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Chang YS, Lee JM, Huang K, Vagts CL, Ascoli C, Edafetanure-Ibeh R, Huang Y, Cherian RA, Sarup N, Warpecha SR, Hwang S, Goel R, Turturice BA, Schott C, Martinez MH, Finn PW, Perkins DL. Network Analysis of Dysregulated Immune Response to COVID-19 mRNA Vaccination in Hemodialysis Patients. Vaccines (Basel) 2024; 12:1146. [PMID: 39460313 PMCID: PMC11511558 DOI: 10.3390/vaccines12101146] [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: 08/01/2024] [Revised: 09/29/2024] [Accepted: 10/01/2024] [Indexed: 10/28/2024] Open
Abstract
INTRODUCTION End-stage renal disease (ESRD) results in immune dysfunction that is characterized by both systemic inflammation and immune incompetence, leading to impaired responses to vaccination. METHODS To unravel the complex regulatory immune interplay in ESRD, we performed the network-based transcriptomic profiling of ESRD patients on maintenance hemodialysis (HD) and matched healthy controls (HCs) who received the two-dose regimen of the COVID-19 mRNA vaccine BNT162b2. RESULTS Co-expression networks based on blood transcription modules (BTMs) of genes differentially expressed between the HD and HC groups revealed co-expression patterns that were highly similar between the two groups but weaker in magnitude in the HD compared to HC subjects. These networks also showed weakened coregulation between BTMs within the dendritic cell (DC) family as well as with other BTM families involved with innate immunity. The gene regulatory networks of the most enriched BTMs, likewise, highlighted weakened targeting by transcription factors of key genes implicated in DC, natural killer (NK) cell, and T cell activation and function. The computational deconvolution of immune cell populations further bolstered these findings with discrepant proportions of conventional DC subtypes, NK T cells, and CD8+ T cells in HD subjects relative to HCs. CONCLUSION Altogether, our results indicate that constitutive inflammation in ESRD compromises the activation of DCs and NK cells, and, ultimately, their mediation of downstream lymphocytes, leading to a delayed but intact immune response to mRNA vaccination.
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Affiliation(s)
- Yi-Shin Chang
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jessica M. Lee
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Kai Huang
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Christen L. Vagts
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Christian Ascoli
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Russell Edafetanure-Ibeh
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Yue Huang
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Ruth A. Cherian
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Nandini Sarup
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Samantha R. Warpecha
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Sunghyun Hwang
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Rhea Goel
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Benjamin A. Turturice
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Medicine, Stanford University, Palo Alto, CA 94305, USA
| | - Cody Schott
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | - Montserrat H. Martinez
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
| | - Patricia W. Finn
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - David L. Perkins
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA (J.M.L.); (K.H.); (C.L.V.); (C.A.); (S.R.W.); (B.A.T.); (M.H.M.); (D.L.P.)
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
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Yasar E, Yildiz Y, Ozturk E, Gok Oguz E, Coskun Yenigun E, Ozturk R, Helvaci O, Ozger HS, Keles M, Karacin C, Ugras Dikmen A, Caglar K, Duranay M, Ayli MD, Dizbay M, Erten Y, Guz G, Derici U. Comparison of homologous and heterologous inactivated and mRNA vaccination programme against SARS-CoV-2 in dialysis patients. Nephrology (Carlton) 2024; 29:405-414. [PMID: 38485143 DOI: 10.1111/nep.14292] [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: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 06/27/2024]
Abstract
AIM To evaluate the vaccine response and the effect of the booster dose on COVID-19 positivity in haemodialysis (HD) and peritoneal dialysis (PD) patients who received and did not receive BNT162b2 as a booster dose after two doses of CoronaVac. METHODS The study included 80 PD and 163 HD patients, who had been administered two doses of the CoronaVac. Antibody levels were measured on Days 42 and 90 after the first dose. Measurements were repeated on Day 181 after the first dose in the patients that received two vaccine doses and on Day 28 after the third dose in those that also received the booster dose. Antibody levels below 50 AU/mL were considered negative. RESULTS The seropositivity rate was similar in the HD and PD group on Days 42 and 90 (p = 0.212 and 0.720). All patients were seropositive in the booster group. The antibody level was lower in the patients that received CoronaVac as the booster compared to those administered BNT162b2 in HD and PD groups (p < 0.001 and 0.002). COVID-19 positivity was detected in 11 patients (7 = had not received the booster dose, 4 = had received third dose of CoronaVac). The multivariate analysis revealed that as age increased, COVID-19 positivity also increased (OR: 1.080, 95% CI: 1.017 - 1.146, p = 0.012), while booster dose administration decreased this positivity (OR: 0.113, 95% CI: 0.028 - 0.457, p = 0.002). CONCLUSION Our results may indicate the need for additional vaccination doses in patients with HD and PD. Our findings indicate a higher antibody response in dialysis patients with heterologous BNT162b2 as a booster dose after two doses of CoronaVac compared to homologous CoronaVac.
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Affiliation(s)
- Emre Yasar
- Department of Nephrology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Yesim Yildiz
- Department of Infectious Disease and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Erensu Ozturk
- Department of Medical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, University of Health Sciences, Etlik Ihtisas Training & Research Hospital, Ankara, Turkey
| | - Ezgi Coskun Yenigun
- Department of Nephrology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ramazan Ozturk
- Department of Nephrology, University of Health Sciences, Ankara Training & Research Hospital, Ankara, Turkey
| | - Ozant Helvaci
- Department of Nephrology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Hasan Selcuk Ozger
- Department of Infectious Disease and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Meryem Keles
- Department of Nephrology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cengiz Karacin
- Department of Medical Oncology, University of Health Sciences, Dr Abdurrahman Yurtaslan Oncology Training & Research Hospital, Ankara, Turkey
| | - Asiye Ugras Dikmen
- Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kayhan Caglar
- Department of Medical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Duranay
- Department of Nephrology, University of Health Sciences, Ankara Training & Research Hospital, Ankara, Turkey
| | - Mehmet Deniz Ayli
- Department of Nephrology, University of Health Sciences, Etlik Ihtisas Training & Research Hospital, Ankara, Turkey
| | - Murat Dizbay
- Department of Infectious Disease and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Erten
- Department of Nephrology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Galip Guz
- Department of Nephrology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ulver Derici
- Department of Nephrology, Gazi University, Faculty of Medicine, Ankara, Turkey
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Friebus-Kardash J, Kuang F, Peitz T, Hamdan TA, Eisenberger U, Boss K, Kribben A, Lang KS, Jahn M. Expression of Interferon Regulatory Factor 8 (IRF8) and Its Association with Infections in Dialysis Patients. Cells 2023; 12:1892. [PMID: 37508555 PMCID: PMC10378315 DOI: 10.3390/cells12141892] [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: 06/24/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Patients on dialysis have dysfunctions of innate and adaptive immune system responses. The transcriptional factor IRF8 (interferon regulatory factor 8) is primarily expressed in plasmacytoid cells (pDCs) and myeloid dendritic cells (mDCs), playing a crucial role in the maturation of dendritic cells, monocytes, and macrophages, and contributing to protection against bacterial infections. The current study analyzed the expression patterns of IRF8 and assessed its association with the risk of infections in 79 dialysis patients compared to 44 healthy controls. Different subsets of leukocytes and the intracellular expression of IRF8 were measured using flow cytometry. Compared to the healthy controls, the dialysis patients showed significantly reduced numbers of pDCs and significantly increased numbers of natural killer cells and classical and intermediate monocytes. The dialysis patients exhibited decreased numbers of IRF8-positive dendritic cells (pDC p < 0.001, mDC1 p < 0.001, mDC2 p = 0.005) and increased numbers of IRF8-positive monocytes (p < 0.001). IRF8 expression in pDC, mDC, and classical monocytes was lower in the dialysis patients than in the controls. Dialysis patients who required hospitalization due to infections within one year of follow-up displayed significantly reduced IRF8 expression levels in pDCs compared to patients without such infections (p = 0.04). Our results suggest that reduced IRF8 expression in pDCs is a potential risk factor predisposing dialysis patients to serious infections.
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Affiliation(s)
- Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Fei Kuang
- Institute of Immunology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Tobias Peitz
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Thamer A Hamdan
- Institute of Immunology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Kristina Boss
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Karl Sebastian Lang
- Institute of Immunology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
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Ni W, Guo K, Shi S, Cheng L, Zhou Y, Zhang F, Xu J, Lin K, Chen C, Gao Z, Zhou H. Prevalence and prognostic value of malnutrition in patients with acute coronary syndrome and chronic kidney disease. Front Nutr 2023; 10:1187672. [PMID: 37521420 PMCID: PMC10376694 DOI: 10.3389/fnut.2023.1187672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background Malnutrition is a rising global health issue associated with unfavorable outcomes of a variety of disorders. Currently, the prevalence and prognostic significance of malnutrition to patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) remained largely unclear. Methods A total of 705 patients diagnosed with ACS and CKD in the First Affiliated Hospital of Wenzhou Medical University between 2013 and 2021 were included in this retrospective cohort study. Malnutrition was assessed by the Controlling Nutritional Status (CONUT), the Geriatric Nutritional Risk Index (GNRI), and the Prognostic Nutritional Index (PNI), respectively. The relationships between malnutrition and all-cause mortality and major cardiovascular events (MACEs) were analyzed. Results During a median follow-up of 31 months, 153 (21.7%) patients died, and 165 (23.4%) had MACEs. The prevalence of malnutrition was 29.8, 80.6, and 89.8% for the PNI, CONUT, and GNRI, respectively. All the malnutrition indexes were correlated with each other (r = 0.77 between GNRI and PNI, r = -0.72 between GNRI and CONUT, and r = -0.88 between PNI and CONUT, all p < 0.001). Compared with normal nutrition, malnutrition was independently associated with an increased risk for all-cause mortality (adjusted hazard ratio for moderate and severe degrees of malnutrition, respectively: 7.23 [95% confidence interval (CI): 2.69 to 19.49] and 17.56 [95% CI: 5.61 to 55.09] for the CONUT score, 2.18 [95% CI: 0.93 to 5.13] and 3.16 [95% CI: 1.28 to 7.79] for the GNRI, and 2.52 [95% CI: 1.62 to 3.94] and 3.46 [95% CI: 2.28 to 5.25] for the PNI score. p values were lower than 0.05 for all nutritional indexes, except for moderate GNRI p value = 0.075). As for MACEs, similar results were observed in the CONUT and PNI. All the risk scores could improve the predictive ability of the Global Registry of Acute Coronary Events (GRACE) risk score for both all-cause mortality and MACEs. Conclusion Malnutrition was common in patients with ACS and CKD regardless of the screening tools used, and was independently associated with all-cause mortality and MACEs. Malnutrition scores could facilitate risk stratification and prognosis assessment.
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Toda M, Yoshifuji A, Nakayama T, Mise-Omata S, Oyama E, Uwamino Y, Namkoong H, Komatsu M, Yoshimura A, Hasegawa N, Kikuchi K, Ryuzaki M. Cellular and Humoral Immune Responses after Breakthrough Infection in Patients Undergoing Hemodialysis. Vaccines (Basel) 2023; 11:1214. [PMID: 37515030 PMCID: PMC10384632 DOI: 10.3390/vaccines11071214] [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: 03/10/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 07/30/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) following primary immunization (breakthrough infection) has been reported in hemodialysis patients; however, their post-infection immune status remains unclear. We evaluated the humoral and cellular immunity of hemodialysis patients after breakthrough infection. Hemodialysis patients who had received primary immunization against COVID-19 at least six months prior to the study but developed mild/moderate COVID-19 before a booster dose (breakthrough infection group) and hemodialysis patients who were not infected with COVID-19 but received a booster dose (booster immunization group) were recruited. In both groups, SARS-CoV-2 antigen-specific cytokines and IgG levels were measured three weeks after infection or three weeks after receiving a booster dose. Memory T and B cells were also counted in the breakthrough infection group using flow cytometry three weeks after infection. Significantly higher SARS-CoV-2 antigen-specific IgG, IFN-γ, IL-5, TNF-α, and IL-6 levels occurred in the breakthrough infection group compared to the booster immunization group (p = 0.013, 0.039, 0.024, 0.017, and 0.039, respectively). The SARS-CoV-2 antigen-specific IgG and cytokine levels were not significantly different between the two groups. The breakthrough infection group had significantly higher percentages of central and effector memory T cells and regulatory T cells than the comparison group (p = 0.008, 0.031, and 0.026, respectively). Breakthrough infections may induce stronger cellular and humoral immune responses than booster immunizations in hemodialysis patients.
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Affiliation(s)
- Masataro Toda
- Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan
| | - Ayumi Yoshifuji
- Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tetsuo Nakayama
- Kitasato Institute for Life Sciences, Laboratory of Viral Infection, Kitasato University, Tokyo 108-8641, Japan
| | - Setsuko Mise-Omata
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Emi Oyama
- Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan
| | - Yoshifumi Uwamino
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Motoaki Komatsu
- Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan
| | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kan Kikuchi
- Division of Nephrology, Shimoochiai Clinic, Tokyo 161-0033, Japan
| | - Munekazu Ryuzaki
- Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan
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Franzin R, Stasi A, Caggiano G, Squiccimarro E, Losappio V, Fiorentino M, Alfieri C, Stallone G, Gesualdo L, Castellano G. Enhancing Immune Protection in Hemodialysis Patients: Role of the Polymethyl Methacrylate Membrane. Blood Purif 2023; 52 Suppl 1:49-61. [PMID: 37075738 PMCID: PMC10210079 DOI: 10.1159/000529971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/07/2023] [Indexed: 04/21/2023]
Abstract
End-stage renal disease (ESRD) is characterized by deep disorders in both innate and adaptive immune systems that imply unbalance deactivation and immunosuppression. The central, widely recognized factors responsible for this immune dysregulation are uremia, uremic toxin retention, hemodialysis membrane biocompatibility, and related cardiovascular complications. Recently, several studies strengthened the concept that dialysis membranes are not considered as a simple diffusive/adsorptive device but as a platform to personalize a dialysis approach to improve the quality of life of ESRD patients. Therefore, understanding of the molecules associated with altered immune response is crucial and could lead to therapeutically intervention or adaptation of the dialysis procedure itself for the management of immunological dysfunction of ESRD patients. The polymethyl methacrylate (PMMA)-based membrane is characterized by a symmetrical structure with large-sized pores, providing a better hydrophobic and cationic adsorption capacity compared to the other synthetic membranes. Together with hydrophobic interactions, the high adsorption rate of cytokines (i.e., IL-6) can also be enhanced by the size of nano-pores placed on the membrane surface. PMMA membranes exhibit adsorptive properties for a large amount of uremic toxins including p-cresol and indoxyl sulfate, as well as β2-microglobulin characterized by higher molecular weight, maintaining the diffusive clearance of small molecules like urea with a great biocompatibility. Besides exerting a strong anti-inflammatory effects in line with the improvement of immune responses in patients undergoing dialysis, PMMA also plays a role in modulating adaptive immune response, i.e., can clear blood from soluble CD40, a natural antagonist of the CD40/CD40L signaling that acts inhibiting immunoglobulin production by B cells. This review provides an overview of the main concepts and current understanding of immune dysfunction in hemodialysis and summarizes the recent findings regarding PMMA-based dialysis as potential strategy to restore immune balance in ESRD patients.
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Affiliation(s)
- Rossana Franzin
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Alessandra Stasi
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Gianvito Caggiano
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Elena Squiccimarro
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Vincenzo Losappio
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Marco Fiorentino
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Carlo Alfieri
- Unit of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppe Castellano
- Unit of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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T-Cell Response and Antibody Production Induced by the COVID-19 Booster Vaccine in Japanese Chronic Kidney Disease Patients Treated with Hemodialysis. Vaccines (Basel) 2023; 11:vaccines11030653. [PMID: 36992238 DOI: 10.3390/vaccines11030653] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Humoral and cellular responses are critical in understanding immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Here, we evaluated these responses in hemodialysis (HD) patients after the booster vaccination. SARS-CoV-2 immunoglobulin (IgG) levels, neutralizing antibody titers, and the T-SPOT®.COVID test (T-SPOT) were measured prior to, three weeks after, and three months after the booster administration. The HD group had significantly higher SARS-CoV-2 IgG levels and neutralizing antibody titers against the original strain at three weeks and three months after the booster vaccination compared to the control group, albeit the HD group had lower SARS-CoV-2 IgG levels and neutralizing antibody titers before the booster administration. Moreover, the HD group had significantly higher T-SPOT levels at all three time points compared to the control group. The HD group also had significantly higher local and systemic adverse reaction rates than the control group. By booster vaccination, HD patients could acquire more effective SARS-CoV-2-specific humoral and cellular immunity than the control group.
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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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9
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Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10101670. [PMID: 36298535 PMCID: PMC9610516 DOI: 10.3390/vaccines10101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Maintenance hemodialysis (MHD) patients have impaired immunological responses to pathogens and vaccines. In this study, we compared the humoral response to HBV and COVID-19 vaccines in a cohort of MHD patients. Demographic and clinical characteristics of vaccine responders and non-responders were also compared, and the association between the humoral responses to both vaccines was evaluated. The cohort included 94 MHD patients who were vaccinated at least once for HBV and twice for COVID-19. Among the 94 patients, 28 (29.8%) did not develop protective titers to HBV. Hypertension, coronary heart disease, and heart failure were more common in non-responders. Among MHD patients, 85% had positive IgG anti-spike SARS-CoV-2 levels 6 months after two doses of BNT162b2 (Pfizer/Biotech) vaccine. Age and immunosuppressive therapy were the main predictors of humoral response to COVID-19 vaccine. We did not find any association between non-responders to HBV and non-responders to COVID-19 vaccine. There was no difference in IgG anti-spike titers between HBV responders and non-responders (505 ± 644 vs. 504 ± 781, p = 0.9) Our results suggest that reduced humoral response to hepatitis B is not associated with reduced response to COVID-19 vaccine. Different risk-factors were associated with poor immune response to HBV and to COVID-19 vaccines.
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10
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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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11
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Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients at Dialysis Initiation. Nutrients 2022; 14:nu14112317. [PMID: 35684116 PMCID: PMC9182995 DOI: 10.3390/nu14112317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and affects their prognosis. The Controlling Nutritional Status (CONUT) score is a nutritional screening tool calculated using only blood test data. This study aimed to investigate the prognostic value of CONUT score in patients just initiating dialysis. A total of 311 CKD patients who stably initiated dialysis were enrolled. Only 27 (8.7%) patients were classified as having normal nutritional status. The CONUT score was also independently correlated with elevated C-reactive protein levels (β = 0.485, p < 0.0001). During the median follow-up of 37 months, 100 patients (32.2%) died. The CONUT score was an independent predictor of all-cause mortality (adjusted hazard ratio 1.13, 95% confidence interval 1.04−1.22, p < 0.0024). As model discrimination, the addition of the CONUT score to a prediction model based on established risk factors significantly improved net reclassification improvement (0.285, p = 0.028) and integrated discrimination improvement (0.025, p = 0.023). The CONUT score might be a simplified surrogate marker of the PEW with clinical utility and could predict all-cause mortality, in addition to improving the predictability in CKD patients just initiating dialysis. The CONUT score also could predict infectious-disease mortality.
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12
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Ben-Dov IZ, Oster Y, Tzukert K, Alster T, Bader R, Israeli R, Asayag H, Aharon M, Burstein I, Pri-Chen H, Imam A, Abel R, Mor-Yosef Levi I, Khalaileh A, Oiknine-Djian E, Bloch A, Wolf DG, Dranitzki Elhalel M. Impact of tozinameran (BNT162b2) mRNA vaccine on kidney transplant and chronic dialysis patients: 3-5 months follow-up. J Nephrol 2022; 35:153-164. [PMID: 34988942 PMCID: PMC8731189 DOI: 10.1007/s40620-021-01210-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Determining the humoral immunogenicity of tozinameran (BNT162b2) in patients requiring chronic renal replacement therapy, and its impact on COVID-19 morbidity several months after vaccination, may guide risk assessment and changes in vaccination policy. METHODS In a prospective post-vaccination cohort study with up to 5 months follow-up we studied outpatient dialysis and kidney transplant patients and respective healthcare teams. Outcomes were anti S1/S2 antibody responses to vaccine or infection, and infection rate during follow-up. RESULTS One hundred seventy-five dialysis patients (40% women, 65 ± 15 years), 252 kidney transplant patients (33% women, 54 ± 14 years) and 71 controls (65% women, 44 ± 14 years) were followed. Three months or longer after vaccination we detected anti S1/S2 IgG antibodies in 79% of dialysis patients, 42% of transplant recipients and 100% of controls, whereas respective rates after infection were 94%, 69% and 100%. Predictors of non-response were older age, diabetes, history of cancer, lower lymphocyte count and lower vitamin-D levels. Factors associated with lower antibody levels in dialysis patients were modality (hemodialysis vs peritoneal) and high serum ferritin levels. In transplant patients, hypertension and higher calcineurin or mTOR inhibitor drug levels were linked with lower antibody response. Vaccination was associated with fewer subsequent infections (HR 0.23, p < 0.05). Moreover, higher antibody levels (particularly above 59 AU/ml) were associated with fewer events, with a HR 0.41 for each unit increased in log10titer (p < 0.05). CONCLUSIONS Dialysis patients, and more strikingly kidney transplant recipients, mounted reduced antibody response to COVID-19 mRNA vaccination. Lesser humoral response was associated with more infections. Measures to identify and protect non-responsive patients are required.
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Affiliation(s)
- Iddo Z Ben-Dov
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel.
| | - Yonatan Oster
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Keren Tzukert
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Talia Alster
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Raneem Bader
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Israeli
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Haya Asayag
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Michal Aharon
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Ido Burstein
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Hadas Pri-Chen
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Ashraf Imam
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roy Abel
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Irit Mor-Yosef Levi
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Abed Khalaileh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aharon Bloch
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Dana G Wolf
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Dranitzki Elhalel
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
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13
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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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14
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Suh JW, Kim MJ, Kim JH. Risk factors of septic shock development and thirty-day mortality with a predictive model in adult candidemia patients in intensive care units. Infect Dis (Lond) 2021; 53:908-919. [PMID: 34330205 DOI: 10.1080/23744235.2021.1959052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This study aimed to investigate factors associated with septic shock development and 30-day mortality outcome with a prediction model among adult candidemia patients in the intensive care unit (ICU). METHODS A retrospective study was conducted among patients admitted to the ICU from 2009 to 2018 at a tertiary care medical centre. The study subjects included adult patients ≥ 19 years with candidemia treated with antifungal agent for ≥ 3 days. Clinical variables were collected and analysed. RESULTS A total of 126 patients were included in the study. Of these patients, 32 patients (25.4%) had septic shock. Multivariate logistic regression analysis revealed that chronic liver disease was associated with septic shock (odds ratio [OR] 3.372, 95% confidence interval [CI] 1.057 - 10.057). The rate of 30-day mortality was 35.7% and the associated mortality risk factors were malignancy (OR 8.251, 95% CI 2.227 - 30.573), chronic liver disease (OR 3.605, 95% CI 0.913 - 14.227), haemodialysis (OR 8.479, 95% CI 1.801 - 39.924), mycological failure (OR 29.675, 95% CI 7.012 - 125.578), and septic shock (OR 3.980, 95% CI 1.238 - 12.796). A predictive model for 30-day mortality was created based on the mortality risk factor scores, which had an area of 0.862 under the receiver operating characteristic curve. CONCLUSIONS Adult candidemia patients in the ICU who have chronic liver disease may be at higher risk of developing septic shock. Furthermore, our predictive model for 30-day mortality based on the mortality risk factors may be useful for clinical assessment.
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Affiliation(s)
- Jin Woong Suh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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15
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Oud JA, Evers D, Middelburg RA, de Vooght KMK, van de Kerkhof D, Visser O, Péquériaux NCV, Hudig F, van der Bom JG, Zwaginga JJ. Association between renal failure and red blood cell alloimmunization among newly transfused patients. Transfusion 2020; 61:35-41. [PMID: 33295653 PMCID: PMC7839777 DOI: 10.1111/trf.16166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Renal failure and renal replacement therapy (RRT) affect the immune system and could therefore modulate red blood cell (RBC) alloimmunization after transfusion. STUDY DESIGN AND METHODS We performed a nationwide multicenter case-control study within a source population of newly transfused patients between 2005 and 2015. Using conditional multivariate logistic regression, we compared first-time transfusion-induced RBC alloantibody formers (N = 505) with two nonalloimmunized recipients with similar transfusion burden (N = 1010). RESULTS Renal failure was observed in 17% of the control and 13% of the case patients. A total of 41% of the control patients and 34% of case patients underwent acute RRT. Renal failure without RRT was associated with lower alloimmunization risks after blood transfusion (moderate renal failure: adjusted relative rate [RR], 0.82 [95% confidence interval (CI), 0.67-1.01]); severe renal failure, adjusted RR, 0.76 [95% CI, 0.55-1.05]). With severe renal failure patients mainly receiving RRT, the lowest alloimmunization risk was found in particularly these patients [adjusted RR 0.48 (95% CI 0.39-0.58)]. This was similar for patients receiving RRT for acute or chronic renal failure (adjusted RR, 0.59 [95% CI, 0.46-0.75]); and adjusted RR, 0.62 [95% CI 0.45-0.88], respectively). CONCLUSION These findings are indicative of a weakened humoral response in acute as well as chronic renal failure, which appeared to be most pronounced when treated with RRT. Future research should focus on how renal failure and RRT mechanistically modulate RBC alloimmunization.
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Affiliation(s)
- Josine A Oud
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorothea Evers
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karen M K de Vooght
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan van de Kerkhof
- Department of Clinical Chemistry and Hematology, Catharina Hospital, Eindhoven, The Netherlands
| | - Otto Visser
- Department of Hematology, Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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16
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Luo Y, Li J, Liu Z, Yu H, Peng X, Cao C. Characteristics and outcomes of hemodialysis patients with COVID-19: a retrospective single center study. PeerJ 2020; 8:e10459. [PMID: 33304660 PMCID: PMC7700734 DOI: 10.7717/peerj.10459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
Background The coronavirus 19 (COVID-19) pandemic has heightened the threat to the health and lives of patients with comorbid diseases. Infection by COVID-19 is especially detrimental to patients on hemodialysis. In this study, we evaluated the clinical characteristics, laboratory findings, treatments and prognoses of hemodialysis patients with COVID-19. Methods A total of 16 hemodialysis patients with COVID-19 were recruited from Wuhan Fourth Hospital from 5 February to 20 March 2020 for a retrospective, single-center study. A total of 62 non-dialysis patients with COVID-19 were the control group. We collected data on the clinical characteristics, laboratory findings, treatments, and clinical outcomes of patients affected by the virus. Results Hemodialysis patients with COVID-19 had a lower incidence of fever (P = 0.001) and relatively higher incidence of pre-admission comorbidities and shortness of breath than non-dialysis patients with COVID-19 (75% vs. 61%, P = 0.467 50% vs. 33.87%, P = 0.248 ). Hemodialysis patients had lower levels of hemoglobin (P < 0.001), white blood cell counts (P = 0.015), neutrophils (P = 0.016), AST (P = 0.037), ALT (P < 0.001) and procalcitonin (P < 0.001), and higher levels of D-dimer (P < 0.001) and thrombin time (P < 0.001). Hemodialysis patients had a higher incidence of pulmonary effusion, cord-like high-density shadows, pleural thickening, and atelectasis (P < 0.05). Hemodialysis patients also had relatively higher rates of mortality and prolonged hospital stays compared with the control group. Conclusions Hemodialysis patients typically present with multiple comorbidities and are considered to be a high-risk group for COVID-19 infections. Hemodialysis patients with COVID-19 may have prolonged hospital stays and unfavorable prognoses and should be closely monitored.
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Affiliation(s)
- Yongwen Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Junli Li
- Institute of Laboratory Animal Sciences, Peking Union Medical College, Beijing, China
| | - Zhifen Liu
- Department of Nephrology, Wuhan Fourth Hospital, Wuhan, China
| | - Heping Yu
- Department of Thyroid and Breast Surgery, Wuhan Fourth Hospital, Wuhan, China
| | - Xiang Peng
- Department of Neurology, Wuhan Fourth Hospital, Wuhan, China
| | - Cheng'an Cao
- Department of Neurology, Wuhan Fourth Hospital, Wuhan, China
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17
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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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18
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Espi M, Koppe L, Fouque D, Thaunat O. Chronic Kidney Disease-Associated Immune Dysfunctions: Impact of Protein-Bound Uremic Retention Solutes on Immune Cells. Toxins (Basel) 2020; 12:toxins12050300. [PMID: 32384617 PMCID: PMC7291164 DOI: 10.3390/toxins12050300] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022] Open
Abstract
Regardless of the primary disease responsible for kidney failure, patients suffering from chronic kidney disease (CKD) have in common multiple impairments of both the innate and adaptive immune systems, the pathophysiology of which has long remained enigmatic. CKD-associated immune dysfunction includes chronic low-grade activation of monocytes and neutrophils, which induces endothelial damage and increases cardiovascular risk. Although innate immune effectors are activated during CKD, their anti-bacterial capacity is impaired, leading to increased susceptibility to extracellular bacterial infections. Finally, CKD patients are also characterized by profound alterations of cellular and humoral adaptive immune responses, which account for an increased risk for malignancies and viral infections. This review summarizes the recent emerging data that link the pathophysiology of CKD-associated immune dysfunctions with the accumulation of microbiota-derived metabolites, including indoxyl sulfate and p-cresyl sulfate, the two best characterized protein-bound uremic retention solutes.
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Affiliation(s)
- Maxime Espi
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69000 Lyon, France;
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, 69000 Lyon, France
| | - Laetitia Koppe
- Département de Néphrologie-Dialyse-Nutrition, Centre Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France; (L.K.); (D.F.)
- CarMeN, INSERM U1060, INRA 1397, 69310 Pierre-Bénite, France
- Lyon-Sud Medical Faculty, Université de Lyon, 69000 Lyon, France
| | - Denis Fouque
- Département de Néphrologie-Dialyse-Nutrition, Centre Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France; (L.K.); (D.F.)
- CarMeN, INSERM U1060, INRA 1397, 69310 Pierre-Bénite, France
- Lyon-Sud Medical Faculty, Université de Lyon, 69000 Lyon, France
| | - Olivier Thaunat
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69000 Lyon, France;
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, 69000 Lyon, France
- Lyon-Est Medical Faculty, Université de Lyon, 69000 Lyon, France
- Correspondence:
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Artemov DV, Zulkarnaev AB, Vatazin AV. Age-related features of the pattern of lymphocyte subpopulations and functional activity of peripheral blood mononuclear cells in patients with chronic kidney disease before and after transplantation. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2020. [DOI: 10.15825/1995-1191-2020-1-40-49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- D. V. Artemov
- M.F. Vladimirsky Moscow Regional Clinical and Research Institute
| | - A. B. Zulkarnaev
- M.F. Vladimirsky Moscow Regional Clinical and Research Institute
| | - A. V. Vatazin
- M.F. Vladimirsky Moscow Regional Clinical and Research Institute
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20
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de Paiva BR, Esgalhado M, Borges NA, Kemp JA, Alves G, Leite PEC, Macedo R, Cardozo LFMF, de Brito JS, Mafra D. Resistant starch supplementation attenuates inflammation in hemodialysis patients: a pilot study. Int Urol Nephrol 2020; 52:549-555. [PMID: 32008198 DOI: 10.1007/s11255-020-02392-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE In chronic kidney disease (CKD) patients, dysbiosis is associated with inflammation and cardiovascular risk, so many nutritional strategies are being studied to reduce these complications. Resistant starch (RS) can be considered a prebiotic that promotes many benefits, including modulation of gut microbiota which is linked to immune-modulatory effects. The aim of this study was to evaluate the effects of RS supplementation on proinflammatory cytokines in CKD patients on hemodialysis (HD). METHODS A double-blind, placebo-controlled, randomized trial was conducted with sixteen HD patients (55.3 ± 10.05 years, body mass index (BMI) 25.9 ± 5.42 kg/m2, 56% men, time on dialysis 38.9 ± 29.23 months). They were allocated to the RS group (16 g RS/day) or placebo group (manioc flour). The serum concentration of ten cytokines and growth factors was detected through a multiparametric immunoassay based on XMap-labeled magnetic microbeads (Luminex Corp, USA) before and after 4 weeks with RS supplementation. RESULTS After RS supplementation, there was a reduction of Regulated upon Activation, Normal T-Cell Expressed and Secreted (p < 0.001), platelet-derived growth factor (two B subunits) (p = 0.014) and interferon-inducible protein 10 (IP-10) (p = 0.027). The other parameters did not change significantly. CONCLUSION This preliminary result indicates that RS may contribute to a desirable profile of inflammatory markers in CKD patients.
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Affiliation(s)
- Bruna Regis de Paiva
- Graduate Program in Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil. .,Hospital Universitário Antônio Pedro, Rua Marquês do Paraná nº 303, 4º andar, Niterói, Rio de Janeiro, Brazil.
| | - Marta Esgalhado
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, RJ, Brazil
| | | | - Julie Ann Kemp
- Graduate Program in Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil
| | - Gutemberg Alves
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niterói, RJ, Brazil
| | - Paulo Emílio Corrêa Leite
- Laboratory of Bioengineering and in Vitro Toxicology, Directory of Metrology Applied to Life Science-Dimav, National Institute of Metrology Quality and Technology-INMETRO, Duque de Caxias, RJ, Brazil
| | - Renata Macedo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, RJ, Brazil
| | - Ludmila F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, RJ, Brazil
| | - Jessyca Sousa de Brito
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, RJ, Brazil
| | - Denise Mafra
- Graduate Program in Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil.,Graduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, RJ, Brazil
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21
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Kim SH, Moon JH, Jeong SU, Jung HH, Park CS, Hwang BY, Lee CK. Induction of antigen-specific immune tolerance using biodegradable nanoparticles containing antigen and dexamethasone. Int J Nanomedicine 2019; 14:5229-5242. [PMID: 31371958 PMCID: PMC6636315 DOI: 10.2147/ijn.s210546] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose Dexamethasone (Dex) has long been used as a potent immunosuppressive agent in the treatment of inflammatory and autoimmune diseases, despite serious side effects. In the present study, Dex and model antigen ovalbumin (OVA) were encapsulated with poly(lactic-co-glycolic acid) to deliver Dex and OVA preferentially to phagocytic cells, reducing systemic side effects of Dex. The OVA-specific immune tolerance-inducing activity of the nanoparticles (NPs) was examined. Methods Polymeric NPs containing OVA and Dex (NP[OVA+Dex]) were prepared by the water-in-oil-in-water double emulsion solvent evaporation method. The effects of NP[OVA+Dex] on the maturation and function of immature dendritic cells (DCs) were examined in vitro. Furthermore, the OVA-specific immune tolerizing effects of NP[OVA+Dex] were confirmed in mice that were intravenously injected or orally fed with the NPs. Results Immature DCs treated in vitro with NP[OVA+Dex] did not mature into immunogenic DCs but instead were converted into tolerogenic DCs. Furthermore, profoundly suppressed generation of OVA-specific cytotoxic T cells and production of OVA-specific IgG were observed in mice injected with NP[OVA+Dex], whereas regulatory T cells were concomitantly increased. Feeding of mice with NP[OVA+Dex] also induced OVA-specific immune tolerance. Conclusion The present study demonstrates that oral feeding as well as intravenous injection of poly(lactic-co-glycolic acid) NPs encapsulating both antigen and Dex is a useful means of inducing antigen-specific immune tolerance, which is crucial for the treatment of autoimmune diseases.
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Affiliation(s)
- Sang-Hyun Kim
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Jun-Hyeok Moon
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Seong-Un Jeong
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Ho-Hyun Jung
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Chan-Su Park
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Bang Yeon Hwang
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Chong-Kil Lee
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
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22
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Hsieh MH, Lu YA, Kuo G, Chen CY, Sun WC, Lin Y, Tian YC, Hsu HH. Epidemiology and outcomes of anal abscess in patients on chronic dialysis: a 14-year retrospective study. Clinics (Sao Paulo) 2019; 74:e638. [PMID: 30916172 PMCID: PMC6438129 DOI: 10.6061/clinics/2019/e638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/02/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.
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Affiliation(s)
- Meng-Hsuan Hsieh
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-An Lu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chiao Sun
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - YuJr Lin
- Research Services Center For Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- Corresponding author. E-mail:
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Kundert F, Platen L, Iwakura T, Zhao Z, Marschner JA, Anders HJ. Immune mechanisms in the different phases of acute tubular necrosis. Kidney Res Clin Pract 2018; 37:185-196. [PMID: 30254843 PMCID: PMC6147180 DOI: 10.23876/j.krcp.2018.37.3.185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/25/2018] [Indexed: 12/18/2022] Open
Abstract
Acute kidney injury is a clinical syndrome that can be caused by numerous diseases including acute tubular necrosis (ATN). ATN evolves in several phases, all of which are accompanied by different immune mechanisms as an integral component of the disease process. In the early injury phase, regulated necrosis, damage-associated molecular patterns, danger sensing, and neutrophil-driven sterile inflammation enhance each other and contribute to the crescendo of necroinflammation and tissue injury. In the late injury phase, renal dysfunction becomes clinically apparent, and M1 macrophage-driven sterile inflammation contributes to ongoing necroinflammation and renal dysfunction. In the recovery phase, M2-macrophages and anti-inflammatory mediators counteract the inflammatory process, and compensatory remnant nephron and cell hypertrophy promote an early functional recovery of renal function, while some tubules are still badly injured and necrotic material is removed by phagocytes. The resolution of inflammation is required to promote the intrinsic regenerative capacity of tubules to replace at least some of the necrotic cells. Several immune mechanisms support this wound-healing-like re-epithelialization process. Similar to wound healing, this response is associated with mesenchymal healing, with a profound immune cell contribution in terms of collagen production and secretion of profibrotic mediators. These and numerous other factors determine whether, in the chronic phase, persistent loss of nephrons and hyperfunction of remnant nephrons will result in stable renal function or progress to decline of renal function such as progressive chronic kidney disease.
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Affiliation(s)
- Fedor Kundert
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Louise Platen
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Takamasa Iwakura
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Zhibo Zhao
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Julian A Marschner
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Hans-Joachim Anders
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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24
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Rezapour M, Sepehri MM, Khavanin Zadeh M, Alborzi M. A new method to determine anastomosis angle configuration for arteriovenous fistula maturation. Med J Islam Repub Iran 2018; 32:62. [PMID: 30643737 PMCID: PMC6325282 DOI: 10.14196/mjiri.32.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Indexed: 11/18/2022] Open
Abstract
Background: The kidneys of patients with chronic kidney disease (CKD) do not function well enough and those in end-stage renal disease (ESRD) of CKD need hemodialysis (HD) as a common renal replacement therapy (RRT) procedure. HD requires a vascular access (VA), and arteriovenous fistula (AVF) is the common VA choice in the world due to its very few complications. Despite the widespread use of AVFs, some risk factors maximize AVF failure, which is accompanied by complications of the patient such as repeating VA surgeries and hospitalization. Therefore, finding effective factors in the success of surgery is highly important and, thus, this study aimed at measuring the effect of anastomosis angle on the success of AVF surgery. Methods: This study evaluated the effect of conducted angle in an AVF anastomosis on AVF maturation. The images of 48 created AVFs for CKD patients was provided over a one-year period (from May 2016 to April 2017). Cross-tab analysis was used, and significance level was considered meaningful at p-value≤0.001. A centralized database was designed to integrate data. A method for image processing was developed and geometrical characteristics of the vessels (such as anastomosis angle) and also the diameter of artery and vein were measured via AutoCAD 2017 software and exported to the database along with other data. Results: The rate of the AVF failure in the studied patients was 8.96%. The anastomosis angle ≤ 30° is preferable from the AVF status point of view because most AVF maturation (or least AVF failure) rates are detected at this range. Conclusion: This study was performed based on a new approach without the need to measure hemodynamic parameters. Moreover, it signified the important role of anastomosis angle in the function of AVF, showing that the anastomosis angle ≤ 30° is a preferable intraoperative recommendation for AVF surgery.
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Affiliation(s)
- Mohammad Rezapour
- Department of Information Technology Management, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Mehdi Sepehri
- Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran, & Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Khavanin Zadeh
- Faculty of Medicine, Iran University of Medical Sciences, Hasheminejad Kidney Center (HKC), Tehran, Iran
| | - Mahmood Alborzi
- Faculty of IT Management, Science and Research Branch, Islamic Azad University, Tehran, Iran
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25
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Less primary fistula failure in hypertensive patients. J Hum Hypertens 2018; 32:311-318. [PMID: 29581557 DOI: 10.1038/s41371-018-0052-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/28/2018] [Accepted: 02/05/2018] [Indexed: 11/08/2022]
Abstract
End stage renal disease (ESRD) patients suffer from advanced renal diseases and actually nonfunctioning kidneys, and need kidney transplantation or dialysis. Hemodialysis (HD) is the most used method and requires a vascular access (VA). Arteriovenous fistula (AVF) is the first choice of VA over the world for having least morbidity and mortality. Despite the wide-spread use of AVFs, the rate of AVF failures are notable. Detecting the factors that cause AVF failure can reduce repeating VA surgeries and hospitalization of ESRD patients. Present research studies 480 Iranian HD patients who underwent AVF surgery from 2010 to 2017 and aged 18-90 years old, using data mining techniques. (i) The AVF failure rate was equal to 8.96%, such that AVF failure has occurred in 3.54% and 5.52% of HD patient with and without hypertension, respectively. (ii) The rate of non-failure AVF in hypertensive patients is 61.46%, whereas the same rate for patients with negative history of hypertension reaches to 29.58%. (iii) Hypertension has a significant inverse association with AVF failure (Spearman's ρ = -0.160, P-value ≤ 0.005). (iv) The decision tree (with accuracy rate = 92.24%) shows less AVF failure in hypertsensive patients (5.53%) comparing with non-hypertensive patients (15.09%). (v) The AVFs with greater failure rates and non-hypertensive HD patients were clustered together. "Significantly lower risk of AVF failure was associated with presence of a positive history of hypertension; in other words, positive history of hypertension has an adverse effect on AVF failure and Hypertensive HD patients have more maturated AVF."
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