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Tavener SK, Jewell DE, Panickar KS. The Increase in Circulating Levels of Pro-Inflammatory Chemokines, Cytokines, and Complement C5 in Canines with Impaired Kidney Function. Curr Issues Mol Biol 2022; 44:1664-1676. [PMID: 35723372 PMCID: PMC9164022 DOI: 10.3390/cimb44040114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic low-grade inflammation is a key contributor to the progression of kidney disease. The release of cytokines and other pro-inflammatory proteins may further contribute to detrimental kidney health by increasing interstitial edema and renal fibrosis. The aim of the present study was to investigate the inflammatory markers in canines who developed renal disease naturally and were diagnosed with renal disease either during life or following necropsy, as assessed by a veterinarian. RNA was isolated from canine blood obtained at necropsy and stored as bioarchived samples from ten canines with renal disease (9.6−14.7 yr) and ten controls (10.1−14.8 yr). At the time of death, the mean blood creatinine concentration and BUN were elevated in dogs with renal disease compared to control (both p < 0.01). Samples were assessed for changes in gene expression using the Canine cytokine RT2 Profiler PCR Array for inflammation. There was a significant increase in C-C Motif Chemokine Ligand 16 (CCL16), C-X-C Motif Chemokine Ligand 5 (CXCL5), Interleukin 16 (IL-16), and Complement Component 5 (C5) (all p < 0.05 vs. con). In addition, there was also a statistically non-significant increase in 49 genes and a down-regulation in 35 genes from a panel of total 84 genes. Pro-inflammatory genes including CCL16, CXCL5, IL-16, and C5 can all contribute to renal inflammation and fibrosis through different signaling pathways and may lead to a progressive impairment of kidney function. Blockade of their activation may be important in ameliorating the initiation and/or the progression of renal disease.
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Affiliation(s)
- Selena K. Tavener
- Science & Technology Center, Hill’s Pet Nutrition, Inc., Topeka, KS 66617, USA;
| | - Dennis E. Jewell
- Department of Grain Science & Industry, Kansas State University, Manhattan, KS 66506, USA;
| | - Kiran S. Panickar
- Science & Technology Center, Hill’s Pet Nutrition, Inc., Topeka, KS 66617, USA;
- Correspondence: ; Tel.: 1-(785)-286-8002
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Bowry SK, Kircelli F, Himmele R, Nigwekar SU. Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation. Clin Kidney J 2022; 14:i59-i71. [PMID: 34987786 PMCID: PMC8711760 DOI: 10.1093/ckj/sfab185] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 12/14/2022] Open
Abstract
Blood-incompatibility is an inevitability of all blood-contacting device applications and therapies, including haemodialysis (HD). Blood leaving the environment of blood vessels and the protection of the endothelium is confronted with several stimuli of the extracorporeal circuit (ECC), triggering the activation of blood cells and various biochemical pathways of plasma. Prevention of blood coagulation, a major obstacle that needed to be overcome to make HD possible, remains an issue to contend with. While anticoagulation (mainly with heparin) successfully prevents clotting within the ECC to allow removal of uraemic toxins across the dialysis membrane wall, it is far from ideal, triggering heparin-induced thrombocytopenia in some instances. Soluble fibrin can form even in the presence of heparin and depending on the constitution of the patient and activation of platelets, could result in physical clots within the ECC (e.g. bubble trap chamber) and, together with other plasma and coagulation proteins, result in increased adsorption of proteins on the membrane surface. The buildup of this secondary membrane layer impairs the transport properties of the membrane to reduce the clearance of uraemic toxins. Activation of complement system-dependent immune response pathways leads to leukopenia, formation of platelet–neutrophil complexes and expression of tissue factor contributing to thrombotic processes and a procoagulant state, respectively. Complement activation also promotes recruitment and activation of leukocytes resulting in oxidative burst and release of pro-inflammatory cytokines and chemokines, thereby worsening the elevated underlying inflammation and oxidative stress condition of chronic kidney disease patients. Restricting all forms of blood-incompatibility, including potential contamination of dialysis fluid with endotoxins leading to inflammation, during HD therapies is thus still a major target towards more blood-compatible and safer dialysis to improve patient outcomes. We describe the mechanisms of various activation pathways during the interaction between blood and components of the ECC and describe approaches to mitigate the effects of these adverse interactions. The opportunities to develop improved dialysis membranes as well as implementation strategies with less potential for undesired biological reactions are discussed.
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Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
| | - Fatih Kircelli
- Global Medical Information and Education, Fresenius Medical Care, Bad Homburg, Germany
| | - Rainer Himmele
- Global Medical Information and Education, Fresenius Medical Care, Charlotte, NC, USA
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Bowry SK, Chazot C. The scientific principles and technological determinants of haemodialysis membranes. Clin Kidney J 2021; 14:i5-i16. [PMID: 34987782 PMCID: PMC8711766 DOI: 10.1093/ckj/sfab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
In most biological or industrial (including medical) separation processes, a membrane is a semipermeable barrier that allows or achieves selective transport between given compartments. In haemodialysis (HD), the semipermeable membrane is in a tubular geometry in the form of miniscule pipes (hollow fibres) and separation processes between compartments involve a complex array of scientific principles and factors that influence the quality of therapy a patient receives. Several conditions need to be met to accomplish the selective and desired removal of substances from blood in the inner cavity (lumen) of the hollow fibres and across the membrane wall into the larger open space surrounding each fibre. Current HD membranes have evolved and improved beyond measure from the experimental membranes available in the early developmental periods of dialysis. Today, the key functional determinants of dialysis membranes have been identified both in terms of their potential to remove uraemic retention solutes (termed ‘uraemic toxins’) as well subsidiary criteria they must additionally fulfill to avoid undesirable patient reactions or to ensure safety. The production of hundreds of millions of kilometres of hollow fibre membranes is truly a technological achievement to marvel, particularly in ensuring that the fibre dimensions of wall thickness and inner lumen diameter and controlled porosity—all so vital to core solute removal and detoxification functions of dialysis—are maintained for every centimetre length of the fragile fibres. Production of membranes will increase in parallel with the increase in the number of chronic kidney disease (CKD) patients expected to require HD therapies in the future. The provision of high-quality care entails detailed consideration of all aspects of dialysis membranes, as quality cannot in any way be compromised for the life-sustaining—like the natural membranes within all living organisms—function artificial dialysis membranes serve.
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Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
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Bowry SK, Kircelli F, Nandakumar M, Vachharajani TJ. Clinical relevance of abstruse transport phenomena in haemodialysis. Clin Kidney J 2021; 14:i85-i97. [PMID: 34987788 PMCID: PMC8711756 DOI: 10.1093/ckj/sfab183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
Haemodialysis (HD) utilizes the bidirectional properties of semipermeable membranes to remove uraemic toxins from blood while simultaneously replenishing electrolytes and buffers to correct metabolic acidosis. However, the nonspecific size-dependent transport across membranes also means that certain useful plasma constituents may be removed from the patient (together with uraemic toxins), or toxic compounds, e.g. endotoxin fragments, may accompany electrolytes and buffers of the dialysis fluids into blood and elicit severe biological reactions. We describe the mechanisms and implications of these undesirable transport processes that are inherent to all HD therapies and propose approaches to mitigate the effects of such transport. We focus particularly on two undesirable events that are considered to adversely affect HD therapy and possibly impact patient outcomes. Firstly, we describe how loss of albumin (and other essential substances) can occur while striving to eliminate larger uraemic toxins during HD and why hypoalbuminemia is a clinical condition to contend with. Secondly, we describe the origins and mode of transport of biologically active substances (from dialysis fluids with bacterial contamination) into the blood compartment and biological reactions they elicit. Endotoxin fragments activate various proinflammatory pathways to increase the underlying inflammation associated with chronic kidney disease. Both phenomena involve the physical as well as chemical properties of membranes that must be selected judiciously to balance the benefits with potential risks patients may encounter, in both the short and long term.
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Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
| | - Fatih Kircelli
- Global Medical Information and Education, Fresenius Medical Care, Bad Homburg, Germany
| | | | - Tushar J Vachharajani
- Department of Hypertension and Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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Hammes MS, Watson S, Coe FL, Ahmed F, Beltran E, Dhar P. Asymmetric dimethylarginine and whole blood viscosity in renal failure. Clin Hemorheol Microcirc 2016; 59:245-55. [PMID: 24840340 DOI: 10.3233/ch-141843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Renal failure is a disease with accelerated atherosclerosis beginning with endothelial cell dysfunction. Factors affecting endothelial cell dysfunction include whole blood viscosity (WBV) and asymmetric dimethylarginine (ADMA). The relationship in controls and renal failure was determined. METHODS 51 subjects, 20 controls, 11 renal transplant recipients, 10 chronic kidney disease and 10 end-stage renal disease patients had blood samples drawn for WBV, Hematocrit, and ADMA. WBV was measured at various shear rates from 10 s(-1) to 780 s(-1) at 37 °C. Hematocrit using CritSpin, and ADMA was assayed using an ELISA method. The significance between groups was compared by boxplots and analysis of variance. Linear relationships were shown by regression lines and correlation coefficients. RESULTS ADMA was elevated in all groups with renal failure when compared to controls (p < 0.05). Control subjects showed a positive correlation between ADMA and WBV, while those who received a renal transplant had a negative correlation (p < 0.05). The difference in ADMA comparing pre-dialysis to post-dialysis conditions was positive (p < 0.05). CONCLUSIONS The positive relationship between WBV and ADMA in controls is a novel finding and allows for comparison with other groups. This relationship is dramatically altered in renal failure.
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Affiliation(s)
- Mary S Hammes
- Department of Medicine, Nephrology Section, The University of Chicago, Chicago, IL, USA
| | - Sydeaka Watson
- Department of Health Studies, Biostatistics Laboratory, The University of Chicago, Chicago, IL, USA
| | - Frederic L Coe
- Department of Medicine, Nephrology Section, The University of Chicago, Chicago, IL, USA
| | - Faris Ahmed
- Department of Medicine, Nephrology Section, The University of Chicago, Chicago, IL, USA
| | - Emily Beltran
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Promila Dhar
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
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Rempel LCT, Finco AB, Maciel RAP, Bosquetti B, Alvarenga LM, Souza WM, Pecoits-Filho R, Stinghen AEM. Effect of PKC-β Signaling Pathway on Expression of MCP-1 and VCAM-1 in Different Cell Models in Response to Advanced Glycation End Products (AGEs). Toxins (Basel) 2015; 7:1722-37. [PMID: 26008233 PMCID: PMC4448170 DOI: 10.3390/toxins7051722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/05/2015] [Indexed: 12/18/2022] Open
Abstract
Advanced glycation end products (AGEs) are compounds classified as uremic toxins in patients with chronic kidney disease that have several pro-inflammatory effects and are implicated in the development of cardiovascular diseases. To explore the mechanisms of AGEs–endothelium interactions through the receptor for AGEs (RAGE) in the PKC-β pathway, we evaluated the production of MCP-1 and VCAM-1 in human endothelial cells (HUVECs), monocytes, and a coculture of both. AGEs were prepared by albumin glycation and characterized by absorbance and electrophoresis. The effect of AGEs on cell viability was assessed with an MTT assay. The cells were also treated with AGEs with and without a PKC-β inhibitor. MCP-1 and VCAM-1 in the cell supernatants were estimated by ELISA, and RAGE was evaluated by immunocytochemistry. AGEs exposure did not affect cell viability, but AGEs induced RAGE, MCP-1, and VCAM-1 expression in HUVECs. When HUVECs or monocytes were incubated with AGEs and a PKC-β inhibitor, MCP-1 and VCAM-1 expression significantly decreased. However, in the coculture, exposure to AGEs and a PKC-β inhibitor produced no significant effect. This study demonstrates, in vitro, the regulatory mechanisms involved in MCP-1 production in three cellular models and VCAM-1 production in HUVECs, and thus mimics the endothelial dysfunction caused by AGEs in early atherosclerosis. Such mechanisms could serve as therapeutic targets to reduce the harmful effects of AGEs in patients with chronic kidney disease.
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Affiliation(s)
- Lisienny C T Rempel
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná; Av. Cel. Francisco H. dos Santos, S/N, Jd. das Américas, Curitiba, PR, 81.531-980, Brazil.
| | - Alessandra B Finco
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná; Av. Cel. Francisco H. dos Santos, S/N, Jd. das Américas, Curitiba, PR, 81.531-980, Brazil.
| | - Rayana A P Maciel
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná; Av. Cel. Francisco H. dos Santos, S/N, Jd. das Américas, Curitiba, PR, 81.531-980, Brazil.
| | - Bruna Bosquetti
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná; Av. Cel. Francisco H. dos Santos, S/N, Jd. das Américas, Curitiba, PR, 81.531-980, Brazil.
| | - Larissa M Alvarenga
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná; Av. Cel. Francisco H. dos Santos, S/N, Jd. das Américas, Curitiba, PR, 81.531-980, Brazil.
| | - Wesley M Souza
- Universidade Tuiuti do Paraná, Rua Sydnei Antonio Rangel Santos, 238, Santo Inácio, Curitiba, PR, 82.010-330, Brazil.
- Clinical Analysis Department, Universidade Federal do Paraná, Av. Lothário Meissner, 632, Curitiba, PR, 81.531-980, Brazil.
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Av. Imaculada Conceição, 1155, Curitiba, PR, 80.215-901, Brazil.
| | - Andréa E M Stinghen
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná; Av. Cel. Francisco H. dos Santos, S/N, Jd. das Américas, Curitiba, PR, 81.531-980, Brazil.
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7
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Gross P, Six I, Kamel S, Massy ZA. Vascular toxicity of phosphate in chronic kidney disease: beyond vascular calcification . Circ J 2014; 78:2339-46. [PMID: 25077548 DOI: 10.1253/circj.cj-14-0735] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic kidney disease (CKD) is characterized by high cardiovascular morbidity/mortality, which is linked in part to vascular calcification (VC) and endothelial dysfunction (ED). Hyperphosphatemia, a feature of CKD, is a well-known inducer of VC in preclinical models and is associated with poor outcomes in epidemiological studies. However, it remains to be seen whether lowering phosphate levels in CKD patients reduces VC and the morbidity/mortality rate. Furthermore, it is now clear from preclinical and clinical studies that phosphate is involved in ED. The present article reviews the direct and indirect mechanisms (eg, via fibroblast growth factor 23 and/or parathyroid hormone) by which hyperphosphatemia influence the onset of VC and ED in CKD.
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Impaired L-Arginine Uptake But Not Arginase Contributes to Endothelial Dysfunction in Rats With Chronic Kidney Disease. J Cardiovasc Pharmacol 2014; 63:40-8. [DOI: 10.1097/fjc.0000000000000022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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9
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Chang JF, Hsu SP, Pai MF, Yang JY, Chen HY, Wu HY, Peng YS. High soluble vascular cell adhesion molecule-1 concentrations predict long-term mortality in hemodialysis patients. Int Urol Nephrol 2013; 45:1693-701. [DOI: 10.1007/s11255-013-0425-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/16/2013] [Indexed: 11/29/2022]
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Rodrigues SD, Batista GB, Ingberman M, Pecoits-Filho R, Nakao LS. Plasma Cysteine/Cystine Reduction Potential Correlates with Plasma Creatinine Levels in Chronic Kidney Disease. Blood Purif 2012; 34:231-7. [DOI: 10.1159/000342627] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 08/09/2012] [Indexed: 01/16/2023]
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ZSOM M, FÜLÖP T, ZSOM L, BARÁTH Á, MARÓTI Z, ENDREFFY E. Genetic polymorphisms and the risk of progressive renal failure in elderly Hungarian patients. Hemodial Int 2011; 15:501-8. [DOI: 10.1111/j.1542-4758.2011.00593.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/01/2011] [Indexed: 01/21/2023]
Affiliation(s)
| | - Tibor FÜLÖP
- Department of Internal Medicine; Division of Nephrology; University of Mississippi Medical Center; Jackson; Mississippi; USA
| | - Lajos ZSOM
- Department of Internal Medicine; Division of Nephrology; University of Mississippi Medical Center; Jackson; Mississippi; USA
| | - Ákos BARÁTH
- Department of Pediatrics and Child Health Center; Albert Szent-Györgyi Medical Center; Faculty of Medicine; University of Szeged; Szeged; Hungary
| | - Zoltán MARÓTI
- Department of Pediatrics and Child Health Center; Albert Szent-Györgyi Medical Center; Faculty of Medicine; University of Szeged; Szeged; Hungary
| | - Emőke ENDREFFY
- Department of Pediatrics and Child Health Center; Albert Szent-Györgyi Medical Center; Faculty of Medicine; University of Szeged; Szeged; Hungary
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Stinghen AEM, Pecoits-Filho R. Vascular damage in kidney disease: beyond hypertension. Int J Hypertens 2011; 2011:232683. [PMID: 21876786 PMCID: PMC3160729 DOI: 10.4061/2011/232683] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/30/2011] [Accepted: 07/03/2011] [Indexed: 12/24/2022] Open
Abstract
Chronic kidney disease (CKD) is highly prevalent and a multiplier of cardiovascular disease (CVD) and cannot be completely explained by traditional Framinghan risk factors. Consequently, greater emphasis has been placed in nontraditional risk factors, such as inflammation, endothelial dysfunction, sympathetic overactivation, protein-energy wasting oxidative stress, vascular calcification, and volume overload. The accumulation of uremic toxins (and the involvement of genetic factors) is responsible for many of the clinical consequences of a condition known as uremia. In this brief paper, we discuss mechanisms involved in the vascular damage of CKD patients, aiming to point out that important factors beyond hypertension are largely responsible for endothelial activation and increased CVD risk, with potential impact on risk stratification and development of novel therapeutic options.
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Affiliation(s)
- Andréa E M Stinghen
- Basic Pathology Department, Laboratory of Experimental Nephrology, Universidade Federal do Paraná, 80531-980 Curitiba, PR, Brazil
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Petchey WG, Hawley CM, Johnson DW, Haluska BA, Watkins TW, Isbel NM. Multimodality vascular imaging in CKD: divergence of risk between measured parameters. Nephrol Dial Transplant 2011; 27:1004-12. [PMID: 21771753 DOI: 10.1093/ndt/gfr397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High cardiovascular risk in chronic kidney disease (CKD) patients appears only partly attributable to atherosclerosis, with much of the remaining risk being ascribed to other vasculature abnormalities, including endothelial dysfunction, arterial stiffness and vascular calcification (VC). To date, these factors have been primarily studied in isolation or in dialysis patients. This study performed a global vascular assessment in moderate CKD and assessed the relationships with both traditional and novel risk factors. METHODS This was a prospective cross-sectional analysis of 120 patients (age 60 ± 10 years; estimated glomerular filtration rate 25-60 mL/min/1.73m(2)). Demographic, clinical and biochemical characterization was performed. VC was characterized by lateral lumbar radiograph; arterial stiffness by aortic pulse-wave velocity (PWV); atheroma burden by carotid intima-media thickness (cIMT) and endothelial function by flow-mediated dilation (FMD) of the brachial artery. RESULTS VC was highly prevalent (74%), and FMD generally poor (FMDΔ 3.3 ± 3.3%). There were significant correlations between all vascular parameters; although these were predominantly explained by age. cIMT was independently associated with classical risks and also PWV (adjusted standardized β = 0.31, P = 0.001). However, traditional risks showed almost no independent associations with other vascular measurements. In contrast, serum phosphate and 1,25-dihydroxyvitamin D (1,25-OHD) correlated with PWV and the presence of VC, respectively. After adjustment, every 1 pg/mL increase in 1,25-OHD was related to a 3% reduction in the chance of VC (odds ratio 0.97; 95% confidence interval 0.94-1.00, P = 0.03). Medication use, HOMA-IR and C-reactive protein did not correlate with any of the vascular measures. CONCLUSIONS This study demonstrates extensive vascular disease across multimodality imaging in moderate CKD. Atherosclerotic burden correlated with traditional risks and PWV, while higher 1,25-OHD was associated with less VC. The lack of association between renal function and imaging indices raises the possibility of a threshold, rather than graded uraemic effect on vascular health that warrants further exploration.
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Affiliation(s)
- William G Petchey
- Centre for Clinical Research Excellence—Cardiovascular Disease and Metabolic Disorders, School of Medicine, University of Queensland, Brisbane, Australia
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Hogas S, Ardeleanu S, Segall L, Serban DN, Serban IL, Hogas M, Apetrii M, Onofriescu M, Sascau R, Covic A. Changes in arterial stiffness following dialysis in relation to overhydration and to endothelial function. Int Urol Nephrol 2011; 44:897-905. [DOI: 10.1007/s11255-011-9933-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
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15
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Bronas UG. Exercise training and reduction of cardiovascular disease risk factors in patients with chronic kidney disease. Adv Chronic Kidney Dis 2009; 16:449-58. [PMID: 19801135 DOI: 10.1053/j.ackd.2009.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Observational studies have reported a significant inverse association between physical function/aerobic capacity and mortality in patients with CKD. Several randomized controlled trials have provided evidence of a cardioprotective effect of exercise training via multiple mechanisms, which may result in a reduction of cardiovascular disease risk factors in patients with CKD. This review focuses on the available evidence for the role of exercise training in the reduction of cardiovascular disease risk factors as classified into antiatherosclerotic, anti-ischemic, antiarrhythmic, and antithrombotic protective effects. Preliminary evidence, primarily from studies in patients requiring hemodialysis, suggests that exercise training improves arterial compliance, cardiac autonomic control, and left ventricular systolic function while decreasing inflammation, oxidative stress, and blood pressure levels. It is concluded that these studies have provided preliminary evidence that exercise training may result in a reduction of cardiovascular disease risk factors. The available evidence supports the use of therapeutic exercise training as an adjunct component of a comprehensive treatment program for patients with CKD. However, it is clear that much additional research is required to confirm the apparent, multiple, cardioprotective effects of exercise training and to identify additional mechanisms, especially in patients with predialysis CKD.
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16
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Chu PL, Chiu YL, Lin JW, Chen SI, Wu KD. Effects of low- and high-flux dialyzers on oxidative stress and insulin resistance. Blood Purif 2008; 26:213-20. [PMID: 18285698 DOI: 10.1159/000117440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 11/09/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality in patients with end-stage renal disease (ESRD). The cornerstone of high CVD incidence in ESRD patients is endothelial dysfunction which results from inflammation, oxidative stress and insulin resistance. Although various modalities of hemodialysis (HD) have been presumed to exert different effects on oxidative stress and insulin resistance, solid evidence is still lacking. METHODS 40 ESRD patients undergoing HD were prospectively enrolled and divided randomly into two groups. Patients in each group received either F8 HPS (low-flux) (Group A) or FX80 (high-flux) (Group B) as HD dialyzers for 2 consecutive months. Diet pattern and medications were kept as usual in both groups to avoid considerable blood glucose change during study period. Blood samples were taken at the start and end of the study. RESULTS A total of 38 patients (18 and 20 for Groups A and B, respectively) completed the study. Within each group, there was no change in adiponectin, plasma 8-iso-prostaglandin F(2)(alpha), high-sensitivity C-reactive protein, blood glucose and insulin after 2 months of treatment except a significant change of HOMA(IR) (p = 0.02) in high-flux group. The significant change of HOMA(IR) between the two groups (p = 0.017) mainly results from the parallel change of insulin between the two groups (p = 0.03). CONCLUSION For patients receiving HD, the high-flux dialyzer with synthetic polysulfone membranes fails to provide a better anti-inflammatory or antioxidative effect than the low-flux dialyzer; however, the high-flux dialyzer does significantly improve insulin resistance in this short-term study. This result implies that the high-flux dialyzer might provide better cardiovascular protection than the low-flux dialyzer. Therefore, the low-flux dialyzer might be considered for patients who only need short-term HD therapy. Regarding patients under long-term maintenance HD therapy, a high-flux dialyzer might be the choice of dialyzer.
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Affiliation(s)
- Pei-Lun Chu
- Duke University, Cell and Molecular Biology Program, Durham, NC, USA
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17
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Toussaint ND, Kerr PG. Vascular calcification and arterial stiffness in chronic kidney disease: implications and management. Nephrology (Carlton) 2007; 12:500-9. [PMID: 17803475 DOI: 10.1111/j.1440-1797.2007.00823.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular (CV) disease is the commonest cause of mortality in patients with chronic kidney disease (CKD). Vascular calcification (VC), induced by calcium and phosphate excess and uraemia, is a major risk factor and is independently associated with CV events and death. Local and systemic calcium-regulatory proteins as well as inhibitory extracellular factors are involved in the pathogenesis of VC. In CKD the balance becomes dysregulated leading to differentiation of vascular smooth muscle cells into phenotypically distinct osteoblast-like cells with subsequent ossification of the arterial wall. Associated with imbalances in mineral metabolism, VC has intimate interactions with bone mineralization and enhanced bone resorption. Arterial stiffness represents the functional disturbance of VC, with reduced compliance of large arteries, and predominantly results from greater medial calcification. As with VC, arterial stiffness is an independent predictor of CV mortality and patients with CKD have greater arterial stiffness than the general population resulting in the principal consequences of left ventricular hypertrophy and altered coronary perfusion. Both VC and arterial stiffness can be measured through non-invasive techniques involving computed tomography, ultrasound, echocardiography, and pulse wave velocity. Management in CKD is difficult but detection, prevention and treatment is crucial to reduce CV mortality. The optimal control of mineral metabolism, especially hyperphosphatemia with non-calcium based phosphate binders, has been shown to be effective to reduce VC, and attenuation of arterial stiffness, especially with good blood pressure control, can have a favourable effect with regression of left ventricular hypertrophy. The use of bisphosphonates, calcimimetics, vitamin D therapy and newer experimental treatments, as well as nocturnal dialysis, may have potential benefit.
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Affiliation(s)
- Nigel D Toussaint
- Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.
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Zenovich AG, Taylor DA. Cell Therapy in Kidney Disease: Cautious Optimism … But Optimism Nonetheless. Perit Dial Int 2007. [DOI: 10.1177/089686080702702s17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The recently discovered therapeutic potential of stem or progenitor cells has initiated development of novel treatments in a number of diseases—treatments that could not only improve patients’ quality of life, but also halt or even prevent disease progression. Hypertension; fluctuations in glycemia, electrolytes, nutrient levels, and circulating volume; and frequent infections and the associated inflammation all greatly impair the endothelium in patients undergoing peritoneal dialysis. As our understanding of the regulatory function of the endothelium advances, focus is increasingly being placed on endothelial repair in acute and chronic renal failure and after renal transplantation. The potential of progenitor cells to repair damaged endothelium and to reduce inflammation in patients with renal failure remains unexamined; however, a successful cell therapy could reduce morbidity and mortality in kidney disease. Important contributions have been made in identifying progenitor cell populations in the kidney, and further investigations into the relationships of these cells with the pathophysiology of the disease are underway. As the kidney disease field prepares for the first human trials of progenitor cell therapies, we deemed it important to review representative original research, and to share our perspectives and lessons learned from clinical trials of progenitor cell–based therapies that have commenced in patients with cardiovascular disease.
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Affiliation(s)
- Andrey G. Zenovich
- Center for Cardiovascular Repair, University of Minnesota, Minneapolis, Minnesota
| | - Doris A. Taylor
- Department of Medicine and Center for Cardiovascular Repair, University of Minnesota, Minneapolis, Minnesota
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Brixius K, Funcke F, Graf C, Bloch W. Endothelial progenitor cells: a new target for the prevention of cardiovascular diseases. ACTA ACUST UNITED AC 2007; 13:705-10. [PMID: 17001208 DOI: 10.1097/01.hjr.0000221862.34662.31] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endothelial progenitor cells (EPCs) are circulating precursor cells that have been implicated recently in vascular and cardiac regeneration. There is an ongoing discussion on the immunocytological definition of EPCs, based on various surface markers, and currently different cell types are included in the term 'EPC'. This review summarizes the mechanisms that influence function, survival, mobilization and differentiation of EPCs. Furthermore, there are several reports on the clinical use of EPCs for the treatment of cardiovascular diseases. We have focused specifically on the influence of physical activity on EPC function.
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Affiliation(s)
- Klara Brixius
- Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Cologne, Germany
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