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Fontes A, Jauch AT, Sailer J, Engler J, Azul AM, Zischka H. Metabolic Derangement of Essential Transition Metals and Potential Antioxidant Therapies. Int J Mol Sci 2024; 25:7880. [PMID: 39063122 PMCID: PMC11277342 DOI: 10.3390/ijms25147880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Essential transition metals have key roles in oxygen transport, neurotransmitter synthesis, nucleic acid repair, cellular structure maintenance and stability, oxidative phosphorylation, and metabolism. The balance between metal deficiency and excess is typically ensured by several extracellular and intracellular mechanisms involved in uptake, distribution, and excretion. However, provoked by either intrinsic or extrinsic factors, excess iron, zinc, copper, or manganese can lead to cellular damage upon chronic or acute exposure, frequently attributed to oxidative stress. Intracellularly, mitochondria are the organelles that require the tightest control concerning reactive oxygen species production, which inevitably leaves them to be one of the most vulnerable targets of metal toxicity. Current therapies to counteract metal overload are focused on chelators, which often cause secondary effects decreasing patients' quality of life. New therapeutic options based on synthetic or natural antioxidants have proven positive effects against metal intoxication. In this review, we briefly address the cellular metabolism of transition metals, consequences of their overload, and current therapies, followed by their potential role in inducing oxidative stress and remedies thereof.
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Affiliation(s)
- Adriana Fontes
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, D-85764 Neuherberg, Germany;
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Adrian T. Jauch
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
| | - Judith Sailer
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
| | - Jonas Engler
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
| | - Anabela Marisa Azul
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
- IIIUC-Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - Hans Zischka
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, D-85764 Neuherberg, Germany;
- School of Medicine and Health, Institute of Toxicology and Environmental Hygiene, Technical University Munich, D-80802 Munich, Germany
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2
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Lanser L, Plaikner M, Fauser J, Petzer V, Denicolò S, Haschka D, Neuwirt H, Stefanow K, Rudnicki M, Kremser C, Henninger B, Weiss G. Tissue Iron Distribution in Anemic Patients with End-Stage Kidney Disease: Results of a Pilot Study. J Clin Med 2024; 13:3487. [PMID: 38930016 PMCID: PMC11204586 DOI: 10.3390/jcm13123487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Anemia is a frequent multifactorial co-morbidity in end-stage kidney disease (ESKD) associated with morbidity and poor QoL. Apart from insufficient erythropoietin formation, iron deficiency (ID) contributes to anemia development. Identifying patients in need of iron supplementation with current ID definitions is difficult since no good biomarker is available to detect actual iron needs. Therefore, new diagnostic tools to guide therapy are needed. Methods: We performed a prospective cohort study analyzing tissue iron content with MRI-based R2*-relaxometry in 20 anemic ESKD patients and linked it with iron biomarkers in comparison to 20 otherwise healthy individuals. Results: ESKD patients had significantly higher liver (90.1 s-1 vs. 36.1 s-1, p < 0.001) and spleen R2* values (119.8 s-1 vs. 19.3 s-1, p < 0.001) compared to otherwise healthy individuals, while their pancreas and heart R2* values did not significantly differ. Out of the 20 ESKD patients, 17 had elevated spleen and 12 had elevated liver R2* values. KDIGO guidelines (focusing on serum iron parameters) would recommend iron supplementation in seven patients with elevated spleen and four patients with elevated liver R2* values. Conclusions: These findings highlight that liver and especially spleen iron concentrations are significantly higher in ESKD patients compared to controls. Tissue iron overload diverged from classical iron parameters suggesting need of iron supplementation. Measurement of MRI-guided tissue iron distribution might help guide treatment of anemic ESKD patients.
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Affiliation(s)
- Lukas Lanser
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Michaela Plaikner
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Josia Fauser
- Department of Internal Medicine V, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Verena Petzer
- Department of Internal Medicine V, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Sara Denicolò
- Department of Internal Medicine IV, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Haschka
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hannes Neuwirt
- Department of Internal Medicine IV, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Kiril Stefanow
- Department of Internal Medicine IV, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Michael Rudnicki
- Department of Internal Medicine IV, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Guenter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria
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3
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Tkachenko A. Hemocompatibility studies in nanotoxicology: Hemolysis or eryptosis? (A review). Toxicol In Vitro 2024; 98:105814. [PMID: 38582230 DOI: 10.1016/j.tiv.2024.105814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024]
Abstract
Hemocompatibility evaluation is an important step in nanotoxicological studies. It is generally accepted that nanomaterials promote lysis of erythrocytes, blood clotting, alter phagocytosis, and upregulate pro-inflammatory cytokines. However, there are no standardized guidelines for testing nanomaterials hemocompatibility despite the fact that nanomaterials enter the bloodstream and interact with blood cells. In this review, the current knowledge on the ability of nanomaterials to induce distinct cell death modalities of erythrocytes is highlighted primarily focusing on hemolysis and eryptosis. This review aims to summarize the molecular mechanisms underlying erythrotoxicity of nanomaterials and critically compare the sensitivity and efficiency of hemolysis or eryptosis assays for nanomaterials blood compatibility testing. The list of eryptosis-inducing nanomaterials is growing, but it is still difficult to generalize how physico-chemical properties of nanoparticles affect eryptosis degree and molecular mechanisms involved. Thus, another aim of this review is to raise the awareness of eryptosis as a nanotoxicological tool to encourage the corresponding studies. It is worthwhile to consider adding eryptosis to in vitro nanomaterials hemocompatibility testing protocols and guidelines.
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Affiliation(s)
- Anton Tkachenko
- BIOCEV, First Faculty of Medicine, Charles University, Průmyslová 595, 25250 Vestec, Czech Republic.
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4
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Banerjee S, Sarkar S, Saha S, Hira SK, Karmakar S. Observing temporal variation in hemolysis through photoacoustics with a low cost LASER diode based system. Sci Rep 2023; 13:7002. [PMID: 37117171 PMCID: PMC10147907 DOI: 10.1038/s41598-023-32839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/03/2023] [Indexed: 04/30/2023] Open
Abstract
Patients under hemolytic condition need continuous monitoring of lysis as depletion of Red Blood Cells (RBC) and the presence of antioxidant free hemoglobin (Hb) in excess amount due to hemolysis lead to severe deterioration of their health. Out of many modalities, Photoacoustics (PA) offers real time information noninvasively from deep lying blood vessels since Hb is the strongest chromophore in mammalian blood and the PA response of blood varies with the amount of Hb present. During hemolysis, total Hb content in blood however remains unchanged, thus, questions the use of PA in hemolysis detection. In this report, a hypothesis that the amplitude of the PA signal would not change with the amount of lysis is framed and tested by applying osmotic shock to the RBCs in hypotonic environment and the PA response is recorded over time using a low cost NIR based PA system. The experimental outcome indicates that PA amplitude falls off as lysis progresses in course of time consequently rejecting the hypothesis. The decaying PA response also carries the signature of RBC swelling during the early phase of lysis. The PA measurement can detect hemolysis as low as 1.7%. These findings further advocate transforming this NIR-PA system into a portable, noninvasive patient care device to monitor hemolysis in-vivo.
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Affiliation(s)
- Soumyodeep Banerjee
- University Science Instrumentation Centre, The University of Burdwan, Bardhaman, 713104, India
| | - Sandip Sarkar
- Applied Nuclear Physics Division, Saha Institute of Nuclear Physics, A CI of Homi Bhabha National Institute, Kolkata, 700064, India
| | - Shaibal Saha
- Applied Nuclear Physics Division, Saha Institute of Nuclear Physics, A CI of Homi Bhabha National Institute, Kolkata, 700064, India
| | - Sumit K Hira
- Department of Zoology, The University of Burdwan, Bardhaman, 713104, India
| | - Subhajit Karmakar
- University Science Instrumentation Centre, The University of Burdwan, Bardhaman, 713104, India.
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5
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Dufour I, Briol S, Van Regemorter E, Goffin E, Devresse A. Quiz: A Case of Acute Intravascular Hemolysis During Dialysis: A Quiz. Am J Kidney Dis 2023; 81:A12-A15. [PMID: 36822738 DOI: 10.1053/j.ajkd.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/08/2022] [Indexed: 02/23/2023]
Affiliation(s)
- Inès Dufour
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Sébastien Briol
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Eric Goffin
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Arnaud Devresse
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
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6
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Selvananthan B, Aziz O, Lee AD, Werner-Gibbings K, Bose B, Sud K. Angiojet™ mechanical thrombectomy-induced hemolysis triggering blood-leak alarms. Hemodial Int 2023; 27:E19-E22. [PMID: 36735589 DOI: 10.1111/hdi.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
Blood leak alarms are increasingly rare and may be triggered by rupture of the dialyzer membrane, or intravascular hemolysis. We report two patients who developed hemolysis following Angiojet™ thrombolysis and thrombectomy of thrombosed arteriovenous fistulas, triggering blood leak alarms on hemodialysis, the occurrence of which has not been reported before. AngioJet™-induced hemolysis should be considered in the differential diagnosis for blood leak alarms occurring soon after an intervention on an arterio-venous (AV) fistula.
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Affiliation(s)
- Babitha Selvananthan
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, Australia
| | - Omar Aziz
- Department of Vascular Surgery, Nepean Hospital, Kingswood, Australia
| | - Arvind D Lee
- Department of Vascular Surgery, Nepean Hospital, Kingswood, Australia
| | | | - Bhadran Bose
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, Australia.,Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Kingswood, Australia
| | - Kamal Sud
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, Australia.,Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Kingswood, Australia
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7
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Optimal Time for Recirculation with Ultrafiltration to Remove Disinfectant in Reused Dialyzer. ASAIO J 2022; 68:1414-1418. [PMID: 36326706 DOI: 10.1097/mat.0000000000001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The practice of dialyzer reuse is common in developing countries. One essential technique for safe dialyzer reprocessing is to remove disinfectants properly to the recommended standards before treatment initiation, using dialysis machine recirculation with ultrafiltration. This study was conducted to identify the most effective time for carrying out this procedure, and the factors affecting it. We studied 420 high-flux dialyzers with three different membrane types: FB210U (cellulose triacetate), F80S (polysulfone), and Elisio-210HR (polyethersulfone) at four reused cycles (5th, 10th, 15th, and 19th). Peracetic acid was used as the disinfectant at a concentration of 0.16%. The total cell volume (TCV) and clot inspection grade of the reused dialyzer were recorded before the procedure. The optimal time for disinfectant removal was independently determined by two observers using the residual peroxide strip test of the ultrafiltrate. We observed that disinfectant removal was dependent on the recirculation time and became undetectable at 5 minutes. The type of dialyzer had a significant effect on the effective recirculation time (shortest for FB210U followed by Elisio-210HR and F80S; p < 0.001), but the reused number, TCV, and clot inspection grade did not. It is conceivable that the dialyzer membrane type might affect peracetic acid removal. In conclusion, the interval for carrying out dialysis machine recirculation with ultrafiltration depends on the dialyzer type, and 5 minutes is the optimal time for the operation. This result can be implemented to improve further practice in dialyzer reprocessing.
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8
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Vanderick A, Goffin É, Gillion V. [Acute pancreatitis as a complication of massive hemolysis in patients on hemodialysis: About three observations]. Nephrol Ther 2022; 18:207-210. [PMID: 35525785 DOI: 10.1016/j.nephro.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
Haemolysis is an uncommon complication of haemodialysis which can be serious. We herein report on three patients with kidney failure who developed acute pancreatitis due to mechanical haemolysis during a haemodialysis session. We also review the current literature and discuss putative etiopathogenic mechanisms.
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Affiliation(s)
- Ariane Vanderick
- Service de néphrologie, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique
| | - Éric Goffin
- Service de néphrologie, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique; Institut de recherche expérimentale et clinique, université catholique de Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgique
| | - Valentine Gillion
- Service de néphrologie, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique; Institut de recherche expérimentale et clinique, université catholique de Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
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9
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Santos JA, Gimbel AA, Peppas A, Truslow JG, Lang DA, Sukavaneshvar S, Solt D, Mulhern TJ, Markoski A, Kim ES, Hsiao JCM, Lewis DJ, Harjes DI, DiBiasio C, Charest JL, Borenstein JT. Design and construction of three-dimensional physiologically-based vascular branching networks for respiratory assist devices. LAB ON A CHIP 2021; 21:4637-4651. [PMID: 34730597 DOI: 10.1039/d1lc00287b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Microfluidic lab-on-a-chip devices are changing the way that in vitro diagnostics and drug development are conducted, based on the increased precision, miniaturization and efficiency of these systems relative to prior methods. However, the full potential of microfluidics as a platform for therapeutic medical devices such as extracorporeal organ support has not been realized, in part due to limitations in the ability to scale current designs and fabrication techniques toward clinically relevant rates of blood flow. Here we report on a method for designing and fabricating microfluidic devices supporting blood flow rates per layer greater than 10 mL min-1 for respiratory support applications, leveraging advances in precision machining to generate fully three-dimensional physiologically-based branching microchannel networks. The ability of precision machining to create molds with rounded features and smoothly varying channel widths and depths distinguishes the geometry of the microchannel networks described here from all previous reports of microfluidic respiratory assist devices, regarding the ability to mimic vascular blood flow patterns. These devices have been assembled and tested in the laboratory using whole bovine or porcine blood, and in a porcine model to demonstrate efficient gas transfer, blood flow and pressure stability over periods of several hours. This new approach to fabricating and scaling microfluidic devices has the potential to address wide applications in critical care for end-stage organ failure and acute illnesses stemming from respiratory viral infections, traumatic injuries and sepsis.
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Affiliation(s)
- Jose A Santos
- Bioengineering Division, Draper, Cambridge, MA, USA.
| | - Alla A Gimbel
- Bioengineering Division, Draper, Cambridge, MA, USA.
| | | | | | - Daniel A Lang
- Bioengineering Division, Draper, Cambridge, MA, USA.
| | | | | | | | - Alex Markoski
- Bioengineering Division, Draper, Cambridge, MA, USA.
| | - Ernest S Kim
- Bioengineering Division, Draper, Cambridge, MA, USA.
| | | | - Diana J Lewis
- Bioengineering Division, Draper, Cambridge, MA, USA.
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10
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Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients. PLoS One 2021; 16:e0254345. [PMID: 34252125 PMCID: PMC8274924 DOI: 10.1371/journal.pone.0254345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/25/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Ferritin is the major iron storage protein and an acute phase reactant. Hyperferritinemia is frequently seen in the critically ill where it has been hypothesized that not only underlying conditions but also factors such as transfusions, hemodialysis and extracorporeal life support (ECLS) lead to hyperferritinemia. This study aims to investigate the influence of transfusions, hemodialysis, and ECLS on hyperferritinemia in a multidisciplinary ICU cohort. METHODS This is a post-hoc analysis of a retrospective observational study including patients aged ≥ 18 years who were admitted to at least one adult ICU between January 2006 and August 2018 with hyperferritinemia ≥ 500 μg/L and of ≥ 14 days between two ICU ferritin measurements. Patients with hemophagocytic lymphohistiocytosis (HLH) were excluded. To identify the influence of transfusions, hemodialysis, and ECLS on ferritin change, multivariable linear regression analysis with ferritin change between two measurements as dependent variable was performed. RESULTS A total of 268 patients was analyzed. Median duration between measurements was 36 days (22-57). Over all patients, ferritin significantly increased between the first and last measurement (p = 0.006). Multivariable linear regression analysis showed no effect of transfusions, hemodialysis, or ECLS on ferritin change. Changes in aspartate aminotransferase (ASAT) and sequential organ failure assessment (SOFA) score were identified as influencing factors on ferritin change [unstandardized regression coefficient (B) = 2.6; (95% confidence interval (CI) 1.9, 3.3); p < 0.001 and B = 376.5; (95% CI 113.8, 639.1); p = 0.005, respectively]. Using the same model for subgroups of SOFA score, we found SOFA platelet count to be associated with ferritin change [B = 1729.3; (95% CI 466.8, 2991.9); p = 0.007]. No association of ferritin change and in-hospital mortality was seen in multivariable analysis. CONCLUSIONS The present study demonstrates that transfusions, hemodialysis, and ECLS had no influence on ferritin increases in critically ill patients. Hyperferritinemia appears to be less the result of iatrogenic influences in the ICU thereby underscoring its unskewed diagnostic value. TRIAL REGISTRATION The study was registered with www.ClinicalTrials.gov (NCT02854943) on August 1, 2016.
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11
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Cadavid Aljure D, Alvarez-Vallejo S, Posada-Alvarez G, Ruiz-Aguilar E, Higuita-Urrego L, Guerra-Alvarez C, Marin-Durango S, Ocampo-Kohn C, Nieto-Rios JF, Aristizabal-Alzate A, Zuluaga-Valencia G. Hemolysis in Hemodialysis, Secondary to Severe Vena Cava Stenosis. Cureus 2021; 13:e15156. [PMID: 34168923 PMCID: PMC8214918 DOI: 10.7759/cureus.15156] [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] [Indexed: 11/25/2022] Open
Abstract
Complications in hemodialysis patients are increasingly rare thanks to advances in technology, including more compatible membranes, more flexible lines, safety in water treatments, alarms in the circuit, and standardization in dialysate fluids plus exhaustive chemical and microbiological tests. In addition, it is highly unusual having hemolysis on hemodialysis; however, it is a life-threatening complication, so the cause must be identified and early managed. The etiology can be chemical or mechanical; however, so far, there are no reports in the literature of an association with severe stenosis of the vena cava, as it is described in the case reported here, where a patient presented hemolysis in two hemodialysis sessions, without initially being possible to find the cause; the only identifiable factor was that he had a dysfunctional tunneled jugular catheter, with a history of difficult vascular access. The patient underwent interventional radiology, finding 99% stenosis of the vena cava, which prevented the passage of the contrast agent to the atrium. Angioplasty and catheter replacement were performed, with a resolution of the complication; the subsequent dialysis therapies were satisfactory.
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Affiliation(s)
| | | | | | | | | | | | | | - Catalina Ocampo-Kohn
- Nephrology and Kidney Transplant Department, Nephrology Section, Department of Internal Medicine, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, COL
| | - John Fredy Nieto-Rios
- Nephrology and Kidney Transplant Department, Nephrology Section, Department of Internal Medicine, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, COL
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12
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Gotta V, Tancev G, Marsenic O, Vogt JE, Pfister M. Identifying key predictors of mortality in young patients on chronic haemodialysis-a machine learning approach. Nephrol Dial Transplant 2021; 36:519-528. [PMID: 32510143 DOI: 10.1093/ndt/gfaa128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/28/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The mortality risk remains significant in paediatric and adult patients on chronic haemodialysis (HD) treatment. We aimed to identify factors associated with mortality in patients who started HD as children and continued HD as adults. METHODS The data originated from a cohort of patients <30 years of age who started HD in childhood (≤19 years) on thrice-weekly HD in outpatient DaVita dialysis centres between 2004 and 2016. Patients with at least 5 years of follow-up since the initiation of HD or death within 5 years were included; 105 variables relating to demographics, HD treatment and laboratory measurements were evaluated as predictors of 5-year mortality utilizing a machine learning approach (random forest). RESULTS A total of 363 patients were included in the analysis, with 84 patients having started HD at <12 years of age. Low albumin and elevated lactate dehydrogenase (LDH) were the two most important predictors of 5-year mortality. Other predictors included elevated red blood cell distribution width or blood pressure and decreased red blood cell count, haemoglobin, albumin:globulin ratio, ultrafiltration rate, z-score weight for age or single-pool Kt/V (below target). Mortality was predicted with an accuracy of 81%. CONCLUSIONS Mortality in paediatric and young adult patients on chronic HD is associated with multifactorial markers of nutrition, inflammation, anaemia and dialysis dose. This highlights the importance of multimodal intervention strategies besides adequate HD treatment as determined by Kt/V alone. The association with elevated LDH was not previously reported and may indicate the relevance of blood-membrane interactions, organ malperfusion or haematologic and metabolic changes during maintenance HD in this population.
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Affiliation(s)
- Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Georgi Tancev
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Olivera Marsenic
- Pediatric Nephrology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Julia E Vogt
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,Certara, Princeton, NJ, USA
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13
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Ranchin B, Maucort-Boulch D, Bacchetta J. Big data and outcomes in paediatric haemodialysis: how can nephrologists use these new tools in daily practice? Nephrol Dial Transplant 2021; 36:387-391. [PMID: 33257930 DOI: 10.1093/ndt/gfaa225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Delphine Maucort-Boulch
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.,Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron Cedex, France.,Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.,Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France.,INSERM 1033, LYOS, Prévention des Maladies Osseuses, Lyon, France
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14
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Heparin immobilized graphene oxide in polyetherimide membranes for hemodialysis with enhanced hemocompatibility and removal of uremic toxins. J Memb Sci 2021. [DOI: 10.1016/j.memsci.2021.119068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Haider T, Diaz-Canestro C, Pentz B, Montero D. Intravascular albumin loss is strongly associated with plasma volume withdrawal in dialysis patients. Hemodial Int 2020; 25:86-93. [PMID: 32996274 DOI: 10.1111/hdi.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Low circulating albumin closely predicts mortality in end-stage renal disease (ESRD) patients. The cause(s) of hypoalbuminemia (hALB) in ESRD patients remains to be elucidated. The aim of the present study was to determine the role of plasma volume (PV) withdrawal in the reduction of total circulating albumin and essential blood solutes induced by hemodialysis (HD). METHODS PV determined with high-precision automated carbon monoxide-rebreathing, total circulating as well as concentration of plasma albumin and electrolytes were assessed prior to and after 4-hour HD in 10 ESRD patients. FINDINGS Baseline PV ranged from 3.5 to 6.2 l. After HD, PV was decreased by 689 ± 566 mL (-16%) (P = 0.004). Total circulating albumin was largely reduced after HD (170.8 ± 35.1 vs. 146.1 ± 48.9 g, P = 0.008), while albumin concentration was unaltered. According to a strong linear relationship (r = 0.91, P < 0.001), one-third of total circulating albumin is lost from the intravascular compartment for every liter of PV removed. Similar results were found regarding Na+ and Ca2+ electrolytes. DISCUSSION Total circulating albumin, but not albumin concentration, is substantially reduced by HD in proportion to the amount of PV removed from the circulation. This study highlights the potential contributing role of PV withdrawal to hALB in ESRD patients.
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Affiliation(s)
- Thomas Haider
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Candela Diaz-Canestro
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Brandon Pentz
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - David Montero
- University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, Calgary, Alberta, Canada
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Elevated plasma hemoglobin in COVID-19-related illnesses: a critical appraisal. Ann Hematol 2020; 100:2125-2126. [PMID: 32974839 PMCID: PMC7515552 DOI: 10.1007/s00277-020-04281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
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Hill K, Sharp R, Childs J, Esterman A, Le Leu R, Juneja R, Jesudason S. Cannulation practices at haemodialysis initiation via an arteriovenous fistula or arteriovenous graft. J Vasc Access 2019; 21:573-581. [PMID: 31423945 DOI: 10.1177/1129729819869093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION A functioning long-term vascular access is required for haemodialysis therapy; however, establishing this can be challenging in the setting of advanced age and vessels damaged by diabetes. Complications include the inability to insert two needles for the treatment resulting in miscannulation trauma and in some cases insertion of a temporary central venous access device. The broad objective of this review is to define the evidence base regarding cannulation practices in the initiation of haemodialysis via an arteriovenous fistula or an arteriovenous graft. METHODS This review uses the framework recommended by the Joanna Briggs Institute and the process by which papers were included or excluded followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses group approach. A total of 20 primary research studies met the inclusion criteria. RESULTS Cannulation in the 10- to 15-week period rather than delaying past this time frame is associated with the best outcomes. New vascular access given time to mature through single-needle haemodialysis treatments may improve long-term patency. Duplex ultrasound mapping prior to initiation of cannulation supports the clinical decision-making process on timing of and selection of cannulation sites. CONCLUSION Cannulation trauma at the initiation of haemodialysis could potentially be reduced with a strategy of incremental haemodialysis using single-needle treatment supported with duplex ultrasonography assessment to 'map' the vascular access as a guide for clinicians prior to cannulation initiation.
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Affiliation(s)
- Kathleen Hill
- University of South Australia, Adelaide, SA, Australia
| | - Rebecca Sharp
- University of South Australia, Adelaide, SA, Australia
| | - Jessie Childs
- University of South Australia, Adelaide, SA, Australia
| | | | - Richard Le Leu
- Central and Northern Adelaide Renal and Transplantation Service, Adelaide, SA, Australia
| | - Rajiv Juneja
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Shilpa Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Adelaide, SA, Australia
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Gene Expression Pattern and Regulatory Network of α-Toxin Treatment in Bombyx mori. Int J Genomics 2019; 2019:7859121. [PMID: 30956974 PMCID: PMC6425383 DOI: 10.1155/2019/7859121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/03/2019] [Accepted: 01/20/2019] [Indexed: 11/24/2022] Open
Abstract
Bacillus bombyseptieus is a pathogen of Bombyx mori; it can cause bacterial septicemia in silkworm. One of the components of the parasporal crystal toxin of B. bombyseptieus, α-toxin, plays an important role in the process of infection in silkworm. In this study, we investigated the immune response of silkworm induced by α-toxin by using RNA-seq. We compared the changes in gene expression in the midgut, fatbody, and hemocytes of silkworm and in the B. mori embryonic cell line (BmE) after treatment with α-toxin and identified 952 differentially expressed genes and 353 differentially expressed long noncoding RNAs (lncRNAs). These regulated genes in different tissues were found to be enriched in different pathways. The upregulated genes in the midgut were mainly involved in peptidoglycan catabolic process and tyrosine kinase signaling pathway, whereas the downregulated genes were mainly involved in chitin metabolic pathways. The upregulated genes in fatbody were also involved in peptidoglycan catabolic process, but they were for a different peptidoglycan subtype. Further, genes encoding cecropins were enriched in the fatbody. The downregulated genes were mainly involved in the metabolic pathways of fundamental substances such as cellular protein metabolic process and nucleobase-containing compound metabolic process. These results suggest that α-toxin can induce various immune responses in silkworm, and further studies are warranted to understand the mechanism of α-toxin action in silkworm. Further, lncRNAs and differentially expressed genes were correlated using coexpression network analysis. Our findings revealed potential candidate genes and lncRNAs that might play important physiological functions in the immune response to α-toxins in silkworm.
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