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Højagergaard MA, Beske RP, Hassager C, Holmvang L, Jensen LO, Shacham Y, Meyer MAS, Moeller JE, Helgestad OKL, Mark PD, Møgelvang R, Frydland M. Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Patients with ST-Elevation Myocardial Infarction and Its Association with Acute Kidney Injury and Mortality. J Clin Med 2023; 12:jcm12113681. [PMID: 37297879 DOI: 10.3390/jcm12113681] [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: 04/17/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory biomarker related to acute kidney injury (AKI). Including 1892 consecutive patients with ST-elevation myocardial infarction (STEMI), in which NGAL was measured in 1624 (86%) on admission and in a consecutive subgroup at 6-12 h (n = 163) and 12-24 h (n = 222) after admission, this study aimed to evaluate the prognostic value of NGAL in predicting AKI and mortality. Patients were stratified based on whether their admission NGAL plasma concentration was greater than or equal to/less than the median. The primary endpoint was a composite of the first occurrence of AKI or all-cause death within 30 days. AKI was classified by the maximal plasma creatinine increase from baseline during index admission as KDIGO1 (<200% increase) or KDIGO23 (≥200% increase) according to the Kidney Disease Improving Global Outcomes (KDIGO) system. Admission NGAL > the median was independently associated with a higher risk of severe AKI (KDIGO2-3) and 30-day all-cause mortality when adjusted for age, admission systolic blood pressure and high-sensitivity C-reactive protein, left-ventricular ejection fraction, known kidney dysfunction, and cardiogenic shock with an odds ratio (95% confidence interval) of 2.26 (1.18-4.51), p = 0.014. Finally, we observed increasing predictive values in a subgroup during the first day of hospitalization suggesting that assessment of NGAL should be delayed for optimal prognostic purposes.
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Affiliation(s)
| | - Rasmus Paulin Beske
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | | | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Martin Abild Stengaard Meyer
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jacob Eifer Moeller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, 5230 Odense, Denmark
| | | | - Peter Dall Mark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Bispebjerg, 2400 Copenhagen, Denmark
| | - Rasmus Møgelvang
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Martin Frydland
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
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Petrova I, Alexandrov A, Vladimirov G, Mateev H, Bogov I, Paskaleva I, Gotcheva N. NGAL as Biomarker of Clinical and Subclinical Damage of Kidney Function after Coronary Angiography. Diagnostics (Basel) 2023; 13:diagnostics13061180. [PMID: 36980488 PMCID: PMC10047760 DOI: 10.3390/diagnostics13061180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 03/22/2023] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a serious complication after angiographic examinations in cardiology. Diagnosis may be delayed based on standard serum creatinine, and subclinical forms of kidney damage may not be detected at all. In our study, we investigate the clinical use in these directions of a “damage”-type biomarker—neutrophil gelatinase-associated lipocalin (NGAL). Among patients with a high-risk profile undergoing scheduled coronary angiography and/or angioplasty, plasma NGAL was determined at baseline and at 4th and 24th h after contrast administration. In the CI-AKI group, NGAL increased significantly at the 4th hour (Me 109.3 (IQR 92.1–148.7) ng/mL versus 97.6 (IQR 69.4–127.0) ng/mL, p = 0.006) and at the 24th hour (Me 131.0 (IQR 81.1–240.8) ng/mL, p = 0.008). In patients with subclinical CI-AKI, NGAL also increased significantly at the 4th hour (Me 94.0 (IQR 75.5–148.2) ng/mL, p = 0.002) and reached levels close to those in patients with CI-AKI. Unlike the new biomarker, however, serum creatinine did not change significantly in this group. The diagnostic power of NGAL is extremely good—AUC 0.847 (95% CI: 0.677–1.000; p = 0.001) in CI-AKI and AUC 0.731 (95% CI: 0.539–0.924; p = 0.024) in subclinical CI-AKI. NGAL may be a reliable biomarker for the early diagnosis of clinical and subclinical forms of renal injury after contrast angiographic studies.
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Affiliation(s)
- Iliyana Petrova
- Clinic of Cardiology, National Heart Hospital, 65 Konioviza Str., 1309 Sofia, Bulgaria
- Correspondence:
| | - Alexander Alexandrov
- Clinic of Cardiology, National Heart Hospital, 65 Konioviza Str., 1309 Sofia, Bulgaria
| | - Georgi Vladimirov
- Clinic of Cardiology, National Heart Hospital, 65 Konioviza Str., 1309 Sofia, Bulgaria
| | - Hristo Mateev
- Clinic of Cardiology, National Heart Hospital, 65 Konioviza Str., 1309 Sofia, Bulgaria
| | - Ivaylo Bogov
- Central hospitalier Châlons-en-Champagne, 51 Rue du Commandant Derrien, 51000 Châlons-en-Champagne, France
| | - Iva Paskaleva
- Laboratory Department, National Heart Hospital, 65 Konioviza Str., 1309 Sofia, Bulgaria
| | - Nina Gotcheva
- Clinic of Cardiology, National Heart Hospital, 65 Konioviza Str., 1309 Sofia, Bulgaria
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Tangpaisarn T, Srimakam N, Senthong V, Phungoen P, Kotruchin P. Differential Association Between Significant Coronary Stenosis and Cardiac Troponin T Serial Algorithms in Chronic Kidney Disease Patients Diagnosed with Non-ST-Segment Elevation Acute Coronary Syndromes. Open Access Emerg Med 2022; 14:41-49. [PMID: 35140532 PMCID: PMC8818962 DOI: 10.2147/oaem.s348378] [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: 11/15/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. METHODS This was a retrospective cohort study. Patients aged ≥18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported. RESULTS There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27-10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01-1.06), male sex (OR = 2.15; 95% CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20-8.10) were associated with significant coronary stenosis. CONCLUSION Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.
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Affiliation(s)
- Thanat Tangpaisarn
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nirut Srimakam
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Vichai Senthong
- Department of Internal Medicine, Faculty of Medicine Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Pariwat Phungoen
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Guo L, Zhu B, Yuan H, Zhao W. Evaluation of serum neutrophil gelatinase-associated lipocalin in older patients with chronic kidney disease. Aging Med (Milton) 2020; 3:32-39. [PMID: 32232190 PMCID: PMC7099757 DOI: 10.1002/agm2.12098] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is a major health-care burden all over the world, and aging is an important risk factor for end-stage renal disease (ESRD). Neutrophil gelatinase-associated lipocalin (NGAL) has been confirmed as a novel marker for early diagnosis of acute kidney injury. Other studies have found that NGAL takes part in the mechanisms of CKD progression. The aim of this study was to evaluate the expression of serum NGAL in CKD, particularly in elderly patients who rapidly progressed to end-stage renal failure. METHODS Serum NGAL, cystatin C, creatinine, urea, and other factors were evaluated in a cohort of 160 CKD patients (mean age 75.29 ± 12.08 years) with various etiologies. RESULTS Serum NGAL was closely related to cystatin C, creatinine, urea, and estimated glomerular filtration rate (eGFR). Special correlations between NGAL and, respectively, anemia and hypoalbuminemia were also found. The cutoff value of NGAL was calculated from Stage 2 to Stage 5. Receiver-operator curve analysis showed good area under the curve (>0.8) and high sensitivity (> 70%) on the cutoff value of NGAL. The NGAL levels increased progressively with the increasing of 2- and 5-year risk of ESRD using the Kidney Failure Risk Equations (KFRE). CONCLUSION In elderly patients with CKD, serum NGAL reflects renal impairment and presents a strong and independent risk marker for progression of ESRD.
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Affiliation(s)
- Lulu Guo
- Division of Nephrology Department of Geriatrics The First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Bei Zhu
- Division of Nephrology Department of Geriatrics The First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Haichuan Yuan
- Division of Nephrology Department of Geriatrics The First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Weihong Zhao
- Division of Nephrology Department of Geriatrics The First Affiliated Hospital with Nanjing Medical University Nanjing China
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Guo L, Zhao Y, Yong Z, Zhao W. Evaluation value of neutrophil gelatinase-associated lipocalin for the renal dysfunction of patients with chronic kidney disease: A meta-analysis. Aging Med (Milton) 2018; 1:185-196. [PMID: 31942496 PMCID: PMC6880667 DOI: 10.1002/agm2.12033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The role of neutrophil gelatinase-associated lipocalin (NGAL) for the evaluation of renal function in chronic kidney disease (CKD) has not yet to be determined. We aimed to perform a meta-analysis exploring the correlation between NGAL and glomerular filtration rate (GFR) in CKD patients, and to further identify factors affecting NGAL's performance. METHODS Studies dated before November 2017 were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. A total of 28 relevant studies (involving 3082 patients from 17 countries) were included. The second version of the Quality Assessment for Studies of Diagnostic Accuracy demonstrated that no significant bias had influenced the methodological quality of the included studies. RESULTS Neutrophil gelatinase-associated lipocalin showed a strong negative correlation with measured glomerular filtration rate (mGFR). The pooled correlation coefficient (r) with corresponding 95% confidence intervals for the correlation between serum NGAL (sNGAL) and GFR was -0.48, meanwhile that for urine NGAL (uNGAL) and GFR was -0.34. However, NGAL's performance is different in subgroups restricted by clinical settings, race, sex, age, and staging of renal function. CONCLUSION Neutrophil gelatinase-associated lipocalin could be a renal function evaluation marker for patients with renal dysfunction in CKD. Compared with uNGAL, there was a significant negative correlation between sNGAL and GFR. The performances of sNGAL and uNGAL were restricted by clinical factors that should be considered in regards to the sampling source selection.
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Affiliation(s)
- Lulu Guo
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Yaya Zhao
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Zhenzhu Yong
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
| | - Weihong Zhao
- Division of NephrologyDepartment of Geriatrics of The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina
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Papadopoulou-Marketou N, Chrousos GP, Kanaka-Gantenbein C. Diabetic nephropathy in type 1 diabetes: a review of early natural history, pathogenesis, and diagnosis. Diabetes Metab Res Rev 2017; 33. [PMID: 27457509 DOI: 10.1002/dmrr.2841] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/20/2016] [Accepted: 07/15/2016] [Indexed: 12/16/2022]
Abstract
Diabetic nephropathy constitutes a devastating complication in patients with type 1 diabetes mellitus, and its diagnosis is traditionally based on microalbuminuria. The aim of this review is to update through the medical literature the suggested early natural course of diabetic nephropathy, the theories behind the pathways of its pathogenesis, and its diagnosis. Poor glycemic control, dyslipidemia, smoking, advanced glycation end products, and environmental and genetic clues play an important role in the development of diabetic nephropathy. Microalbuminuria has been traditionally considered as a primary early marker of microvascular complication unraveling the risk for progress to the advanced stages of chronic kidney disease, but because of our inability to make an early diagnosis of diabetic nephropathy in young patients as well as nonalbuminuric diabetic nephropathy, recently, other additional markers of renal injury like serum and urinary neutrophil gelatinase-associated lipocalin, chitinase-3-like protein 1, cystatin C, and plasma growth differentiation factor 15 have been proposed to unmask early renal dysfunction, even before microalbuminuria supervenes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nektaria Papadopoulou-Marketou
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
- Department of Endocrinology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - George P Chrousos
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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Colantonio LD, Tanner RM, Warnock DG, Gutiérrez OM, Judd S, Muntner P, Bowling CB. The role of cystatin-C in the confirmation of reduced glomerular filtration rate among the oldest old. Arch Med Sci 2016; 12:55-67. [PMID: 26925119 PMCID: PMC4754366 DOI: 10.5114/aoms.2016.57580] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Current guidelines suggest using cystatin-C to confirm a reduced creatinine-based estimated glomerular filtration rate (eGFRcr) when the latter is thought to be inaccurate. Older adults have reduced muscle mass, which may affect the accuracy of eGFRcr. We evaluated the use of cystatin-C-based eGFR (eGFRcys) to confirm reduced eGFRcr among adults ≥ 80 years of age and, for comparison, younger adults. MATERIAL AND METHODS We analyzed data from 3,059 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with reduced eGFRcr (< 60 ml/min/1.73 m(2)) enrolled in 2003-2007 who were not on dialysis. eGFRcr and eGFRcys were calculated using age, sex and race-adjusted equations. Confirmed reduced eGFRcr was defined as eGFRcys < 60 ml/min/1.73 m(2). Prevalence of chronic kidney disease complications at baseline and all-cause mortality up to March 2012 were calculated. Analyses were stratified by age: < 65, 65-79 and ≥ 80 years. RESULTS Among participants < 65, 65-79 and ≥ 80 years of age, 76.5%, 85.7% and 92.5%, respectively, had reduced eGFRcr confirmed with eGFRcys (p < 0.001). Among participants ≥ 80 years of age, those with reduced eGFRcr confirmed with eGFRcys had higher prevalence of hypertension (79.1% vs. 65.1%, p = 0.03) and albuminuria (38.3% vs. 22.7%, p = 0.04) and higher risk for all-cause mortality (hazard ratio: 2.43; 95% confidence interval: 1.19-5.01) as compared with those in whom reduced eGFRcr was not confirmed by eGFRcys. CONCLUSIONS Reduced eGFRcr was confirmed using eGFRcys for the vast majority of adults ≥ 80 years. These results suggest that using cystatin-C to confirm a reduced eGFRcr may not be necessary among the oldest old.
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Affiliation(s)
| | - Rikki M. Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David G. Warnock
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Orlando M. Gutiérrez
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C. Barrett Bowling
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
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Banach M, Aronow WS, Serban MC, Rysz J, Voroneanu L, Covic A. Lipids, blood pressure and kidney update 2015. Lipids Health Dis 2015; 14:167. [PMID: 26718096 PMCID: PMC4696333 DOI: 10.1186/s12944-015-0169-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/22/2015] [Indexed: 02/07/2023] Open
Abstract
The most important studies and guidelines in the topics of lipid, blood pressure and kidney published in 2015 were reviewed. In lipid research, the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial revalidated the concept "lower is better" for low density lipoprotein (LDL)-cholesterol as a target for therapy, increasing the necessity of treatment the high-risk patients to achieve LDL-C goals. After these results, ezetimibe might become the preferred additional drug in the combination therapy of lipid disorders because of oral dosage form and lower acquisition cost. However, for the statin-intolerant patients and those patients requiring essential reductions in LDL-C to achieve their goals, new therapies, including PCSK9 inhibitors remain promising drugs. In blood pressure research, American Heart Association (AHA)/American College of Cardiology (ACC) 2015 guidelines recommended a target for blood pressure below 140/90 mmHg in stable or unstable coronary artery disease patients and below 150/90 mmHg in patients older than 80 years of age, however the recent results of the Systolic Blood Pressure Intervention Trial (SPRINT) trial have suggested that there might be significant benefits, taking into account cardiovascular risk, for hypertensive patients over 50 without diabetes and blood pressure levels <120/80. In kidney research, reducing the progression of chronic kidney disease and related complications such as anemia, metabolic acidosis, bone and mineral diseases, acute kidney injury and cardiovascular disease is still a goal for clinicians.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
| | - Wilbert S Aronow
- Department of Medicine, New York Medical College, Valhalla, NY, USA
| | - Maria-Corina Serban
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Jacek Rysz
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland
| | - Luminita Voroneanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital and Grigore. T. Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital and Grigore. T. Popa, University of Medicine and Pharmacy, Iasi, Romania
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Wen-Jing L, Chuan-Qiang P, Hong-Hua L, Xiang-Hui L, Jie-Xiao L. A new modified animal model of myosin-induced experimental autoimmune myositis enhanced by defibrase. Arch Med Sci 2015; 11:1272-8. [PMID: 26788090 PMCID: PMC4697045 DOI: 10.5114/aoms.2015.52883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/27/2014] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION We investigated the effect of defibrase (a proteolytic enzyme extraction of Agkistrodon halys venom) on experimental autoimmune myositis (EAM) in guinea pigs and explored the option of using a modified pig model of EAM to enhance the study of this disease. MATERIAL AND METHODS Guinea pigs were divided into 3 groups: group A (control group) was immunized with complete Freund adjuvant (CFA), then received 6 injections of saline weekly; group B (EAM group) was immunized with partially purified rabbit myosin emulsified with CFA, then received an injection of saline; group C (EAM + defibrase group) was immunized with purified rabbit myosin emulsified with CFA, then received an injection of defibrase. The animals were observed for their general health condition and the body weight was measured daily. Plasma levels of fibrinogen and creatine kinase (CK) were determined. Muscle tissues were examined histologically. RESULTS After immunizations for 6 weeks, incidence of EAM in groups A, B and C was 0 (0/7), 83.3% (10/12) and 100% (15/15), respectively. Guinea pigs with EAM presented angeitis symptoms of muscle weakness. Histological analysis revealed a significant difference. Muscles with EAM had scattered or diffuse inflammatory manifestations, which are also common pathological features of human idiopathic polymyositis (IPM). Defibrase-treated animals displayed extensive inflammation and fiber necrosis compared with the EAM group (histological score: 2.80 ±1.15 vs. 1.88 ±1.32, p < 0.05). Severity of inflammation of group B was mainly mild to moderate; 16.7% (2/12) of animals developed severe inflammation. Incidence of severe inflammation with a score up to 4 in group C was 40% (6/15). CONCLUSIONS Defibrase can exacerbate myosin-induced EAM; thus a new modified model was generated.
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Affiliation(s)
- Luo Wen-Jing
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
- Department of Neurology, Chinese PLA Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
| | - Pu Chuan-Qiang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Li Hong-Hua
- Department of Neurology, Chinese PLA Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
| | - Lu Xiang-Hui
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Liu Jie-Xiao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Zalewska-Adamiec M, Bachorzewska-Gajewska H, Malyszko J, Malyszko JS, Kralisz P, Tomaszuk-Kazberuk A, Hirnle T, Dobrzycki S. Chronic kidney disease in patients with significant left main coronary artery disease qualified for coronary artery bypass graft operation. Arch Med Sci 2015; 11:446-52. [PMID: 25995765 PMCID: PMC4424263 DOI: 10.5114/aoms.2015.50978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 01/29/2013] [Accepted: 05/28/2013] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Hanna Bachorzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Transplantation with Dialysis Center, Medical University of Bialystok, Bialystok, Poland
| | - Jacek S. Malyszko
- Department of Nephrology, Transplantation with Dialysis Center, Medical University of Bialystok, Bialystok, Poland
| | - Pawel Kralisz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Tomasz Hirnle
- Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Slawomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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Stelmach-Goldys A, Czarkowska-Paczek B, Wyczalkowska-Tomasik A, Paczek L. Serum cystatin C and serum and urine NGAL in the kidney function assessment of patients with MGUS. Eur J Haematol 2014; 94:162-8. [PMID: 25046079 DOI: 10.1111/ejh.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Monoclonal gammopathy of undetermined significance (MGUS) occurs without other symptoms, although monoclonal proteins can cause kidney injuries. Here, we assessed kidney function and identified the best follow-up parameters in patients with MGUS without kidney damage symptoms. METHODOLOGY Forty-six patients with MGUS were included in the study group. The control group (CRT, n = 23) consisted of healthy subjects matched for age and sex. Serum cystatin C was determined using an immunonephelometric method, serum and urine neutrophil gelatinase-associated lipocalin (NGAL) was measured with an immunoenzymatic method, and cathepsin B activity was determined fluorometrically. RESULTS Serum cystatin C and urine NGAL were higher, and serum NGAL was lower in MGUS patients compared with CRT. Neither serum cystatin C, nor serum or urine NGAL, correlated with the biomarkers of MGUS. The serum activity of cathepsin B did not differ between groups and did not correlate with serum cystatin C. Serum cystatin C correlated with serum creatinine, while serum NGAL did not correlate with serum creatinine or cystatin C. The estimated glomerular filtration rates (eGFRs) in MGUS were within normal range and correlated with serum cystatin C. The strongest correlation was observed for CKD-EPI. Seven patients presented with albuminuria >30 mg/day. There was a correlation between albuminuria in this group and λ free light chains. CONCLUSIONS The kidney function in MGUS patients is impaired, although there are no clinical and standard laboratory test manifestations. Cystatin C and urine, but not serum, NGAL should be considered markers for kidney injury. CKD-EPI is recommended for eGFR assessment.
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Banach M, Serban C, Aronow WS, Rysz J, Dragan S, Lerma EV, Apetrii M, Covic A. Lipid, blood pressure and kidney update 2013. Int Urol Nephrol 2014; 46:947-61. [PMID: 24573394 PMCID: PMC4012155 DOI: 10.1007/s11255-014-0657-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/28/2014] [Indexed: 12/24/2022]
Abstract
The year 2013 proved to be very exciting as far as landmark trials and new guidelines in the field of lipid disorders, blood pressure and kidney diseases. Among these are the International Atherosclerosis Society Global Recommendations for the Management of Dyslipidemia, European Society of Cardiology (ESC)/European Society of Hypertension Guidelines for the Management of Arterial Hypertension, American Diabetes Association Clinical Practice Recommendations, the Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease (CKD) Patients, the American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, the Joint National Committee Expert Panel (JNC 8) Evidence-Based Guideline for the Management of High Blood Pressure in Adults, the American Society of Hypertension/International Society of Hypertension Clinical Practice Guidelines for the Management of Hypertension in the Community, the American College of Physicians Clinical Practice Guideline on Screening, Monitoring, and Treatment of Stage 1-3 CKD and many important trials presented among others during the ESC Annual Congress in Amsterdam and the American Society of Nephrology Annual Meeting--Kidney Week in Atlanta, GA. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland,
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Głowiński J, Małyszko J, Głowińska I, Myśliwiec M. Use of short prosthesis segments for brachiocephalic arteriovenous fistulas in elderly hemodialysis population. Arch Med Sci 2014; 10:58-62. [PMID: 24701215 PMCID: PMC3953965 DOI: 10.5114/aoms.2013.35195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/13/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The autogenous brachiocephalic fistula is a recognized secondary access for hemodialysis. However, veins in the antecubital fossa are often damaged, due to repeated venipunctures and subsequent scarring. Sometimes their anatomy does not enable successful arteriovenous fistula creation. In cases when the proximal part of the cephalic vein seemed patent, during ultrasound Doppler examination, we decided to use a short segment of 6 mm polytetrafluoroethylene graft to connect the vein with the brachial artery. We report our series of this procedure. MATERIAL AND METHODS Over an 8-year period, 34 patients underwent such an operation. Grafts were anastomosed either to the end of the cephalic vein or to the side. The decision was made based on the vein condition: small-caliber veins were considered better for the end-to-side anastomosis. All procedures were performed under local anesthesia, and were well tolerated. RESULTS Thirty-three fistulas were successfully cannulated at 2-8 weeks after the operation. Fistula patency rates were 84%, 73% and 55% at 12, 24 and 36 months. Comparison of two anastomosis types showed differences, 50% and 62.8% at 36 months, yet without statistical significance (p = 0.27, log-rank test). Fistula patency was not influenced by patient's age, sex or comorbidities. CONCLUSIONS The described procedure provides satisfactory cumulative patency with an acceptable complication rate. It can enhance the number of cephalic veins used with its main advantages of simple surgical technique and low perioperative morbidity.
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Affiliation(s)
- Jerzy Głowiński
- Department of Vascular Surgery and Transplantology, Medical University of Bialystok, Poland
| | - Jolanta Małyszko
- Department of Nephrology and Transplantology, Medical University of Bialystok, Poland
| | - Irena Głowińska
- Department of Nephrology and Transplantology, Medical University of Bialystok, Poland
| | - Michał Myśliwiec
- Department of Nephrology and Transplantology, Medical University of Bialystok, Poland
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Franczyk-Skóra B, Gluba A, Banach M, Rysz J. Treatment of non-ST-elevation myocardial infarction and ST-elevation myocardial infarction in patients with chronic kidney disease. Arch Med Sci 2013; 9:1019-27. [PMID: 24482645 PMCID: PMC3902722 DOI: 10.5114/aoms.2013.39792] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 11/29/2013] [Accepted: 12/04/2013] [Indexed: 02/06/2023] Open
Abstract
Renal dysfunction is frequent in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Chronic kidney disease (CKD) is associated with very poor prognosis and is an independent predictor of early and late mortality and major bleeding in patients with NSTE-ACS. Patients with NSTE-ACS and CKD are still rarely treated according to guidelines. Medical registers reveal that patients with CKD are usually treated with too high doses of antithrombotics, especially anticoagulants and inhibitors of platelet glycoprotein (GP) IIb/IIIa receptors, and therefore they are more prone to bleeding. Drugs which are excreted mainly or exclusively by the kidney should be administered in a reduced dose or discontinued in patients with CKD. These drugs include enoxaparin, fondaparinux, bivalirudin, and small molecule inhibitors of GP IIb/IIIa inhibitors. In long-term treatment of patients after myocardial infarction, anti-platelet therapy, lipid-lowering therapy and β-blockers are used. Chronic kidney disease patients before qualification for coronary interventions should be carefully selected in order to avoid their use in the group of patients who could not benefit from such procedures. This paper presents schemes of non-ST and ST-segment elevation myocardial infarction treatment in CKD patients in accordance with the current recommendations of the European Society of Cardiology (ESC).
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Affiliation(s)
- Beata Franczyk-Skóra
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Poland
| | - Anna Gluba
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Poland
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Olechnowicz-Tietz S, Gluba A, Paradowska A, Banach M, Rysz J. The risk of atherosclerosis in patients with chronic kidney disease. Int Urol Nephrol 2013; 45:1605-12. [PMID: 23483304 PMCID: PMC3844144 DOI: 10.1007/s11255-013-0407-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 02/19/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is becoming a serious health problem; the number of people with impaired renal function is rapidly rising, especially in industrialized countries. A major complication of CKD is cardiovascular disease. Accelerated atherosclerosis has been observed in early stages of renal dysfunction. The purpose of this study was to examine the relationship between the degree of renal insufficiency and both the prevalence and intensity of coronary artery disease (assessed on the basis of number of vessels with stenosis). METHODS 446 individuals with both serum creatinine >120 μmol/l (men) or >96 μmol/l (women) and acute coronary syndrome were included in the study. All patients included in this analysis underwent urgent coronarography. Data concerning glomerular filtration rate (GFR), number of vessels with stenosis, hypertension, lipid disorders, creatinine concentration, C-reactive protein, glucose and lipid profile were analyzed. RESULTS This study confirmed that moderate to severe renal impairment is associated with accelerated atherosclerosis. Moreover, patients with GFR values below 60 ml/min/1.73 m(2) are predisposed to accelerated, multivessel cardiovascular disease. CONCLUSIONS GFR seems to be an independent risk factor for multivessel cardiovascular disease. Due to the fact that patients with renal dysfunction are at high risk of cardiovascular events, they should obtain optimal treatment resulting not only in kidney protection but also in the elimination of cardiovascular risk factors.
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Affiliation(s)
| | - Anna Gluba
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital in Lodz, Lodz, Poland
| | - Anna Paradowska
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital in Lodz, Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital in Lodz, Lodz, Poland
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz , Poland
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Athyros VG, Katsiki N, Tziomalos K, Gossios TD, Theocharidou E, Gkaliagkousi E, Anagnostis P, Pagourelias ED, Karagiannis A, Mikhailidis DP. Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study. Arch Med Sci 2013; 9:418-26. [PMID: 23847661 PMCID: PMC3701988 DOI: 10.5114/aoms.2013.35424] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The effect of cardiovascular disease (CVD) prevention measures aimed at elderly patients requires further evidence. We investigated the effect of statin treatment (targeted to achieve guideline goals) on CVD outcomes in different age groups to determine whether statins are more beneficial in the elderly. MATERIAL AND METHODS The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study (n = 1,600 patients with established coronary heart disease (CHD), mean follow-up 3 years) was the absolute and relative CVD event (a composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles (each n = 200). Patients on "structured care" with atorvastatin (n = 800) followed up by the university clinic and treated to lipid goal were compared with the corresponding quartiles on "usual care" (n = 800) followed up by specialists or general practitioners of the patient's choice outside the hospital. RESULTS In the elderly (mean age 69 ±4 and 70 ±3 years in the "structured" and "usual care", respectively) the absolute CVD event reduction between "structured" and "usual care" was 16.5% (p < 0.0001), while in the younger patients (mean age 51 ±3 years and 52 ±3 years in the "structured" and "usual care", respectively) this was 8.5% (p = 0.016); relative risk reduction (RRR) 60% (p < 0.0001) vs. 42% respectively (p = 0.001). The elderly had higher rates of chronic kidney disease and higher uric acid levels, plus an increased prevalence of diabetes, metabolic syndrome and non-alcoholic fatty liver disease. These factors might contribute to the increased CVD risk in older patients. CONCLUSIONS All age groups benefited from statin treatment, but the elderly on "structured care" had a greater absolute and relative CVD risk reduction than the younger patients when compared with the corresponding patients assigned to "usual care". These findings suggest that we should not deprive older patients of CVD prevention treatment and lipid target achievement.
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Affiliation(s)
- Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas D. Gossios
- First Cardiology Clinic, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Eleni Theocharidou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Eygenia Gkaliagkousi
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | | | - Efstathios D. Pagourelias
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Kokot M, Biolik G, Ziaja D, Fojt T, Cisak K, Antoniak K, Pawlicki K, Ziaja K, Duława J. Endothelium injury and inflammatory state during abdominal aortic aneurysm surgery: scrutinizing the very early and minute injurious effects using endothelial markers - a pilot study. Arch Med Sci 2013; 9:479-86. [PMID: 23847670 PMCID: PMC3701970 DOI: 10.5114/aoms.2013.34412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/28/2012] [Accepted: 10/18/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Acute kidney injury is an inflammatory process whose pathogenesis involves endothelial cells (EC). The aim of this study was to assess the dynamics of endothelium injury markers measured during elective AAA surgery which might confirm the inflammatory character of AKI. MATERIAL AND METHODS The study group consisted of 14 patients with AAA. We measured plasma soluble forms of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, P-selectin as well as the levels of von Willebrand factor (vWF) before, during (including intra-abdominal vein levels before and after aortic clamp removal) and within 2 days after surgery. RESULTS We have found a biphasic response of ICAM-1, VCAM-1 and P-selectin with an initial fall and subsequent rise. However, only VCAM-1 changes were significant compared to its baseline value. The maximum decrease of VCAM-1 was observed in the renal vein 5 min after aortic clamp removal (335.42 ±129.63 ng/ml vs. 488.90 ±169.80 ng/ml baseline value, p < 0.05), and the highest rise 48 h after aortic clamp removal (721.46 ±333.99 vs. baseline, p < 0.05). CONCLUSIONS Vascular cell adhesion molecule-1 turned out to be the most sensitive indicator of EC injury and inflammatory status after AAA surgery. During AAA surgery, soluble forms of P-selectin, ICAM-1 and VCAM-1 demonstrate a biphasic response with an initial fall and subsequent rise. These soluble forms could have a modulatory effect on the development of inflammation.
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Affiliation(s)
- Michał Kokot
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Biolik
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Damian Ziaja
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Tadeusz Fojt
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Kamila Cisak
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Antoniak
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Pawlicki
- Department of Biophysics, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Ziaja
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
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Impact of cardiovascular organ damage on cortical renal perfusion in patients with chronic renal failure. BIOMED RESEARCH INTERNATIONAL 2013; 2013:137868. [PMID: 23853766 PMCID: PMC3703362 DOI: 10.1155/2013/137868] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022]
Abstract
Introduction. Properly preserved renal perfusion is the basic determinant of oxygenation, vitality, nutrition, and organ function and its structure. Perfusion disorders are functional changes and are ahead of the appearance of biochemical markers of organ damage. The aim of this study was to evaluate a relationship between the renal cortex perfusion and markers of cardiovascular organ damage in patients with stable chronic renal failure (CKD). Methods. Seventeen patients (2 F; 15 M; age 47 ± 16) with stable CKD at 2–4 stages and hypertension or signs of heart failure were enrolled in this study. Blood tests with an estimation of renal and cardiac functions, echocardiographic parameters, intima-media thickness (IMT), renal resistance index (RRI), and total (TPI), proximal (PPI), and distal (DPI) renal cortical perfusion intensity measurements were collected. Results. DPI was significantly lower than PPI. TPI significantly correlated with age, Cys, CKD-EPI (cystatin), and IMT, whereas DPI significantly depended on Cystain, CKD-EPI (cystatin; cystatin-creatinine), IMT, NT-proBNP, and troponin I. In multiple stepwise regression analysis model only CKD-EPI (cystatin) independently influenced DPI. Conclusions. Cardiovascular and kidney damage significantly influences renal cortical perfusion. Ultrasound measurement of renal perfusion could be a sensitive method for early investigation of cardiovascular and renal injuries.
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Michalska M, Rysz J, Pencina MJ, Zdrojewski T, Banach M. The knowledge and awareness of hypertension among patients with hypertension in central Poland: a pilot registry. Angiology 2013; 65:525-32. [PMID: 23650646 DOI: 10.1177/0003319713489166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We assessed the differences in the knowledge and level of awareness of hypertension among patients with hypertension from Central Poland; 248 (57.6% females) patients diagnosed with hypertension completed a questionnaire. Most (79%) of the patients were unaware of the optimal blood pressure (BP) range. The elderly patients did not know the symptoms of hypertension (23.7%), were not willing to make lifestyle changes (57%-65%), and had a poor awareness of hypertension therapy in the absence of symptoms (28.7%). Poor BP control occurred mainly in rural residents (10.7%) and in people with higher education (39.3%). Untreated patients with hypertension did not know the symptoms of hypertension (29.2%), rarely measured BP (37.5%), but were more likely to engage in regular physical activity (70.8%). Efforts should be made to improve knowledge of hypertension, especially among the rural population, the elderly patients, those with a low-education level, and in young males who had the highest BP.
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Affiliation(s)
- Marta Michalska
- Department of Hypertension, Medical University of Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Poland
| | - Michael J Pencina
- Department of Biostatistics, Boston University, Harvard Clinical Research Institute, Boston, MA, USA
| | - Tomasz Zdrojewski
- Department of Hypertension and Diabetology, Medical University in Gdansk, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland
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Anker MS, von Haehling S, Springer J, Banach M, Anker SD. Highlights of mechanistic and therapeutic cachexia and sarcopenia research 2010 to 2012 and their relevance for cardiology. Arch Med Sci 2013; 9:166-71. [PMID: 23515589 PMCID: PMC3598129 DOI: 10.5114/aoms.2013.33356] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 02/07/2023] Open
Abstract
Sarcopenia and cachexia are significant medical problems with a high disease-related burden in cardiovascular illness. Muscle wasting and weight loss are very frequent particularly in chronic heart failure and they relate to poor prognosis. Although clinically largely underestimated, the fields of cachexia and sarcopenia are of great relevance to cardiologists. In cachexia and sarcopenia a significant number of research publications related to basic science questions of muscle wasting and lipolysis were published between 2010 and 2012. Recently, the two processes of muscle wasting and lipolysis were found to be closely linked. Treatment research in pre-clinical models involves studies on a number of different therapeutic entities, including ghrelin, selective androgen receptor modulators (SARMs), as well as drugs targeting myostatin or melanocortin-4. In the human setting, studies using enobosarm (a SARM) and anamorelin (ghrelin) are in phase III. The last 3 years have seen significant efforts to define the field using consensus statements. In the future, these definitions should also be considered for guidelines and treatment trials in cardiovascular medicine. The current review aims to summarize important information and development in the fields of muscle wasting, sarcopenia and cachexia, focusing on findings in cardiovascular research, in order for cardiologists to have a better understanding of the progress in this still insufficiently known field.
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Affiliation(s)
- Markus S. Anker
- Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
| | - Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Jochen Springer
- Applied Cachexia Research, Center for Cardiovascular Research, Charité, Campus Mitte, Berlin, Germany
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland
| | - Stefan D. Anker
- Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
- Applied Cachexia Research, Department of Cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germany
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Anker MS, von Haehling S, Springer J, Banach M, Anker SD. Highlights of the mechanistic and therapeutic cachexia and sarcopenia research 2010 to 2012 and their relevance for cardiology. Int J Cardiol 2013; 162:73-6. [DOI: 10.1016/j.ijcard.2012.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 10/20/2012] [Indexed: 12/25/2022]
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Franczyk-Skóra B, Gluba A, Banach M, Kozłowski D, Małyszko J, Rysz J. Prevention of sudden cardiac death in patients with chronic kidney disease. BMC Nephrol 2012. [PMID: 23206758 PMCID: PMC3519551 DOI: 10.1186/1471-2369-13-162] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular deaths account for about 40% of all deaths of patients with chronic kidney disease (CKD), particularly those on dialysis, while sudden cardiac death (SCD) might be responsible for as many as 60% of SCD in patients undergoing dialysis. Studies have demonstrated a number of factors occurring in hemodialysis (HD) that could lead to cardiac arrhythmias. Patients with CKD undergoing HD are at high risk of ventricular arrhythmia and SCD since changes associated with renal failure and hemodialysis-related disorders overlap. Antiarrhythmic therapy is much more difficult in patients with CKD, but the general principles are similar to those in patients with normal renal function - at first, the cause of arrhythmias should be found and eliminated. Also the choice of therapy is narrowed due to the altered pharmacokinetics of many drugs resulting from renal failure, neurotoxicity of certain drugs and their complex interactions. Cardiac pacing in elderly patients is a common method of treatment. Assessment of patients’ prognosis is important when deciding whether to implant complex devices. There are reports concerning greater risk of surgical complications, which depends also on the extent of the surgical site. The decision concerning implantation of a pacing system in patients with CKD should be made on the basis of individual assessment of the patient.
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Affiliation(s)
- Beata Franczyk-Skóra
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland
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Banach M, Hering D, Narkiewicz K, Mysliwiec M, Rysz J, Malyszko J. Lipids, Blood Pressure, Kidney-what was New in 2012? INT J PHARMACOL 2012. [DOI: 10.3923/ijp.2012.659.678] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nair DR, Mehta S, Mikhailidis DP. Assessing renal function - searching for the perfect marker continues! Arch Med Sci 2011; 7:565-7. [PMID: 22291787 PMCID: PMC3258792 DOI: 10.5114/aoms.2011.24120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 08/10/2011] [Accepted: 08/13/2011] [Indexed: 01/06/2023] Open
Affiliation(s)
- Devaki R. Nair
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
| | - Shweta Mehta
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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