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Allata Y, Chouhani BA, El Bardai G, Kabbali N, Sqalli Houssaini T. A Spontaneous Bilateral Quadriceps Tendon Rupture in a Patient Undergoing Long-Term Hemodialysis. Cureus 2023; 15:e36059. [PMID: 37056527 PMCID: PMC10091470 DOI: 10.7759/cureus.36059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
Spontaneous quadriceps tendon rupture is very rare. Its occurrence is usually linked to an underlying disease that weakens the tendons causing them to rupture. Here, we report the case of a 44-year-old patient undergoing long-term hemodialysis who had spontaneous bilateral quadriceps tendon rupture. We present the clinical presentation and the management of this injury.
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Mizuiri S, Nishizawa Y, Yamashita K, Doi T, Okubo A, Morii K, Usui K, Arita M, Naito T, Shigemoto K, Masaki T. α1‐ and β2‐Microglobulin reduction ratios and survival in patients on predilution online haemodiafiltration. Nephrology (Carlton) 2022; 28:44-50. [DOI: 10.1111/nep.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/16/2022] [Accepted: 10/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sonoo Mizuiri
- Division of Nephrology Ichiyokai Harada Hospital Hiroshima Japan
| | | | | | - Toshiki Doi
- Division of Nephrology Ichiyokai Harada Hospital Hiroshima Japan
- Department of Nephrology Hiroshima University Hiroshima Japan
| | - Aiko Okubo
- Division of Nephrology Ichiyokai Harada Hospital Hiroshima Japan
- Department of Nephrology Hiroshima University Hiroshima Japan
| | - Kenichi Morii
- Division of Nephrology Ichiyokai Harada Hospital Hiroshima Japan
- Department of Nephrology Hiroshima University Hiroshima Japan
| | - Koji Usui
- Division of Dialysis Ichiyokai Ichiyokai Clinic Hiroshima Japan
| | - Michiko Arita
- Division of Dialysis Iciyokai East Clinic Hiroshima Japan
| | - Takayuki Naito
- Division of Dialysis Ichiyokai Yokogawa Clinic Hiroshima Japan
| | | | - Takao Masaki
- Department of Nephrology Hiroshima University Hiroshima Japan
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Canaud B, Davenport A. The rationale and clinical potential of on-line hemodiafiltration as renal replacement therapy. Semin Dial 2022; 35:380-384. [PMID: 35304772 DOI: 10.1111/sdi.13069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
On-line hemodiafiltration (ol-HDF) was developed in the 1980s in response to the unmet medical needs observed with conventional low- and high-flux hemodialysis. Firstly, the limited overall efficacy of conventional HD treatment programs as compared to native kidney function has been consistently documented over the broad MW spectrum of uremic toxins as well as fluid volume and hemodynamic control. Secondly, the unphysiological profile of intermittent treatment leading to repetitive dialysis-induced hemodynamic stress is now a well-recognized component of cardiovascular disease and end organ damage. Thirdly, the bioincompatibility of patient-dialysis system leading to dialysis-induced biological reactions also identified as contributing to dialytic morbidity and mortality. To overcome these limitations and pitfalls, alternative convective-based therapies (hemofiltration and hemodiafiltration), using higher hemoincompatible membranes and ultrapure dialysis fluid, were proposed as a solution to enhance and enlarge MW spectrum of uremic compounds cleared and to reduce dialysis-patient biological interactions. In this context, online HDF appeared soon as the best viable and efficient renal replacement modality to cover these needs. Clinical development and implementation of ol-HDF showed also that dialytic convective dose matters with a threshold point (23 L/1.73 m2 in postdilution mode) to observe clinical benefits and outcomes improvements.
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Affiliation(s)
- Bernard Canaud
- School of Medicine, Montpellier University, Montpellier, France.,Global Medical Office, FMC Deutschland, Bad-Homburg, Germany
| | - Andrew Davenport
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK
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Zhang J, Lu X, Zu Y, Li H, Wang S. Prognostic value of beta-2 microglobulin on mortality in chronic kidney disease patients: A systematic review and meta-analysis. Ther Apher Dial 2021; 26:267-274. [PMID: 34459115 DOI: 10.1111/1744-9987.13729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 08/26/2021] [Indexed: 12/30/2022]
Abstract
The aim of this study was to delve into whether beta-2 microglobulin could assess all-cause mortality in patients with chronic kidney disease. PubMed and Embase were systematically searched. Hazard risk and 95% CI were pooled using random-effect models. A total of eight studies were involved according to the inclusion and exclusion criterions. By meta-analysis, each 1 mg/L increase in beta-2 microglobulin displayed positive relationships to the risk of all-cause mortality (hazard risk 1.03, 95% CI = 1.02-1.03) and cardiovascular events (hazard risk 1.04, 95% CI = 1.00-1.08) in patients with dialysis. However, the relationship between elevated level of serum beta-2 microglobulin as a categorical variable and mortality was not significant. The prognostic value of elevated beta-2 microglobulin might be significant in ESRD patients with dialysis and a proper cutoff value to predict mortality should be determined in the future.
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Affiliation(s)
- Jialing Zhang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuan Zu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Weidhase L, de Fallois J, Haußig E, Kaiser T, Mende M, Petros S. Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:644. [PMID: 33176824 PMCID: PMC7659077 DOI: 10.1186/s13054-020-03366-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Background Myoglobin clearance in acute kidney injury requiring renal replacement therapy is important because myoglobin has direct renal toxic effects. Clinical data comparing different modalities of renal replacement therapy addressing myoglobin clearance are limited. This study aimed to compare two renal replacement modalities regarding myoglobin clearance. Methods In this prospective, randomized, single-blinded, single-center trial, 70 critically ill patients requiring renal replacement therapy were randomized 1:1 into an intervention arm using continuous veno-venous hemodialysis with high cutoff dialyzer and a control arm using continuous veno-venous hemodiafiltration postdilution with high-flux dialyzer. Regional citrate anticoagulation was used in both groups to maintain the extracorporeal circuit. The concentrations of myoglobin, urea, creatinine, β2-microglobulin, interleukin-6 and albumin were measured before and after the dialyzer at 1 h, 6 h, 12 h, 24 h and 48 h after initiating continuous renal replacement therapy. Results Thirty-three patients were allocated to the control arm (CVVHDF with high-flux dialyzer) and 35 patients to the intervention arm (CVVHD with high cutoff dialyzer). Myoglobin clearance, as a primary endpoint, was significantly better in the intervention arm than in the control arm throughout the whole study period. The clearance values for urea and creatinine were higher in the control arm. There was no measurable albumin clearance in both arms. The clearance data for β2-microglobulin and interleukin-6 were non-inferior in the intervention arm compared to those for the control arm. Dialyzer lifespan was 57.0 [38.0, 72.0] hours in the control arm and 70.0 [56.75, 72.0] hours in the intervention arm (p = 0.029). Conclusions Myoglobin clearance using continuous veno-venous hemodialysis with high cutoff dialyzer and regional citrate anticoagulation is better than that with continuous veno-venous hemodiafiltration with regional citrate anticoagulation. Trial registration German Clinical Trials Registry (DRKS00012407); date of registration 23/05/2017. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012407.
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Affiliation(s)
- Lorenz Weidhase
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany.
| | - Jonathan de Fallois
- Division of Nephrology, Medical Department III, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Elena Haußig
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Thorsten Kaiser
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Meinhard Mende
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Saxony, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany
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Chang TI, Lim H, Park CH, Park KS, Park JT, Kang EW, Yoo TH, Kang SW, Han SH. Lower serum beta-2 microglobulin levels are associated with worse survival in incident peritoneal dialysis patients. Nephrol Dial Transplant 2019; 34:138-145. [PMID: 29955831 DOI: 10.1093/ndt/gfy193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/20/2018] [Indexed: 01/30/2023] Open
Abstract
Background There is a general consensus that elevated serum beta-2 microglobulin (B2M) levels measured at a single time-point are significantly associated with mortality in patients on maintenance dialysis. To date, the majority of prior studies that have examined B2M-associated mortality have been conducted in prevalent hemodialysis patients with little residual renal function (RRF). However, studies in incident peritoneal dialysis (PD) patients are lacking. Moreover, changes in serum B2M levels over time have not been considered in this population. Methods We examined the association of time-updated and baseline serum B2M levels with mortality in a 10-year cohort of 725 incident PD patients who were maintained on dialysis between January 2006 and December 2011 using Cox proportional hazards regression analyses. Patients were categorized into tertiles according to B2M levels. Results During a median follow-up of 38 (interquartile range 23-64) months, 258 (35.4%) deaths occurred, including 106 (14.6%) and 86 (11.9%) deaths from cardiovascular and infectious causes, respectively. The lowest B2M tertile was associated with a higher risk of all-cause and infectious mortality compared with the middle tertile: the hazard ratios (95% confidence interval) for all-cause deaths were 2.12 (1.38-3.26) and 2.20 (0.96-5.05) in time-varying analyses and 1.52 (1.07-2.17) and 2.41 (1.19-4.88) in baseline analyses. Subgroup analyses showed that this association was particularly observed in females, older patients, those with comorbidities such as diabetes, a lower body mass index, lower albumin levels or those with higher RRF (all P for interactions <0.05). Conclusions In incident PD patients, lower B2M levels were independently associated with overall and infectious mortality. These associations can be potentially modified by malnutrition, inflammation and RRF.
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Affiliation(s)
- Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Hyunsun Lim
- Department of Research and Analysis, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Cheol Ho Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Sook Park
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ea Wha Kang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Predicting Residual Function in Hemodialysis and Hemodiafiltration-A Population Kinetic, Decision Analytic Approach. J Clin Med 2019; 8:jcm8122080. [PMID: 31795401 PMCID: PMC6947429 DOI: 10.3390/jcm8122080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 01/16/2023] Open
Abstract
In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of beta 2 microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations were derived entirely from computer simulations and advanced statistical modeling and had extremely high discrimination (Area Under the Curve, AUC 0.888–0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized predialysis and postdialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions for individualizing dialysis prescriptions in patients with preserved RRF.
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Kerr K, Morse G, Graves D, Zuo F, Lipowicz A, Carpenter DO. A Detoxification Intervention for Gulf War Illness: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4143. [PMID: 31661809 PMCID: PMC6862571 DOI: 10.3390/ijerph16214143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023]
Abstract
Approximately 30% of the 700,000 US veterans of the 1990-1991 Persian Gulf War developed multiple persistent symptoms called Gulf War illness. While the etiology is uncertain, several toxic exposures including pesticides and chemical warfare agents have shown associations. There is no effective medical treatment. An intervention to enhance detoxification developed by Hubbard has improved quality of life and/or reduced body burdens in other cohorts. We evaluated its feasibility and efficacy in ill Gulf War (GW) veterans in a randomized, waitlist-controlled, pilot study at a community-based rehabilitation facility in the United States. Eligible participants (n = 32) were randomly assigned to the intervention (n = 22) or a four-week waitlist control (n = 10). The daily 4-6 week intervention consisted of exercise, sauna-induced sweating, crystalline nicotinic acid and other supplements. Primary outcomes included recruitment, retention and safety; and efficacy was measured via Veteran's Short Form-36 (SF-36) quality of life, McGill pain, multidimensional fatigue inventory questionnaires and neuropsychological batteries. Scoring of outcomes was blinded. All 32 completed the trial and 21 completed 3-month follow-up. Mean SF-36 physical component summary score after the intervention was 6.9 (95% CI; -0.3, 14.2) points higher compared to waitlist control and 11 of 16 quality of life, pain and fatigue measures improved, with no serious adverse events. Most improvements were retained after 3 months. The Hubbard regimen was feasible, safe and might offer relief for symptoms of GW illness.
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Affiliation(s)
- Kathleen Kerr
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada.
| | - Gayle Morse
- Department of Psychology, The Sage Colleges, Troy, NY 12180, USA.
- Institute for Health and the Environment, University at Albany, Albany, NY 12144, USA.
| | - Donald Graves
- Department of Psychology, The Sage Colleges, Troy, NY 12180, USA.
| | - Fei Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, ON M5G 1B1, Canada.
| | - Alain Lipowicz
- Trillium Gift of Life Network, Ministry of Health and Long-Term Care, Toronto, ON M5G 2C9, Canada.
| | - David O Carpenter
- Institute for Health and the Environment, University at Albany, Albany, NY 12144, USA.
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Middle molecule clearance with high cut-off dialyzer versus high-flux dialyzer using continuous veno-venous hemodialysis with regional citrate anticoagulation: A prospective randomized controlled trial. PLoS One 2019; 14:e0215823. [PMID: 31026303 PMCID: PMC6485708 DOI: 10.1371/journal.pone.0215823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Regional anticoagulation with citrate during renal replacement therapy (RRT) reduces the risk of bleeding, extends dialyzer lifespan and is cost-effective. Therefore, current guidelines recommend its use if patients are not anticoagulated for another reason and if there are no contraindications against citrate. RRT with regional citrate anticoagulation has been established in critically ill patients as continuous veno-venous hemodialysis (CVVHD) to reduce citrate load. However, CVVHD is inferior regarding middle molecule clearance compared to continuous veno-venous hemofiltration (CVVH). The use of a high cut-off dialyzer in CVVHD may thus present an option for middle molecule clearance similar to CVVH. This may allow combining the advantages of both techniques. METHODS In this prospective, randomized, single-blinded single-center-trial, sixty patients with acute renal failure and established indication for renal replacement therapy were randomized 1:1 into two groups. The control group was put on CVVHD using regional citrate anticoagulation and a high-flux dialyzer, while the intervention group was on CVVHD using regional citrate anticoagulation and a high-cut-off dialyzer. The concentrations of urea, creatinine, β2-microglobulin, myoglobin, interleukin 6 and albumin were measured pre- and post-dialyzer 1, 6, 12, 24 and 48 hours after initiating CVVHD. RESULTS Mean plasma clearance for β2-microglobulin was 19.6±5.8 ml/min in the intervention group vs. 12.2±3.6 ml/min in the control group (p<0.001). For myoglobin (8.0±4.5 ml/min vs. 0.2±3.6 ml/min, p<0.001) and IL-6 (1.5±4.3 vs. -2.5±3.5 ml/min, p = 0.002) a higher mean plasma clearance using high-cut-off dialyzer could be detected too, but no difference for urea, creatinine and albumin could be observed concerning this parameter between the two groups. CONCLUSION CVVHD using a high cut-off dialyzer results in more effective middle molecule clearance than that with high-flux dialyzer. TRIAL REGISTRATION German Clinical Trials Register (DRKS00005254, registered 26th November 2013).
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Hur I, Lee Y, Kalantar-Zadeh K, Obi Y. Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology. Cardiorenal Med 2018; 9:69-82. [DOI: 10.1159/000494808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/20/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemodialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. Summary: In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.
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Leypoldt JK, Storr M, Agar BU, Boschetti-de-Fierro A, Bernardo AA, Kirsch AH, Rosenkranz AR, Krieter DH, Krause B. Intradialytic kinetics of middle molecules during hemodialysis and hemodiafiltration. Nephrol Dial Transplant 2018; 34:870-877. [DOI: 10.1093/ndt/gfy304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Baris U Agar
- Baxter Healthcare Corporation, Deerfield, IL, USA
| | | | | | - Alexander H Kirsch
- Clinical Division of Nephrology, Medical University of Graz, Graz, Austria
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12
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Leong SC, Sao JN, Taussig A, Plummer NS, Meyer TW, Sirich TL. Residual Function Effectively Controls Plasma Concentrations of Secreted Solutes in Patients on Twice Weekly Hemodialysis. J Am Soc Nephrol 2018; 29:1992-1999. [PMID: 29728422 DOI: 10.1681/asn.2018010081] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/08/2018] [Indexed: 11/03/2022] Open
Abstract
Background Most patients on hemodialysis are treated thrice weekly even if they have residual kidney function, in part because uncertainty remains as to how residual function should be valued and incorporated into the dialysis prescription. Recent guidelines, however, have increased the weight assigned to residual function and thus reduced the treatment time required when it is present. Increasing the weight assigned to residual function may be justified by knowledge that the native kidney performs functions not replicated by dialysis, including solute removal by secretion. This study tested whether plasma concentrations of secreted solutes are as well controlled in patients with residual function on twice weekly hemodialysis as in anuric patients on thrice weekly hemodialysis.Methods We measured the plasma concentration and residual clearance, dialytic clearance, and removal rates for urea and the secreted solutes hippurate, phenylacetylglutamine, indoxyl sulfate, and p-cresol sulfate in nine patients on twice weekly hemodialysis and nine patients on thrice weekly hemodialysis.Results Compared with anuric patients on thrice weekly dialysis with the same standard Kt/Vurea, patients on twice weekly hemodialysis had lower hippurate and phenylacetylglutamine concentrations and similar indoxyl sulfate and p-cresol sulfate concentrations. Mathematical modeling revealed that residual secretory function accounted for the observed pattern of solute concentrations.Conclusions Plasma concentrations of secreted solutes can be well controlled by twice weekly hemodialysis in patients with residual kidney function. This result supports further study of residual kidney function value and the inclusion of this function in dialysis adequacy measures.
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Affiliation(s)
- Sheldon C Leong
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Justin N Sao
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Abigail Taussig
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Natalie S Plummer
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Timothy W Meyer
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Tammy L Sirich
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and .,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
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Konopelniuk VV, Goloborodko II, Ishchuk TV, Synelnyk TB, Ostapchenko LI, Spivak MY, Bubnov RV. Efficacy of Fenugreek-based bionanocomposite on renal dysfunction and endogenous intoxication in high-calorie diet-induced obesity rat model-comparative study. EPMA J 2017; 8:377-390. [PMID: 29209440 PMCID: PMC5700020 DOI: 10.1007/s13167-017-0098-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Worldwide obesity spread is a global health problem and needs to be further studied. Co-morbidities of obesity include insulin resistance, diabetes mellitus type 2, and dyslipidemia, which are the most frequent contributing factors for metabolic syndrome (MetS), as well as non-alcoholic fatty liver disease and chronic kidney disease. The aim was to study renal function and endogenous intoxication panel on high-calorie diet-induced obesity rat model and perform comparative study of the treatment efficacy of Fenugreek-based bionanocomposite vs antiobesogenic drugs (Orlistat). MATERIALS We included 60 male rats and equally divided them to 6 groups of 10 animals in each group: the experimental groups were firstly assigned as controls and high caloric diet (HCD)-fed groups, and each group further was subdivided to remain untreated, Fenugreek bionanocomposite (BNC)-treated, and Orlistat-treated. Normal control rats (groups 1, 2, 3) were fed by a standard chow, while the others (groups 4, 5, 6) were fed with HCD ad libitum during 98 days. From days 77 to 98, groups 2 and 5 were treated with BNC based on Fenugreek (150 mg/kg body weight, orally) and groups 3 and 6 were treated with antiobesogenic drug Orlistat (10 mg/kg body weight, orally). Food and water consumptions were measured daily and body weights were measured once a week. On day 99, blood was collected; the creatinine, urea, and uric acid were estimated in serum according to the standard protocols. Levels of low and middle molecules (MMs) were measured; the quantity of oligopeptides was estimated by Bradford method. We performed the liver and kidney ultrasonography in rats. RESULTS We revealed an increase in the levels of endogenous intoxication syndrome markers (MM and oligopeptides) in all animals with experimental obesity. Ultrasound data showed injury of the liver and kidneys in obese rats. We observed significant decreasing of MM levels after Orlistat treatment vs controls (p < 0.05). However, this effect was more pronounced in Fenugreek BNC-treated group vs both Orlistat-treated and controls (p < 0.05). Orlistat treatment evoked rising of serum creatinine and oligopeptides in control animals and failed to normalize these markers in experimental group. Fenugreek-based BNC treatment did not evoke signs of kidney failure and changes in the studied indices in control group. We noticed normalization levels of uric acid and urea in the blood under the use of BNC and Orlistat. CONCLUSION High-calorie diet-induced obesity evokes endogenous intoxication syndrome and kidney dysfunction in rats. Application of Orlistat- and Fenugreek-based BNC decreases MM content to the normal level. Orlistat induces increasing levels of oligopeptides in both groups, likely due to adverse side effects on renal function and its pro-oxidant activity.
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Affiliation(s)
- Victoria V. Konopelniuk
- Educational and Scientific Centre “Institute of Biology”, Taras Shevchenko National University of Kyiv, Volodymyrska Str., 64/13, Kyiv, 01601 Ukraine
| | - Ievgenii I. Goloborodko
- Educational and Scientific Centre “Institute of Biology”, Taras Shevchenko National University of Kyiv, Volodymyrska Str., 64/13, Kyiv, 01601 Ukraine
| | - Tetyana V. Ishchuk
- Educational and Scientific Centre “Institute of Biology”, Taras Shevchenko National University of Kyiv, Volodymyrska Str., 64/13, Kyiv, 01601 Ukraine
| | - Tetyana B. Synelnyk
- Educational and Scientific Centre “Institute of Biology”, Taras Shevchenko National University of Kyiv, Volodymyrska Str., 64/13, Kyiv, 01601 Ukraine
| | - Ludmila I. Ostapchenko
- Educational and Scientific Centre “Institute of Biology”, Taras Shevchenko National University of Kyiv, Volodymyrska Str., 64/13, Kyiv, 01601 Ukraine
| | - Mykola Ya. Spivak
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv, 03143 Ukraine
| | - Rostyslav V. Bubnov
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv, 03143 Ukraine
- Clinical Hospital “Pheophania” of State Affairs Department, Zabolotny Str., 21, Kyiv, 03143 Ukraine
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14
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Yamashita K, Mizuiri S, Nishizawa Y, Shigemoto K, Doi S, Masaki T. Addition of Novel Biomarkers for Predicting All-Cause and Cardiovascular Mortality in Prevalent Hemodialysis Patients. Ther Apher Dial 2017; 22:31-39. [PMID: 28971590 DOI: 10.1111/1744-9987.12593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 11/29/2022]
Abstract
Novel biomarkers might improve the prediction of mortality in hemodialysis (HD) patients. We simultaneously measured the levels of conventional and novel biomarkers [serum N-terminal pro-brain natriuretic peptide (NT-proBNP), intact fibroblast growth factor-23 (FGF23), β2-microglobulin (β2MG), cystatin C, and high-sensitivity C-reactive protein (hsCRP)] in 307 prevalent Japanese HD patients. There were 66 all-cause deaths, and 25 cardiovascular (CV) deaths during 2 years, which were assessed using Cox models and concordance (C)-statistics. The addition of NT-proBNP alone (P < 0.05) or NT-proBNP, hsCRP, and β2MG as a panel (C-statistics: 0.834 vs. 0.776, P < 0.01) to a conventional risk model composed of age, diabetes, and the serum albumin level significantly improved the prediction of 2-year all-cause mortality, and the addition of NT-proBNP and hsCRP as a panel to a conventional risk model composed of age significantly improved the prediction of 2-year CV mortality (P < 0.05) in Japanese prevalent HD patients. Neither FGF23 nor cystatin C improved mortality prediction.
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Affiliation(s)
- Kazuomi Yamashita
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan.,Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Sonoo Mizuiri
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Yoshiko Nishizawa
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | | | - Shigehiro Doi
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
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15
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Tangvoraphonkchai K, Davenport A. Increasing Haemodialytic Clearances as Residual Renal Function Declines: An Incremental Approach. Blood Purif 2017; 44:217-226. [DOI: 10.1159/000475458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/02/2017] [Indexed: 11/19/2022]
Abstract
Many patients with chronic kidney disease start undergoing thrice-weekly haemodialysis (HD), aiming for an HD sessional dialyzer urea clearance target, irrespective of whether they have residual renal function (RRF). While increasing sessional dialyzer urea clearance above a target of 1.2 has not been shown to improve patient survival, it has been shown that the preservation of RRF improves patient self-reported outcomes and survival. Observational studies have suggested that initiating twice-weekly HD schedules leads to greater preservation of RRF. This has led to the concept of following an incremental approach to initiating HD, steadily increasing the amount of weekly dialyzer clearance as RRF decreases. Incremental dialysis practice requires the regular assessment of RRF to prevent inadequate delivery of dialysis treatment. Once RRF is lost, then the dialysis schedule and modality need to be adjusted to try to increase the middle-sized solute clearance and protein-bound toxins.
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16
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Argyropoulos CP, Chen SS, Ng YH, Roumelioti ME, Shaffi K, Singh PP, Tzamaloukas AH. Rediscovering Beta-2 Microglobulin As a Biomarker across the Spectrum of Kidney Diseases. Front Med (Lausanne) 2017; 4:73. [PMID: 28664159 PMCID: PMC5471312 DOI: 10.3389/fmed.2017.00073] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/26/2017] [Indexed: 12/28/2022] Open
Abstract
There is currently an unmet need for better biomarkers across the spectrum of renal diseases. In this paper, we revisit the role of beta-2 microglobulin (β2M) as a biomarker in patients with chronic kidney disease and end-stage renal disease. Prior to reviewing the numerous clinical studies in the area, we describe the basic biology of β2M, focusing in particular on its role in maintaining the serum albumin levels and reclaiming the albumin in tubular fluid through the actions of the neonatal Fc receptor. Disorders of abnormal β2M function arise as a result of altered binding of β2M to its protein cofactors and the clinical manifestations are exemplified by rare human genetic conditions and mice knockouts. We highlight the utility of β2M as a predictor of renal function and clinical outcomes in recent large database studies against predictions made by recently developed whole body population kinetic models. Furthermore, we discuss recent animal data suggesting that contrary to textbook dogma urinary β2M may be a marker for glomerular rather than tubular pathology. We review the existing literature about β2M as a biomarker in patients receiving renal replacement therapy, with particular emphasis on large outcome trials. We note emerging proteomic data suggesting that β2M is a promising marker of chronic allograft nephropathy. Finally, we present data about the role of β2M as a biomarker in a number of non-renal diseases. The goal of this comprehensive review is to direct attention to the multifaceted role of β2M as a biomarker, and its exciting biology in order to propose the next steps required to bring this recently rediscovered biomarker into the twenty-first century.
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Affiliation(s)
- Christos P Argyropoulos
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Shan Shan Chen
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Yue-Harn Ng
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Maria-Eleni Roumelioti
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Kamran Shaffi
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Pooja P Singh
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Antonios H Tzamaloukas
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States.,Raymond G. Murphy VA Medical Center Albuquerque, Albuquerque, NM, United States
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17
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Lee MJ, Park JT, Park KS, Kwon YE, Oh HJ, Yoo TH, Kim YL, Kim YS, Yang CW, Kim NH, Kang SW, Han SH. Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis. Clin J Am Soc Nephrol 2017; 12:426-434. [PMID: 28228465 PMCID: PMC5338702 DOI: 10.2215/cjn.05520516] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/07/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR β2-microglobulin were calculated from the equations using serum urea and creatinine and β2-microglobulin, respectively. The primary outcome was all-cause death. RESULTS During a mean follow-up of 42 months, 385 (19.8%) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95% confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR β2-microglobulin data, eGFR β2-microglobulin (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95% confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01). CONCLUSIONS Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.
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Affiliation(s)
- Mi Jung Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnamsi, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Sook Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Eun Kwon
- Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyangsi, Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End-Stage Renal Disease, Daegu, Korea
| | - Yon Su Kim
- Clinical Research Center for End-Stage Renal Disease, Daegu, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Clinical Research Center for End-Stage Renal Disease, Daegu, Korea
- Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul, Korea; and
| | - Nam-Ho Kim
- Clinical Research Center for End-Stage Renal Disease, Daegu, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Clinical Research Center for End-Stage Renal Disease, Daegu, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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