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Tian M, Yuan J, He P, Yu F, Long C, Zha Y. Monocyte-to-lymphocyte ratio and gastrointestinal disorder-related hospitalization in patients on maintenance hemodialysis. Ther Apher Dial 2024; 28:225-233. [PMID: 37833240 DOI: 10.1111/1744-9987.14073] [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: 07/25/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION To explore the association between monocyte-to-lymphocyte ratio (MLR) and the risk of hospitalization due to gastrointestinal (GI) disorder in hemodialysis (HD) patients. METHODS In this multicenter, observational cohort study, 1626 patients were enrolled in 2019 and followed up to 2 years. Cox regression models were performed to estimate the association of MLR with GI disorder-related hospitalization risk. Receiver-operating characteristic (ROC) analyses were conducted to evaluate the cutoff value of MLR in identifying GI disorder-related hospitalization. RESULTS During a median follow-up of 24 months, GI disorder-related hospitalization occurred in 107 patients. Higher MLR was independently associated with greater risks of GI disorder-related hospitalization. Furthermore, a cut-off value of 0.42 differentiated patients with GI disorder-related hospitalization from those without GI involvement. CONCLUSION MLR was associated with the occurrence of GI disorder-related hospitalization in HD patients. The blood MLR could be monitored as a useful marker to predict GI disorder-related hospitalization.
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Affiliation(s)
- Maolu Tian
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Yuan
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, Guiyang, China
| | - Pinghong He
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Fangfang Yu
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Changzhu Long
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, Guiyang, China
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Di Marco GS, Chasan AI, Boeckel GR, Beul K, Pavenstädt H, Roth J, Brand M. Monocytes as Targets for Immunomodulation by Regional Citrate Anticoagulation. Int J Mol Sci 2024; 25:2900. [PMID: 38474146 DOI: 10.3390/ijms25052900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Immune alterations in end-stage renal patients receiving hemodialysis are complex and predispose patients to infections. Anticoagulation may also play an immunomodulatory role in addition to the accumulation of uremic toxins and the effects of the dialysis procedure. Accordingly, it has been recently shown that the infection rate increases in patients under regional citrate anticoagulation (RCA) compared with systemic heparin anticoagulation (SHA). We hypothesized that RCA affects the immune status of hemodialysis patients by targeting monocytes. In a cohort of 38 end-stage renal patients undergoing hemodialysis, we demonstrated that whole blood monocytes of patients receiving RCA-but not SHA-failed to upregulate surface activation markers, like human leukocyte antigen class II (HLA-DR), after stressful insults, indicating a state of deactivation during and immediately after dialysis. Additionally, RNA sequencing (RNA-seq) data and gene set enrichment analysis of pre-dialysis monocytes evidenced a great and complex difference between the groups given that, in the RCA group, monocytes displayed a dramatic transcriptional change with increased expression of genes related to the cell cycle regulation, cellular metabolism, and cytokine signaling, compatible with the reprogramming of the immune response. Transcriptomic changes in pre-dialysis monocytes signalize the lasting nature of the RCA-related effects, suggesting that monocytes are affected even beyond the dialysis session. Furthermore, these findings demonstrate that RCA-but not SHA-impairs the response of monocytes to activation stimuli and alters the immune status of these patients with potential clinical implications.
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Affiliation(s)
- Giovana Seno Di Marco
- Department of Internal Medicine D, University Hospital Muenster, 48149 Muenster, Germany
| | - Achmet Imam Chasan
- Institute of Immunology, University of Muenster, 48149 Muenster, Germany
| | - Göran Ramin Boeckel
- Department of Internal Medicine D, University Hospital Muenster, 48149 Muenster, Germany
| | - Katrin Beul
- Department of Internal Medicine D, University Hospital Muenster, 48149 Muenster, Germany
| | - Hermann Pavenstädt
- Department of Internal Medicine D, University Hospital Muenster, 48149 Muenster, Germany
| | - Johannes Roth
- Institute of Immunology, University of Muenster, 48149 Muenster, Germany
| | - Marcus Brand
- Department of Internal Medicine D, University Hospital Muenster, 48149 Muenster, Germany
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Turan YB. The prognostic importance of the pan-immune-inflammation value in patients with septic shock. BMC Infect Dis 2024; 24:69. [PMID: 38200436 PMCID: PMC10777599 DOI: 10.1186/s12879-023-08963-w] [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: 09/07/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine whether the pan-immune-inflammation value (PIV), a novel biomarker combining neutrophil platelet, monocyte, and lymphocyte counts, some of the most widespread indicators of systemic inflammation, can predict mortality and prognosis in patients admitted to the intensive care unit (ICU) with septic shock. METHOD This prospective study was performed with 82 patients aged 18 or over admitted to a tertiary ICU with diagnoses of septic shock. Patients with hematological disease and neutropenia were excluded. PIV was calculated with the formula [neutrophil count (103/μL) × platelet count (103/μL) × monocyte count (103/μL)]/lymphocyte count (103/μL). RESULTS Median age, presence of hypertension, Acute Physiology and Chronic Health Evaluation II (APACHE II) levels, and neutrophil, monocyte, and platelet counts were lower in the low-PIV group than in the high-PIV group (p < 0.05). The highest area under ROC curve (AUC) was determined for Sequential Organ Failure Assessment (SOFA) (0.94 (0.89 - 0.99)), followed by Glasgow Coma Scale (GCS) (0.81 (0.70 - 0.91)), APACHE II (0.80 (0.69 - 0.91)) and lactate (0.77 (0.67 - 0.88)). Median survival was longer in the low-PIV group than in the high-PIV group (28 (15.25 - 40.76) vs 16 (9.46 - 22.55) days, respectively, p < 0.05). The univariate Cox proportional hazards (CPH) model showed that high PIV (HR = 2.13 (1.03-4.38)), low GCS (HR = 3.31 (1.34 - 8.15)), high SOFA (HR = 9.41 (2.86 - 30.95)), high APACHE II (HR = 3.08 (1.47 - 6.45)), high lactate (HR = 6.56 (2.73 - 15.75)), and high procalcitonin (PCT) (HR = 2.73 (1.11 - 6.69)) values were associated with a decreased survival time among ICU patients (p < 0.05). The multivariate CPH model showed the age-adjusted risk estimates for these six laboratory parameters. High lactate (HR = 7.97 (2.19 - 29.08)) and high SOFA scores (HR = 4.85 (1.22 - 19.32)) were significantly associated with shorter survival in ICU patients (p < 0.05). CONCLUSION The findings of this research suggest that PIV could predict the longer survival in patients with septic shock. Despite PIV score's capability to show inflammation, it is not significantly associated with mortality in the multivariate analysis.
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Affiliation(s)
- Yasemin Bozkurt Turan
- Department of Critical Care, Marmara University Faculty of Medicine, Pendik, Istanbul, 34899, Turkey.
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Tarun T, Ghanta SN, Ong V, Kore R, Menon L, Kovesdy C, Mehta JL, Jain N. Updates on New Therapies for Patients with CKD. Kidney Int Rep 2024; 9:16-28. [PMID: 38312786 PMCID: PMC10831355 DOI: 10.1016/j.ekir.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 02/06/2024] Open
Abstract
Individuals diagnosed with chronic kidney disease (CKD) continue to increase globally. This group of patients experience a disproportionately higher risk of cardiovascular (CV) events compared to the general population. Despite multiple guidelines-based medical management, patients with CKD continue to experience residual cardiorenal risk. Several potential mechanisms explain this excessive CV risk observed in individuals with CKD. Several new drugs have become available that could potentially transform CKD care, given their efficacy in this patient population. Nevertheless, use of these drugs presents certain benefits and challenges that are often underrecognized by prescribing these drugs. In this review, we aim to provide a brief discussion about CKD pathophysiology, limiting our discussion to recent published studies. We also explore benefits and limitations of newer drugs, including angiotensin receptor/neprilysin inhibitors (ARNI), sodium glucose transporter 2 inhibitors (SGLT2i), glucagon-like peptides-1 (GLP-1) agonists and finerenone in patients with CKD. Despite several articles covering this topic, our review provides an algorithm where subgroups of patients with CKD might benefit the most from such drugs based on the selection criteria of the landmark trials. Patients with CKD who have nephrotic range proteinuria beyond 5000 mg/g, or those with poorly controlled blood pressure (systolic ≥160 mm Hg or diastolic ≥100 mm Hg) remain understudied.
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Affiliation(s)
- Tushar Tarun
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sai Nikhila Ghanta
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Vincz Ong
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rajshekhar Kore
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lakshmi Menon
- Division of Endocrinology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Csaba Kovesdy
- Renal section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Jawahar L. Mehta
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Cardiology Section, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas, USA
| | - Nishank Jain
- Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Zhang F, Li L, Wu X, Wen Y, Zhan X, Peng F, Wang X, Zhou Q, Feng X. Pan-immune-inflammation value is associated with poor prognosis in patients undergoing peritoneal dialysis. Ren Fail 2023; 45:2158103. [PMID: 36632816 PMCID: PMC9848369 DOI: 10.1080/0886022x.2022.2158103] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Immune-inflammatory biomarkers (IIBs) have been shown to be correlated with prognosis in patients undergoing peritoneal dialysis (PD). In this study, we aimed to evaluate the relationship between a novel comprehensive biomarker, the pan-immune-inflammation value (PIV), and the prognosis of patients undergoing PD. METHODS We retrospectively analyzed data from a multicenter, large-sample PD database. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count. The prognostic endpoints in this study were all-cause death all-cause, cardiovascular disease (CVD) and infection-related death. The Kaplan-Meier method, a Cox proportional hazards regression, Fine-Gray competing risk model, smooth curve, and subgroup analysis were used to analyze the independent relationship between PIV and the prognosis of patients undergoing PD. RESULTS A total of 2796 cases of PD were included, and the study population was divided into Tertiles 1, 2, and 3, according to the tertiles of baseline PIVs. After adjusting for multiple model factors, patients in the Tertile 3 group had a significantly higher risk of all-cause death, CVD death and infection-related death compared with patients with PIV in the Tertile 1 group. Interaction tests showed no positive correlations for subgroup parameters. Regarding all-cause death, compared with the lowest tertile, the multivariable-adjusted hazard ratios (95% confidence intervals) of the highest and middle tertiles were 1.55 (1.25-1.94) and 1.77 (1.43-2.19), respectively; PIV (log2 processing) was associated with 17% excess of mortality in the continuous model. CONCLUSIONS A high PIV at baseline was significantly associated with an increased risk of deaths due to all-causes, CVD and infection in patients undergoing PD.
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Affiliation(s)
- Fengping Zhang
- Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Luohua Li
- Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China,CONTACT Xiaoran Feng Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China
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Sannier G, Nicolas A, Dubé M, Marchitto L, Nayrac M, Tastet O, Chatterjee D, Tauzin A, Lima-Barbosa R, Laporte M, Cloutier R, Sreng Flores AM, Boutin M, Gong SY, Benlarbi M, Ding S, Bourassa C, Gendron-Lepage G, Medjahed H, Goyette G, Brassard N, Delgado GG, Niessl J, Gokool L, Morrisseau C, Arlotto P, Rios N, Tremblay C, Martel-Laferrière V, Prat A, Bélair J, Beaubien-Souligny W, Goupil R, Nadeau-Fredette AC, Lamarche C, Finzi A, Suri RS, Kaufmann DE. A third SARS-CoV-2 mRNA vaccine dose in people receiving hemodialysis overcomes B cell defects but elicits a skewed CD4 + T cell profile. Cell Rep Med 2023; 4:100955. [PMID: 36863335 PMCID: PMC9902290 DOI: 10.1016/j.xcrm.2023.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Cellular immune defects associated with suboptimal responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination in people receiving hemodialysis (HD) are poorly understood. We longitudinally analyze antibody, B cell, CD4+, and CD8+ T cell vaccine responses in 27 HD patients and 26 low-risk control individuals (CIs). The first two doses elicit weaker B cell and CD8+ T cell responses in HD than in CI, while CD4+ T cell responses are quantitatively similar. In HD, a third dose robustly boosts B cell responses, leads to convergent CD8+ T cell responses, and enhances comparatively more T helper (TH) immunity. Unsupervised clustering of single-cell features reveals phenotypic and functional shifts over time and between cohorts. The third dose attenuates some features of TH cells in HD (tumor necrosis factor alpha [TNFα]/interleukin [IL]-2 skewing), while others (CCR6, CXCR6, programmed cell death protein 1 [PD-1], and HLA-DR overexpression) persist. Therefore, a third vaccine dose is critical to achieving robust multifaceted immunity in hemodialysis patients, although some distinct TH characteristics endure.
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Affiliation(s)
- Gérémy Sannier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Nicolas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mathieu Dubé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Lorie Marchitto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Manon Nayrac
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Olivier Tastet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Debashree Chatterjee
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandra Tauzin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | | | - Mélanie Laporte
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Rose Cloutier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Alina M Sreng Flores
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Marianne Boutin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shang Yu Gong
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada
| | - Mehdi Benlarbi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shilei Ding
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Catherine Bourassa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gabrielle Gendron-Lepage
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Halima Medjahed
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Guillaume Goyette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Nathalie Brassard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gloria-Gabrielle Delgado
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Julia Niessl
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Laurie Gokool
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Chantal Morrisseau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Pascale Arlotto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada
| | - Cécile Tremblay
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Neurosciences, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Justin Bélair
- Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - William Beaubien-Souligny
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada
| | - Rémi Goupil
- Centre de Recherche of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC H4J 1C5, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Annie-Claire Nadeau-Fredette
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Caroline Lamarche
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Andrés Finzi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada.
| | - Rita S Suri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada.
| | - Daniel E Kaufmann
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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7
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Khalesi Z, Razizadeh MH, Javadi M, Bahavar A, Keyvanlou Z, Saadati H, Letafati A, Khatami A, Kachooei A, Khales P, Alborzi E, Hosseini M, Tambrchi V, Jafari Maskouni E, Taheri N, Zafarani A, Motlaghzadeh S, Dehghani H, Shalpoush N, Masoudi A, Noorafaz M, Habib Z, Zarei M, Kiani SJ, Ghorbani S. Global epidemiology of HBV infection among hemodialysis patients: A systematic review and meta-analysis. Microb Pathog 2023; 179:106080. [PMID: 36948364 DOI: 10.1016/j.micpath.2023.106080] [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: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND & AIMS Hemodialysis (HD) is a life-saving procedure that purifies the blood in patients with end-stage renal disease (ESRD). Among all major complications, blood-borne diseases like hepatitis B virus (HBV) may be exposed as serious side effects of hemodialysis. A comprehensive review of the global burden of HBV among HD patients has not been written so far. The aim of the current systematic review and meta-analysis was to determine the globally epidemiology of HBV infection among HD patients. METHODS Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles that investigated the prevalence of HBV among HD patients were searched from the major databases such as EMBASE, PubMed, Web of Science collection, and Scopus. Pooled prevalence with 95% CI and identification of heterogeneity were obtained using the random effects model and Cochran's Q-test, respectively, and quantification was evaluated using the I2 statistics. All statistical analyses were performed by STATA 14.1 statistical software. RESULTS among 322 datasets (795,623 cases) that included in this study, the pooled prevalence of HBV infection among HD patients was 7.32% (95% CI: 6.53-8.15%; I2 = 97.91%), including 7.57% (95% CI: 6.69-8.48%) for HBsAg and 6.09% (95% CI: 4.05-8.49%) for DNA, respectively. In addition, based on geographic area, the prevalence was 7.44% (95% CI: 6.35-8.61%) in Asia, 4.32% (95% CI: 2.21-7.04%) in North America, 7.07% (95% CI: 6.35-8.61%) in Europe, 5.52% (95% CI: 3.60-7.78%) in Africa, 8.45% (95% CI: 5.81-11.78%) in Oceania, and 9.73% (95% CI: 7.11-12.70%) in South America. CONCLUSIONS Our analysis indicates a relatively high prevalence of HBV infection in HD patients, even in some developed countries. Considering that ESRD patients are not able to properly respond to the vaccination strategies in order to develop an acceptable immunity, vaccination of healthy individuals is highly recommended to arm their bodies for possible immunocompromise conditions in the future. Moreover, donated blood in blood transfusion centers should be checked for possible hepatitis B virus infection using sensitive molecular tests.
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Affiliation(s)
- Zohreh Khalesi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahsa Javadi
- Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Atefeh Bahavar
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Keyvanlou
- Department of Virology, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Hassan Saadati
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Arash Letafati
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khatami
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Atefeh Kachooei
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pegah Khales
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Alborzi
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdiyeh Hosseini
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Tambrchi
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Jafari Maskouni
- Department of Microbiology and Virology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nafiseh Taheri
- Department of Microbiology and Virology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Zafarani
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Motlaghzadeh
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Dehghani
- Department of Biology, Jahrom Branch, Islamic Azad University, Fars, Iran
| | - Nadia Shalpoush
- Biology Cellular and Molecular Microbiology, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Alireza Masoudi
- Department of Laboratory Sciences, Faculty of Allied Medical Sciences, Medical University of Qom, Qom, Iran
| | - Marzieh Noorafaz
- Department of Microbiology, Faculty of Basic Sciences, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Zahra Habib
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Seyed Jalal Kiani
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Saied Ghorbani
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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8
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de Groot K, Schreiber JG. [This is how I treat rheumatoid arthritis in dialysis patients]. Z Rheumatol 2023; 82:325-327. [PMID: 36853340 DOI: 10.1007/s00393-023-01334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Kirsten de Groot
- Medizinische Klinik 3, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland
| | - Judith G Schreiber
- Medizinische Klinik 3, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland.
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9
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Identification of Differentially Expressed Genes Particularly Associated with Immunity in Uremia Patients by Bioinformatic Analysis. Anal Cell Pathol (Amst) 2022; 2022:5437560. [PMID: 36618529 PMCID: PMC9815924 DOI: 10.1155/2022/5437560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022] Open
Abstract
Uremia is a common syndrome that happens to nearly all end-stage kidney diseases, which profound have changes in human gene expressions, but the related pathways are poorly understood. Gene Ontology categories and Kyoto Encyclopedia of Genes and Genomes pathways enriched in the differentially expressed genes (DEGs) were analyzed by using clusterProfiler, org.Hs.eg.db, and Pathview, and protein-protein interaction (PPI) network was built by Cytoscape. We identified 3432 DEGs (including 3368 down- and 64 up-regulated genes), of which there were 52 different molecular functions, and 178 genes were identified as immune genes controlled by the four transcription factors (POU domain class 6 transcription factor 1 (POU6F1), interferon regulator factor 7 [IRF7], forkhead box D3 (FOXD3), and interferon-stimulated response element [ISRE]). In the gender research, no significant difference was observed. The top 15 proteins of 178 immune-related genes were identified with the highest degree in PPI network. The DEG analysis of uremia patients was expected to provide fundamental information to relieve pain and add years to their life.
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10
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Ponticelli C, Campise M. COVID-19 Vaccination in Kidney Transplant Candidates and Recipients. Vaccines (Basel) 2022; 10:vaccines10111808. [PMID: 36366317 PMCID: PMC9692413 DOI: 10.3390/vaccines10111808] [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: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 12/03/2022] Open
Abstract
Kidney transplant candidates and kidney transplant recipients (KTRs) are at particular risk of severe complications of COVID-19 disease. In Western countries, mortality in affected hospitalized KTRs ranges between 19% and 50%. COVID-19 vaccination remains the most important measure to prevent the severity of infection in candidates and recipients of kidney transplant. However, the uraemic condition may affect the vaccine-induced immunity in patients with advanced chronic kidney disease (CKD) and in KTRs. Retention of uraemic toxins, dysbiosis, dysmetabolism, and dialysis can diminish the normal response to vaccination, leading to dysfunction of inflammatory and immune cells. In KTRs the efficacy of vaccines may be reduced by the immunosuppressive medications, and more than half of kidney transplant recipients are unable to build an immune response even after four administrations of anti-COVID-19 vaccines. The lack of antibody response leaves these patients at high risk for SARS-CoV-2 infection and severe COVID-19 disease. The aim of the present review is to focus on the main reasons for the impaired immunological response among candidates and kidney transplant recipients and to highlight some of the present options available to solve the problem.
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Affiliation(s)
| | - Mariarosaria Campise
- Department of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
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11
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Meng D, Liu T. A lipid metabolism-related risk signature for patients with gliomas constructed with TCGA and CGGA data. Medicine (Baltimore) 2022; 101:e30501. [PMID: 36086728 PMCID: PMC9937104 DOI: 10.1097/md.0000000000030501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Lipid metabolism affects cell proliferation, differentiation, membrane homeostasis and drug resistance. An in-depth exploration of lipid metabolism in gliomas might provide a novel direction for gliomas treatment. A lipid metabolism-related risk signature was constructed in our study to assess the prognosis of patients with gliomas. Lipid metabolism-related genes were extracted. Differentially expressed genes (DEGs) were screened, and a risk signature was built. The ability of the risk signature to predict the outcomes of patients with gliomas was assessed using the log-rank test and Cox regression analysis. The relationships between immunological characteristics, drug sensitivity and the risk score were evaluated, and the risk-related mechanisms were also estimated. Twenty lipid metabolism-related DEGs associated with the patient prognosis were included in the risk signature. The survival rate of high-risk patients was worse than that of low-risk patients. The risk score independently predicted the outcomes of patients. Immunological parameters, drug sensitivity, immunotherapy benefits, and numerous molecular mechanisms were significantly associated with the risk score. A lipid metabolism-related risk signature might effectively assess the prognosis of patients with gliomas. The risk score might guide individualized treatment and further clinical decision-making for patients with gliomas.
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Affiliation(s)
- Dingqiang Meng
- Department of Neurology, Traditional Chinese Medicine Hospital, ChongQing, China
| | - Ting Liu
- Department of Neurology, Traditional Chinese Medicine Hospital, ChongQing, China
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12
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Liu Z, Zhang C, Hao J, Chen G, Liu L, Xiong Y, Chang Y, Li H, Shimosawa T, Yang F, Xu Q. Eplerenone ameliorates lung fibrosis in unilateral ureteral obstruction rats by inhibiting lymphangiogenesis. Exp Ther Med 2022; 24:623. [PMID: 36160894 PMCID: PMC9468786 DOI: 10.3892/etm.2022.11560] [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: 04/28/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic kidney disease (CKD) involves progressive and irreversible loss of renal function, often causing complications and comorbidities and impairing the function of various organs. In particular, lung injury is observed not only in advanced CKD but also in early-stage CKD. The present study investigated the potential involvement of mineralocorticoid receptors (MRs) and lymphatic vessels in lung injury using a 180-day unilateral ureteral obstruction (UUO) model for CKD. Changes in lung associated with lymphangiogenesis and inflammatory were analyzed in UUO rats. The pathology of the lung tissue was observed by hematoxylin and eosin and Masson's staining. Detection of the expression of lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1), Podoplanin, vascular endothelial growth factor receptor-3 (VEGFR-3) and VEGF C to investigate lymphangiogenesis. The mRNA and protein expression levels of IL-1β, monocyte chemotactic protein 1, tumor necrosis factor-α, nuclear factor κB, phosphorylated serum and glucocorticoid-induced protein kinase-1 and MR were evaluated using western blot, reverse transcription-quantitative PCR, immunohistochemical staining and immunofluorescence staining. In the present study, long-term UUO caused kidney damage, which also led to lung inflammation, accompanied by lymphangiogenesis. However, treatment with eplerenone, an MR blocker, significantly reduced the severity of lung injury and lymphangiogenesis. Therefore, lymphangiogenesis contributed to lung fibrosis in UUO rats due to activation of MRs. In addition, transdifferentiation of lymphatic epithelial cells into myofibroblasts may also be involved in lung fibrosis. Collectively, these findings provided a potential mechanism for lung fibrosis in CKD and suggested that the use of eplerenone decreased kidney damage and lung fibrosis.
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Affiliation(s)
- Ziqian Liu
- Hebei Key Laboratory of Integrative Medicine on Liver‑Kidney Patterns, Institute of Integrative Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Cuijuan Zhang
- Hebei Key Laboratory of Integrative Medicine on Liver‑Kidney Patterns, Institute of Integrative Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Juan Hao
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Gege Chen
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Lingjin Liu
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Yunzhao Xiong
- Hebei Key Laboratory of Integrative Medicine on Liver‑Kidney Patterns, Institute of Integrative Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Yi Chang
- Hebei Key Laboratory of Integrative Medicine on Liver‑Kidney Patterns, Institute of Integrative Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Hui Li
- Hebei Key Laboratory of Integrative Medicine on Liver‑Kidney Patterns, Institute of Integrative Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Tatsuo Shimosawa
- Department of Clinical Laboratory, School of Medicine, International University of Health and Welfare, Narita, Chiba 108‑8329, Japan
| | - Fan Yang
- Hebei Key Laboratory of Integrative Medicine on Liver‑Kidney Patterns, Institute of Integrative Medicine, Shijiazhuang, Hebei 050091, P.R. China
| | - Qingyou Xu
- Hebei Key Laboratory of Integrative Medicine on Liver‑Kidney Patterns, Institute of Integrative Medicine, Shijiazhuang, Hebei 050091, P.R. China
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13
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Valentini N, Marchitto L, Raymond M, Goyette G, Kaufmann DE, Finzi A, Suri RS, Lamarche C. Innate Immunity and SARS-CoV-2 Vaccine Response in Hemodialysis Patients. KIDNEY360 2022; 3:1763-1768. [PMID: 36514720 PMCID: PMC9717667 DOI: 10.34067/kid.0002542022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/08/2022] [Indexed: 01/12/2023]
Abstract
Patients receiving hemodialysis (HD) have more inflammatory monocytes and less plasmacytoid dendritic cells (DCs) compared with healthy controls.Patients on HD who have a poor antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine had fewer monocyte-derived DCs and conventional DCs compared with good responders.The defects in antigen presentation might be possible therapeutic targets to increase vaccine efficacy in HD patients.
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Affiliation(s)
- Nicolas Valentini
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada,Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Lorie Marchitto
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Department of Microbiology, Infectiology and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Maxime Raymond
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada
| | - Guillaume Goyette
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada
| | - Daniel E. Kaufmann
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Departement of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Andrés Finzi
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Department of Microbiology, Infectiology and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Rita S. Suri
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Lamarche
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada,Departement of Medicine, University of Montreal, Montreal, Quebec, Canada
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14
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Aranda-Rivera AK, Cruz-Gregorio A, Pedraza-Chaverri J, Scholze A. Nrf2 Activation in Chronic Kidney Disease: Promises and Pitfalls. Antioxidants (Basel) 2022; 11:antiox11061112. [PMID: 35740009 PMCID: PMC9220138 DOI: 10.3390/antiox11061112] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
The nuclear factor erythroid 2-related factor 2 (Nrf2) protects the cell against oxidative damage. The Nrf2 system comprises a complex network that functions to ensure adequate responses to redox perturbations, but also metabolic demands and cellular stresses. It must be kept within a physiologic activity range. Oxidative stress and alterations in Nrf2-system activity are central for chronic-kidney-disease (CKD) progression and CKD-related morbidity. Activation of the Nrf2 system in CKD is in multiple ways related to inflammation, kidney fibrosis, and mitochondrial and metabolic effects. In human CKD, both endogenous Nrf2 activation and repression exist. The state of the Nrf2 system varies with the cause of kidney disease, comorbidities, stage of CKD, and severity of uremic toxin accumulation and inflammation. An earlier CKD stage, rapid progression of kidney disease, and inflammatory processes are associated with more robust Nrf2-system activation. Advanced CKD is associated with stronger Nrf2-system repression. Nrf2 activation is related to oxidative stress and moderate uremic toxin and nuclear factor kappa B (NF-κB) elevations. Nrf2 repression relates to high uremic toxin and NF-κB concentrations, and may be related to Kelch-like ECH-associated protein 1 (Keap1)-independent Nrf2 degradation. Furthermore, we review the effects of pharmacological Nrf2 activation by bardoxolone methyl, curcumin, and resveratrol in human CKD and outline strategies for how to adapt future Nrf2-targeted therapies to the requirements of patients with CKD.
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Affiliation(s)
- Ana Karina Aranda-Rivera
- Laboratory F-315, Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico, Mexico City 04510, Mexico; (A.K.A.-R.); (A.C.-G.); (J.P.-C.)
| | - Alfredo Cruz-Gregorio
- Laboratory F-315, Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico, Mexico City 04510, Mexico; (A.K.A.-R.); (A.C.-G.); (J.P.-C.)
| | - José Pedraza-Chaverri
- Laboratory F-315, Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico, Mexico City 04510, Mexico; (A.K.A.-R.); (A.C.-G.); (J.P.-C.)
| | - Alexandra Scholze
- Department of Nephrology, Odense University Hospital, 5000 Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
- Correspondence:
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15
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Oh ES, You Z, Nowak KL, Jovanovich AJ. Association of Monocyte Count and Monocyte/Lymphocyte Ratio with the Risk of Cardiovascular Outcomes in Patients with CKD. KIDNEY360 2022; 3:657-665. [PMID: 35721602 PMCID: PMC9136887 DOI: 10.34067/kid.0007922021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 01/08/2023]
Abstract
BackgroundEmerging evidence suggests an association of higher monocyte count and monocyte/lymphocyte ratio (MLR) with the risk of cardiovascular disease (CVD) in individuals without chronic kidney disease (CKD); however, limited studies have examined if this association translates to the CKD population. This study examined whether monocyte count and MLR are associated with the risk of CVD, CVD death, and all-cause death in patients with nondialysis CKD who participated in the Chronic Renal Insufficiency Cohort observational study.MethodsBaseline monocyte count and MLR were categorized into tertiles and also modeled continuously. Cox proportional hazards models were used to examine the association between monocyte count (primary predictor) and MLR (secondary predictor) at baseline and time to a composite of CVD events, including heart failure, myocardial infarction, ischemic stroke, and peripheral artery disease (primary outcome). Secondary outcomes were time to CVD death and all-cause death.ResultsThe median follow-up time was 9 years for CVD events and 11.7 years for death. In the fully adjusted model, participants with a higher monocyte count and MLR had a greater risk of CVD events (hazard ratio [HR] per doubling of monocyte count=1.2 [95% CI, 1.1 to 1.31]; HR per doubling of MLR=1.26 [95% CI, 1.16 to 1.36]), CVD death (HR=1.18 [95% CI, 0.99 to 1.41]; HR=1.27 [95% CI, 1.1 to 1.48]), and all-cause death (HR=1.17 [95% CI, 1.06 to 1.3]; HR=1.18 [95% CI, 1.09 to 1.29]).ConclusionsThese results suggest that monocyte count and MLR may have the potential to be cost-effective, clinically available indicators of CVD risk in the CKD population.
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16
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Zhang X, Chen P, Xu G. Update of the mechanism and characteristics of tuberculosis in chronic kidney disease. Wien Klin Wochenschr 2022; 134:501-510. [DOI: 10.1007/s00508-022-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/24/2022] [Indexed: 10/18/2022]
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17
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Zsom L, Zsom M, Salim SA, Fülöp T. Estimated Glomerular Filtration Rate in Chronic Kidney Disease: A Critical Review of Estimate-Based Predictions of Individual Outcomes in Kidney Disease. Toxins (Basel) 2022; 14:127. [PMID: 35202154 PMCID: PMC8875627 DOI: 10.3390/toxins14020127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is generally regarded as a final common pathway of several renal diseases, often leading to end-stage kidney disease (ESKD) and a need for renal replacement therapy. Estimated GFR (eGFR) has been used to predict this outcome recognizing its robust association with renal disease progression and the eventual need for dialysis in large, mainly cross-sectional epidemiological studies. However, GFR is implicitly limited as follows: (1) GFR reflects only one of the many physiological functions of the kidney; (2) it is dependent on several non-renal factors; (3) it has intrinsic variability that is a function of dietary intake, fluid and cardiovascular status, and blood pressure especially with impaired autoregulation or medication use; (4) it has been shown to change with age with a unique non-linear pattern; and (5) eGFR may not correlate with GFR in certain conditions and disease states. Yet, many clinicians, especially our non-nephrologist colleagues, tend to regard eGFR obtained from a simple laboratory test as both a valid reflection of renal function and a reliable diagnostic tool in establishing the diagnosis of CKD. What is the validity of these beliefs? This review will critically reassess the limitations of such single-focused attention, with a particular focus on inter-individual variability. What does science actually tell us about the usefulness of eGFR in diagnosing CKD?
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Affiliation(s)
- Lajos Zsom
- Fresenius Medical Care, Cegléd Dialysis Center, Törteli u 1-3, 2700 Cegléd, Hungary
| | - Marianna Zsom
- Department of Medicine, St. Rókus Hospital, Rókus u 10, 6500 Baja, Hungary;
| | - Sohail Abdul Salim
- Department of Medicine, Division of Nephrology, University of Mississippi, 2500 N State St., Jackson, MS 39216, USA;
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 629, CSB 822, Charleston, SC 29425, USA
- Medicine Services, Ralph H. Johnson VA Medical Center, 109 Bee St., Charleston, SC 29401, USA
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18
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Myeloid leukocytes' diverse effects on cardiovascular and systemic inflammation in chronic kidney disease. Basic Res Cardiol 2022; 117:38. [PMID: 35896846 PMCID: PMC9329413 DOI: 10.1007/s00395-022-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 01/31/2023]
Abstract
Chronic kidney disease's prevalence rises globally. Whereas dialysis treatment replaces the kidney's filtering function and prolongs life, dreaded consequences in remote organs develop inevitably over time. Even milder reductions in kidney function not requiring replacement therapy associate with bacterial infections, cardiovascular and heart valve disease, which markedly limit prognosis in these patients. The array of complications is diverse and engages a wide gamut of cellular and molecular mechanisms. The innate immune system is profoundly and systemically altered in chronic kidney disease and, as a unifying element, partakes in many of the disease's complications. As such, a derailed immune system fuels cardiovascular disease progression but also elevates the propensity for serious bacterial infections. Recent data further point towards a role in developing calcific aortic valve stenosis. Here, we delineate the current state of knowledge on how chronic kidney disease affects innate immunity in cardiovascular organs and on a systemic level. We review the role of circulating myeloid cells, monocytes and neutrophils, resident macrophages, dendritic cells, ligands, and cellular pathways that are activated or suppressed when renal function is chronically impaired. Finally, we discuss myeloid cells' varying responses to uremia from a systems immunology perspective.
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19
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Duarte R, Roldão M, Figueiredo C, Luz I, Ferrer F, Gonçalves H, Sofia F, Lopes K. Humoral response to BNT162b2 mRNA COVID-19 vaccine in peritoneal and hemodialysis patients: A comparative study. Ther Apher Dial 2021; 26:790-796. [PMID: 34837463 PMCID: PMC9011594 DOI: 10.1111/1744-9987.13766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/03/2021] [Accepted: 11/19/2021] [Indexed: 12/20/2022]
Abstract
Introduction Maintenance dialysis patients (MDP) are at higher risk of exposure with increased mortality from COVID‐19 with generalized immunization becoming the cornerstone in prevention. This study aims to compare humoral response between hemodialysis (HD) and peritoneal dialysis (PD) patients. Materials and Methods Observational prospective study following HD and PD programs from a Portuguese Center receiving BNT162b2 vaccine. Specific anti‐Spike IgG quantification to compare both for absolute value and non‐responders (NR) between modalities and against risk factors. Results Of 67 MDP, 42 were HD and 25 PD patients. PD developed higher antibody titers after both first (median 5.44 vs. 0.99 AU/ml, p < 0.01) and second dose (median 170.43 vs. 65.81 AU/ml; p < 0.01). HD associated with NR after the first dose (p < 0.01). Conclusion This study demonstrated improved humoral immunogenicity with BNT162b2 in PD compared to HD patients. These differences are attributed to comorbidity burden and age differences, rather than dialysis modality.
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Affiliation(s)
- Rui Duarte
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Marisa Roldão
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Cátia Figueiredo
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Ivan Luz
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Francisco Ferrer
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Hernâni Gonçalves
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Flora Sofia
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Karina Lopes
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
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20
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McLean MR, Wragg KM, Lopez E, Kiazyk SA, Ball TB, Bueti J, Kent SJ, Juno JA, Chung AW. Serological and cellular inflammatory signatures in end-stage kidney disease and latent tuberculosis. Clin Transl Immunology 2021; 10:e1355. [PMID: 34765193 PMCID: PMC8569694 DOI: 10.1002/cti2.1355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/08/2021] [Accepted: 10/21/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives Tuberculosis comorbidity with chronic diseases including diabetes, HIV and chronic kidney disease is of rising concern. In particular, latent tuberculosis infection (LTBI) comorbidity with end‐stage kidney disease (ESKD) is associated with up to 52.5‐fold increased risk of TB reactivation to active tuberculosis infection (ATBI). The immunological mechanisms driving this significant rise in TB reactivation are poorly understood. To contribute to this understanding, we performed a comprehensive assessment of soluble and cellular immune features amongst a unique cohort of patients comorbid with ESKD and LTBI. Methods We assessed the plasma and cellular immune profiles from patients with and without ESKD and/or LTBI (N = 40). We characterised antibody glycosylation, serum complement and cytokine levels. We also assessed classical and non‐classical monocytes and T cells with flow cytometry. Using a systems‐based approach, we identified key immunological features that discriminate between the different disease states. Results Individuals with ESKD exhibited a highly inflammatory plasma profile and an activated cellular state compared with those without ESKD, including higher levels of inflammatory antibody Fc glycosylation structures and activated CX3CR1+ monocytes that correlate with increased inflammatory plasma cytokines. Similar elevated inflammatory signatures were also observed in ESKD+/LTBI+ compared with ESKD−/LTBI+, suggesting that ESKD induces an overwhelming inflammatory immune state. In contrast, no significant inflammatory differences were observed when comparing LTBI+ and LTBI− individuals. Conclusion Our study highlights the highly inflammatory state induced by ESKD. We hypothesise that this inflammatory state could contribute to the increased risk of TB reactivation in ESKD patients.
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Affiliation(s)
- Milla R McLean
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Kathleen M Wragg
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Ester Lopez
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Sandra A Kiazyk
- National HIV and Retrovirology Laboratory National Microbiology Laboratory JC Wilt Infectious Diseases Research Centre Public Health Agency of Canada Winnipeg MB Canada.,Department of Medical Microbiology and Infectious Diseases University of Manitoba Winnipeg MB Canada
| | - Terry Blake Ball
- National HIV and Retrovirology Laboratory National Microbiology Laboratory JC Wilt Infectious Diseases Research Centre Public Health Agency of Canada Winnipeg MB Canada
| | - Joe Bueti
- Department of Internal Medicine University of Manitoba Winnipeg MB Canada.,Section of Nephrology Department of Internal Medicine University of Manitoba MB Canada.,Health Sciences Centre Winnipeg MB Canada
| | - Stephen J Kent
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia.,Australian Research Council Centre for Excellence in Convergent Bio-Nano Science and Technology University of Melbourne Melbourne VIC Australia.,Melbourne Sexual Health Centre and Department of Infectious Diseases Alfred Hospital and Central Clinical School Monash University Melbourne VIC Australia
| | - Jennifer A Juno
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Amy W Chung
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
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21
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Ye L, Xu Y, Wang L, Zhang C, Hu P, Tong S, Liu Z, Tian D. Downregulation of CYP2E1 is associated with poor prognosis and tumor progression of gliomas. Cancer Med 2021; 10:8100-8113. [PMID: 34612013 PMCID: PMC8607268 DOI: 10.1002/cam4.4320] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/03/2021] [Accepted: 09/19/2021] [Indexed: 12/19/2022] Open
Abstract
Objective To explore the role and possible regulatory mechanisms of CYP2E1 in gliomas. Methods RNA‑seq data and corresponding clinical information of glioma patients were collected from The Cancer Genome Atlas and Chinese Glioma Genome Atlas, and mRNA data of normal brain tissues were obtained by the Genotype‐Tissue Expression project. The Wilcoxon test was performed to analyze the correlation between CYP2E1 expression and glioma subtypes. Univariate and multivariate Cox proportional hazards regression, receiver operating characteristic curves, and Kaplan–Meier plots were used to evaluate the prognostic value of CYP2E1 in glioma. Functional enrichment analyses and immune infiltration analyses were performed to investigate the potential function of CYP2E1 in gliomas. Moreover, we investigated the miRNA and epigenetic mechanisms that regulate CYP2E1 expression. Finally, network pharmacology and molecular docking experiments were used to predict drugs that target CYP2E1. Results The downregulation of CYP2E1 expression may predict a poor prognosis for glioma patients. CYP2E1 expression decreased with increasing WHO grade (II–IV), and its level was correlated with clinical features, including age, 1p19q codeletion status, and IDH state in glioma tissues. Furthermore, CYP2E1 was involved in lipid metabolism and ferroptosis and related to the tumor immune microenvironment due to its strong correlation with the levels of infiltrating monocytes and Tregs. Moreover, variation in the total methylation level and copy number of CYP2E1 was moderately correlated with its mRNA expression (p < 0.05). CYP2E1 was predicted to be targeted by hsa‐miR‐527, whose expression was negatively related to CYP2E1 mRNA expression (p < 0.05). In addition, effective compounds that target CYP2E1, including 18beta‐glycyrrhetinic acid, styrene, toluene, nicotine, m‐xylene, p‐xylene, and colchicine, were identified. Conclusion The downregulation of CYP2E1, which affects lipid metabolism and the ferroptosis signaling pathway, promotes the progression of gliomas.
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Affiliation(s)
- Liguo Ye
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Yang Xu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Long Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Chunyu Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Ping Hu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Shi'ao Tong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Zhennan Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Daofeng Tian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
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22
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Ducloux D, Legendre M, Bamoulid J, Saas P, Courivaud C, Crepin T. End-Stage Renal Disease-Related Accelerated Immune Senescence: Is Rejuvenation of the Immune System a Therapeutic Goal? Front Med (Lausanne) 2021; 8:720402. [PMID: 34540869 PMCID: PMC8446427 DOI: 10.3389/fmed.2021.720402] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 02/05/2023] Open
Abstract
End-stage renal disease (ESRD) patients exhibit clinical features of premature ageing, including frailty, cardiovascular disease, and muscle wasting. Accelerated ageing also concerns the immune system. Patients with ESRD have both immune senescence and chronic inflammation that are resumed in the so-called inflammaging syndrome. Immune senescence is particularly characterised by premature loss of thymic function that is associated with hyporesponsiveness to vaccines, susceptibility to infections, and death. ESRD-related chronic inflammation has multiple causes and participates to accelerated cardiovascular disease. Although, both characterisation of immune senescence and its consequences are relatively well-known, mechanisms are more uncertain. However, prevention of immune senescence/inflammation or/and rejuvenation of the immune system are major goal to ameliorate clinical outcomes of ESRD patients.
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Affiliation(s)
- Didier Ducloux
- Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,University Bourgogne Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Mathieu Legendre
- Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,University Bourgogne Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
| | - Jamal Bamoulid
- Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,University Bourgogne Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Philippe Saas
- Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,University Bourgogne Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,EFS Bourgogne Franche-Comté, Plateforme de Biomonitoring, CIC 1431/UMR1098, Besançon, France
| | - Cécile Courivaud
- Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,University Bourgogne Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Thomas Crepin
- Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
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23
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Falconi CA, Junho CVDC, Fogaça-Ruiz F, Vernier ICS, da Cunha RS, Stinghen AEM, Carneiro-Ramos MS. Uremic Toxins: An Alarming Danger Concerning the Cardiovascular System. Front Physiol 2021; 12:686249. [PMID: 34054588 PMCID: PMC8160254 DOI: 10.3389/fphys.2021.686249] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
The kidneys and heart share functions with the common goal of maintaining homeostasis. When kidney injury occurs, many compounds, the so-called "uremic retention solutes" or "uremic toxins," accumulate in the circulation targeting other tissues. The accumulation of uremic toxins such as p-cresyl sulfate, indoxyl sulfate and inorganic phosphate leads to a loss of a substantial number of body functions. Although the concept of uremic toxins is dated to the 1960s, the molecular mechanisms capable of leading to renal and cardiovascular injuries are not yet known. Besides, the greatest toxic effects appear to be induced by compounds that are difficult to remove by dialysis. Considering the close relationship between renal and cardiovascular functions, an understanding of the mechanisms involved in the production, clearance and overall impact of uremic toxins is extremely relevant for the understanding of pathologies of the cardiovascular system. Thus, the present study has as main focus to present an extensive review on the impact of uremic toxins in the cardiovascular system, bringing the state of the art on the subject as well as clinical implications related to patient's therapy affected by chronic kidney disease, which represents high mortality of patients with cardiac comorbidities.
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Affiliation(s)
- Carlos Alexandre Falconi
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André, Brazil
| | - Carolina Victoria da Cruz Junho
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André, Brazil
| | - Fernanda Fogaça-Ruiz
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André, Brazil
| | - Imara Caridad Stable Vernier
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André, Brazil
| | - Regiane Stafim da Cunha
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Marcela Sorelli Carneiro-Ramos
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André, Brazil
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24
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Betjes MGH. Uremia-Associated Immunological Aging and Severity of COVID-19 Infection. Front Med (Lausanne) 2021; 8:675573. [PMID: 33937299 PMCID: PMC8079657 DOI: 10.3389/fmed.2021.675573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
One year after the start of the COVID-19 pandemic it has become clear that some groups of individuals are at particular high risk of a complicated course of infection resulting in high morbidity and mortality. Two specific risk factors are most prominent, old age and the presence of co-morbidity. Recent studies have shown that patients with compromised renal function, especially those treated with renal replacement therapy or having received a kidney transplant are at a much higher risk for severe COVID infection and increased mortality. This may be in part due to the increased prevalence of co-morbid conditions in these patients but specific alterations in their immune system, reflecting premature immunological aging, may be equally important. In this review the different aspects, in particular thymus function and memory T cell expansion, of uremia-associated immunological aging are reviewed with respect to COVID 19 infection. In essence, the decreased generation of naïve T cells may be instrumental in suboptimal anti-viral immune responses while the relatively uncontrolled expansion of effector T cells may facilitate the feared phase of the COVID-19 infection with excessive and live-threatening inflammation of the lung parenchyma.
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Affiliation(s)
- Michiel G H Betjes
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
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25
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Special Issue: Immune Dysfunction in Uremia. Toxins (Basel) 2021; 13:toxins13010070. [PMID: 33477769 PMCID: PMC7832314 DOI: 10.3390/toxins13010070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 12/26/2022] Open
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26
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Abstract
Cardiovascular disease and infections are major causes for the high incidence of morbidity and mortality of patients with chronic kidney disease. Both complications are directly or indirectly associated with disturbed functions or altered apoptotic rates of polymorphonuclear leukocytes, monocytes, lymphocytes, and dendritic cells. Normal responses of immune cells can be reduced, leading to infectious diseases or pre-activated/primed, giving rise to inflammation and subsequently to cardiovascular disease. This review summarizes the impact of kidney dysfunction on the immune system. Renal failure results in disturbed renal metabolic activities with reduced renin, erythropoietin, and vitamin D production, which adversely affects the immune system. Decreased kidney function also leads to reduced glomerular filtration and the retention of uremic toxins. A large number of uremic toxins with detrimental effects on immune cells have been identified. Besides small water-soluble and protein-bound compounds originating from the intestinal microbiome, several molecules in the middle molecular range, e.g., immunoglobulin light chains, retinol-binding protein, the neuropeptides Met-enkephalin and neuropeptide Y, endothelin-1, and the adipokines leptin and resistin, adversely affect immune cells. Posttranslational modifications such as carbamoylation, advanced glycation products, and oxidative modifications contribute to uremic toxicity. Furthermore, high-density lipoprotein from uremic patients has an altered protein profile and thereby loses its anti-inflammatory properties.
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Affiliation(s)
- Gerald Cohen
- Department of Nephrology and Dialysis, Medical University of Vienna, Vienna A-1090, Austria
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