovascular mortality in patients with end-stage renal disease (ESRD). Cardiac injury markers, such as myoglobin, creatine kinase-MB (CK-MB), or troponins, frequently used to recognize acute coronary events, may be falsely elevated in this patient group. In this study, our aim was to (i) test serum levels of myoglobin, CK-MB, and troponin I (cTnI) in ESRD patients without coronary artery disease (CAD) and compare the results with healthy controls and (ii) to investigate the association between these markers and carotid artery intima-media thickness (CA-IMT), high-sensitive C-reactive protein (hs-CRP), and serum uric acid (SUA) levels in ESRD patients. MATERIALS AND METHODS Fifty-two ESRD patients (25 hemodialysis and 27 peritoneal dialysis) and 17 healthy controls were included in the study. Serum levels of myoglobin, CK-MB, and cTnI were measured and ultrasonographic CA-IMT was determined in all participants. SUA and hs-CRP levels were only measured in the ESRD group. RESULTS Serum myoglobin, CK-MB levels, and the mean CA-IMT were significantly higher in ESRD group (p < 0.01), whereas cTnI levels were not different compared to healthy controls (p = 0.70). There was also a positive correlation between CA-IMT and cTnI levels (p = 0.003, r = 0.35) and CA-IMT and hs-CRP (p = 0.03, r = 0.30) or SUA levels (p = 0.003, r = 0.43). CONCLUSION cTnI may serve as a more sensitive marker in detecting cardiovascular events in patients with renal failure. Besides the traditional risk factors of atherosclerosis, cTnI, hs-CRP, and SUA may have a predictive role in recognizing premature atherosclerosis in ESRD patients.
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Affiliation(s)
- Rüya Mutluay
- Department of Nephrology, Gazi University Hospital, 06100, Ankara, Turkey
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Vannini FD, Antunes AA, Caramori JCT, Martin LC, Barretti P. Associations between nutritional markers and inflammation in hemodialysis patients. Int Urol Nephrol 2010; 41:1003-9. [PMID: 19363697 DOI: 10.1007/s11255-009-9563-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study is to evaluate associations between clinical, laboratory, demographic, and nutritional markers with inflammatory state and malnutrition in hemodialysis (HD) patients. Fifty-two patients on regular HD were evaluated by clinical, demographic, laboratory, and nutritional parameters (food intake, anthropometric measurements, bioelectric impedance, subjective global assessment--SGA and appetite characteristics). Inflammation (serum C-reactive protein >or= 0.9 mg/dl) was present in 13 (25%) and malnutrition (SGA) in 16 (30.7%) patients. Body mass index (BMI), total lymphocytes count, and phase angle were negative and independently associated with malnutrition. Values of BMI >or= 25 kg/m2 were associated with diabetes, positively associated with adipose tissue percentage (BIA) and negatively associated with diastolic blood pressure. Phase angle was positively associated with hematocrit, total lymphocytes count and serum creatinine, and was negatively associated with age. A negative and independent association between muscle mass percentage (BIA) and inflammation was observed. These results suggested that inflammatory state induces muscle mass depletion, while high BMI is associated with diabetes and with lower diastolic blood pressure, a recognized cardiovascular risk factor in uremic patients. Phase angle and SGA were associated with traditional nutritional markers, reinforcing their validity for HD patients.
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Affiliation(s)
- Franciele D Vannini
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, SP, Brazil
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Segall L, Covic A. What to Measure at Dialysis Initiation for Reliable Prediction of Cardiovascular Outcomes: Just Look at CRP and Pulse Pressure. Perit Dial Int 2010; 30:280-3. [DOI: 10.3747/pdi.2010.00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Liviu Segall
- Nephrology Department Dr. C.I. Parhon Hospital “Gr. T. Popa” University of Medicine and Pharmacy Iasi, Romania
| | - Adrian Covic
- Nephrology Department Dr. C.I. Parhon Hospital “Gr. T. Popa” University of Medicine and Pharmacy Iasi, Romania
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Lütfioğlu M, Sakallioğlu U, Sakallioğlu EE, Diraman E, Ciftçi G, Tutkun F. Dietary-induced hyperparathyroidism affects serum and gingival proinflammatory cytokine levels in rats. J Periodontol 2010; 81:150-7. [PMID: 20059427 DOI: 10.1902/jop.2009.090353] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Poor diet and inadequate nutrition are suggested to affect the periodontium as well as impair the systemic health. This study investigated the systemic and periodontal effects of dietary-induced hyperparathyroidism (dHPT) by evaluating serum and gingival proinflammatory cytokine levels. METHODS Twenty-four Sprague-Dawley rats were used in the study. dHPT was induced in 12 rats by calcium/phosphorus imbalance, and 12 rats were fed a standard diet (SD). Afterward, endotoxin-induced periodontitis was induced on the right mandibular molar teeth (mmt). Four study groups were created: dHPT + mmt without periodontitis (group 1), dHPT + mmt with periodontitis (group 2), SD + mmt with periodontitis (group 3), and SD + mmt without periodontitis (group 4). Interleukin (IL)-1beta and tumor necrosis factor-alpha (TNF-alpha) levels were measured by enzyme-linked immunosorbent assay to evaluate the proinflammatory cytokine profiles. Serum cytokines were analyzed in the blood samples collected prior to periodontitis induction, whereas gingival cytokines were analyzed in the gingival supernatants of the four groups. RESULTS Serum cytokines were higher in dHPT rats than in SD rats (P <0.001), with a positive correlation between parathormone and the cytokines (P <0.001). Gingival cytokines were highest in group 2 and lowest in group 4 (group 2 > group 3 > group 1) (P <0.001). There was a positive correlation between parathormone and the gingival cytokines in group 1 (P <0.001 for IL-1beta; P <0.01 for TNF-alpha). CONCLUSION The results suggested that increased serum proinflammatory cytokine production may be a complication of dHPT, and this may affect healthy and diseased periodontia by increasing gingival proinflammatory cytokine levels.
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Affiliation(s)
- Müge Lütfioğlu
- Department of Periodontology, Ondokuz Mayis University, 55139/Kurupelit, Samsun, Turkey.
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da Costa JAC, Alp Ikizler T. Inflammation and Insulin Resistance as Novel Mechanisms of Wasting in Chronic Dialysis Patients. Semin Dial 2009; 22:652-7. [DOI: 10.1111/j.1525-139x.2009.00664.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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The association between pulse pressure and vascular access thrombosis in chronic hemodialysis patients. Hypertens Res 2009; 32:712-5. [PMID: 19590503 DOI: 10.1038/hr.2009.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vascular access thrombosis (VAT) is a major cause of morbidity in chronic hemodialysis (HD) patients and is characterized by chronic inflammation. Pulse pressure (PP) is positively associated with chronic inflammation. Whether patients with high PP are at a higher risk for VAT, however, remains unknown. We retrospectively reviewed chronic HD patients with a functional vascular access point at the China Medical University Hospital between 1986 and 2005. The association between PP and the initial development of VAT at the primary vascular access point was examined using the Kaplan-Meier analysis and multivariate Cox proportional hazards regression. A total of 576 chronic HD patients (264 men and 312 women) with a mean age of 56.9+/-14.0 years were reviewed, of whom 145 (25.2%) experienced at least one episode of VAT. Patients with a PP>60 mm Hg had a lower VAT-free survival rate compared with those with a PP<60 mm Hg (P<0.001). Using Cox regression with adjustments for age, systolic blood pressure and vascular access types, PP (every increase of 10 mm Hg) and serum C-reactive protein (CRP) (every increase of 1 mg per 100 ml) were found to be independently associated with an increasing risk for VAT, with a hazard ratio of 2.57 (95% confidence interval: 1.5-4.4, P=0.001) and 1.14 (95% confidence interval: 1.01-1.27, P=0.017), respectively. High PP was associated with the development of VAT in chronic HD patients. This association was independent of serum CRP levels.
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