1
|
Du Q, Jiang Y, Liu Y. Prevalence of metabolic syndrome in patients with end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 2024; 56:1057-1069. [PMID: 37740847 DOI: 10.1007/s11255-023-03790-z] [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] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Metabolic syndrome, a significant risk factor for cardiovascular mortality in patients with end-stage renal disease, profoundly impacts patient prognosis and survival. Despite its clinical importance, the prevalence of metabolic syndrome remains unexplored in this population. Therefore, the objective of this study was to systematically assess the prevalence of metabolic syndrome among patients with end-stage renal disease and raise awareness among healthcare professionals. METHODS We conducted a comprehensive search in CNKI, WANFANG, WeiPu, CBM, PubMed, Web of Science, EMBASE, and The Cochrane Library databases. The search time was until August 21, 2023. Standardized tables were employed for data extraction and imported into Stata 16.0 software for subsequent meta-analysis. A random-effects model was employed to estimate combined prevalence and 95% confidence intervals. Subgroup and sensitivity analyses were conducted to explore potential sources of heterogeneity, while publication bias was evaluated using a funnel plot and Egger's test. This study has been registered with PROSPERO under the registration number CRD42023456284. RESULTS This meta-analysis comprised 35 studies involving a total of 14,202 participants. The pooled prevalence estimate for metabolic syndrome was 49.0% [95% CI (46.0,53.0)]. We conducted subgroup analyses based on participant characteristics, gender distribution, publication year, national economic status, diagnostic criteria employed, and components of metabolic syndrome. CONCLUSIONS The prevalence of metabolic syndrome is higher among patients with end-stage renal disease, necessitating early prevention and control measures to reduce its incidence and delay the progression of the disease, thereby improving patient life expectancy.
Collapse
Affiliation(s)
- Qiufeng Du
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yunlan Jiang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Yaxin Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
2
|
Guo J, Peng Y, Liu R, Yi C, Guo Q, Yang X. Remnant cholesterol predicts cardiovascular mortality beyond low-density lipoprotein cholesterol in patients with peritoneal dialysis. J Clin Lipidol 2023; 17:708-716. [PMID: 37723014 DOI: 10.1016/j.jacl.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Patients undergoing peritoneal dialysis (PD) are prone to dyslipidemia. However, studies concerning remnant cholesterol (RC) in such patients are limited. OBJECTIVE We aimed to investigate the association between RC and cardiovascular (CV) mortality in patients on PD. METHODS Patients who initiated PD at our center (2006-2018) were retrospectively enrolled. Adjusted Cox models were used to evaluate the independent association between baseline RC levels and CV mortality. We classified patients into 4 concordant/discordant categories according to their baseline lipid profiles. Cox models were then used to determine the association between different low-density lipoprotein cholesterol (LDL-C) and RC levels and CV mortality risk. RESULTS The study enrolled 2333 individuals, with a mean RC of 33.4 mg/dL. RC levels were positively associated with CV mortality risk independent of LDL-C in patients on PD (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 1. 00-1.10). In the concordant/discordant categories, patients with high LDL-C and RC levels had a higher CV mortality risk (HR: 1.52; 95% CI: 1.01-2.28) than those with low LDL-C and RC levels in the entire cohort. Moreover, in older patients, a higher RC level increased CV mortality risk regardless of the LDL-C level (HR: 2.41, 95% CI: 1.22-4.74; HR: 2.15, 95% CI: 1.12-4.14). CONCLUSIONS RC levels are elevated in patients on PD and can predict CV mortality beyond LDL-C levels. RC levels should be considered alongside LDL-C levels when assessing prognostic lipid levels in these patients. More attention should be given to RC than to LDL-C in older patients undergoing PD.
Collapse
Affiliation(s)
- Jing Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang)
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); Department of Nephrology, Ganzhou People's Hospital (The First Affiliated Ganzhou Hospital of Nanchang University), Ganzhou 341000, China (Dr Peng)
| | - Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang)
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang)
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang)
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang).
| |
Collapse
|
3
|
Dragoș D, Timofte D, Georgescu MT, Manea MM, Vacaroiu IA, Ionescu D, Balcangiu-Stroescu AE. Cardiovascular Calcifications Are Correlated with Inflammation in Hemodialysis Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1801. [PMID: 37893519 PMCID: PMC10608311 DOI: 10.3390/medicina59101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The main cause of morbidity and mortality in hemodialysis patients is cardiovascular disease, which is quite common. The main objective of our study was to investigate the relationship between oxidative stress, inflammation, and vascular and valvular calcifications in hemodialysis patients. Materials and Methods: This observational study had 54 hemodialysis patients, with an average age of 60.46 ± 13.18 years. Cardiovascular ultrasound was used to detect and/or measure aortic and mitral valve calcifications, carotid and femoral atheroma plaques, and common carotid intima-media thickness. The aortic calcification score was determined using a lateral abdomen plain radiograph. The inflammatory, oxidative, metabolic, and dietary statuses, as well as demographic characteristics, were identified. Results: There were significant correlations between the levels of IL-6 and carotid plaque number (p = 0.003), fibrinogen level and aortic valve calcifications (p = 0.05), intima-media thickness (p = 0.0007), carotid plaque number (p = 0.035), femoral plaque number (p = 0.00014), and aortic calcifications score (p = 0.0079). Aortic annulus calcifications (p = 0.03) and intima-media thickness (p = 0.038) were adversely linked with TNF-α. Nutrition parameters were negatively correlated with atherosclerosis markers: number of carotid plaques with albumin (p = 0.013), body mass index (p = 0.039), and triglycerides (p = 0.021); number of femoral plaques with phosphorus (0.013), aortic calcifications score with albumin (p = 0.051), intima-media thickness with LDL-cholesterol (p = 0.042). Age and the quantity of carotid plaques, femoral plaques, and aortic calcifications were linked with each other (p = 0.0022, 0.00011, and 0.036, respectively). Aortic annulus calcifications (p = 0.011), aortic valve calcifications (p = 0.023), and mitral valve calcifications (p = 0.018) were all associated with an increased risk of death. Conclusions: Imaging measures of atherosclerosis are adversely connected with dietary status and positively correlated with markers of inflammation and risk of mortality.
Collapse
Affiliation(s)
- Dorin Dragoș
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu nr 37, Sect 2, 020021 Bucharest, Romania (I.A.V.)
- 1st Internal Medicine Clinic, University Emergency Hospital Bucharest, Splaiul Independentei nr 169, Sect 5, 050098 Bucharest, Romania
| | - Delia Timofte
- Department of Dialysis, University Emergency Hospital Bucharest, Splaiul Independentei nr 168, Sect 5, 050098 Bucharest, Romania
| | - Mihai-Teodor Georgescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu nr 37, Sect 2, 020021 Bucharest, Romania (I.A.V.)
- Department of Radiotherapy, Prof. Dr. Al. Trestioreanu Institute of Oncology Bucharest, Șos. Fundeni nr 252, Sect 2, 022328 Bucharest, Romania
| | - Maria-Mirabela Manea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu nr 37, Sect 2, 020021 Bucharest, Romania (I.A.V.)
- National Institute of Neurology and Cerebrovascular Diseases, Șos. Berceni nr 10–12, Sect 4, 041915 Bucharest, Romania
| | - Ileana Adela Vacaroiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu nr 37, Sect 2, 020021 Bucharest, Romania (I.A.V.)
- Nephrology and Dialysis Clinic, “Sf. Ioan” Emergency Clinical Hospital, Șos. Vitan-Barzești nr 12, 042122 Bucharest, Romania
| | - Dorin Ionescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu nr 37, Sect 2, 020021 Bucharest, Romania (I.A.V.)
- Nephrology Clinic, University Emergency Hospital, Splaiul Independentei nr 169, Sect 5, 050098 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu nr 37, Sect 2, 020021 Bucharest, Romania
| |
Collapse
|
4
|
Li X, Shi B, Chen X, Duan J, Liu X, Zhang R, Li G. Fragmented QRS complex on a 12-lead electrocardiogram predicts cardiovascular and all-cause mortality in dialysis patients. Semin Dial 2023; 36:43-52. [PMID: 35080054 DOI: 10.1111/sdi.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the most common cause of mortality in end-stage renal disease (ESRD) patients. Fragmented QRS complex (fQRS) has been reported as a helpful marker in evaluating various cardiovascular pathologies. We aimed to investigate the value of the fQRS complex clinical decision of ESRD patients receiving dialysis. METHODS This prospective observational study included 411 patients receiving hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) between 2016-01-01 and 2020-12-31. The primary outcomes were all-cause and cardiovascular (CV) mortality. RESULTS HD patients have elevated values of fQRS complex compared to CAPD patients (39.1% vs. 28.2%, P = 0.027). Significantly, fQRS complex in the anterior/lateral leads is associated with all-cause and CV mortality stronger than fQRS in the inferior leads (P = 0.008). In a multivariate Cox regression analysis, HD patients with fQRS complex had a higher incidence of all-cause mortality (hazard ratio [HR] = 1.860; 95% confidence interval [CI]: [1.032, 3.349]; p = 0.041) and CV mortality (HR = 2.989; 95% CI [1.357, 6.584]; p = 0.007). For CAPD patients, fQRS complex was also associated with increased risk of all-cause mortality (HR = 1.593; 95% CI [1.023, 2.580]; p = 0.049) and increased risk of CV mortality (HR = 2.392; 95% CI [1.348, 4.173]; p = 0.013). CONCLUSIONS The presence of the fQRS complex was an independent predictor of all-cause and CV mortality in HD and CAPD patients. We suggested a potential role of the fQRS complex in CV risk strata for dialysis patients and the choice of dialysis modality.
Collapse
Affiliation(s)
- Xinjian Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bingshuo Shi
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xu Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Junying Duan
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xing Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ruining Zhang
- Department of Kidney Disease and Blood Purification, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| |
Collapse
|
5
|
Yeter HH, Karacalik C, Eraslan E, Durantas H, Akcay OF, Derici K, Derici U. Comparison of soluble suppression of tumorigenicity 2 and brachial hemodynamic parameters between dialysis modalities in patients with end-stage kidney disease. Int Urol Nephrol 2022; 55:1335-1342. [PMID: 36528841 DOI: 10.1007/s11255-022-03443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Major cardiovascular events (MACE) are the leading cause of mortality in patients with chronic kidney disease. Although hemodialysis (HD) and peritoneal dialysis (PD) are comparable in survival, patients with HD have a significantly higher risk of developing MACE. Soluble suppression of tumorigenicity 2 (sST2) is a cardiac biomarker, that does not vary with age, gender, and kidney function. This study aimed to compare arterial stiffness, fluid status, and sST2 levels, between patients with PD and those with in-center HD. METHODS This was a cross-sectional study, which was conducted with 36 PD patients, 36 HD patients, and 36 age, and gender-matched healthy controls. We used noninvasive methods for the assessment of arterial stiffness and fluid status. RESULTS The patients with PD overhydrated compared to HD patients and healthy control (p < 0.001, and p = 0.05, respectively). Patients with PD had higher central systolic blood pressure and central pulse pressure than patients with HD and the control group (p = 0.004, and p = 0.01; p < 0.001, and p = 0.004, respectively). HD patients had a significantly higher level of plasma sST2 level compared to PD patients and the control group (p = 0.03, and p = 0.005). HD as maintenance dialysis modality and dialysis vintage was associated with higher plasma sST2 concentration, and having a residual renal function in dialysis patients was related to the lower plasma sST2 concentration. CONCLUSION PD is associated with better sST2 levels even though higher volume load than HD. In addition, the loss of RRF may be the most important factor related to increased sST2.
Collapse
|
6
|
Gholipur-Shahraki T, Vahdat S, Seirafian S, Pourfarzam M, Badri S. Effect of Omega-3 Fatty Acids Supplementation on Homocysteine Level in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. J Res Pharm Pract 2022; 11:80-86. [PMID: 36798100 PMCID: PMC9926915 DOI: 10.4103/jrpp.jrpp_67_22] [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: 11/04/2021] [Accepted: 03/05/2022] [Indexed: 12/15/2022] Open
Abstract
Objective One of the most common diseases with high morbidity and mortality rates is chronic kidney disease. Cardiovascular disease affects most patients with chronic kidney disorders, particularly patients undergoing dialysis; hence, appropriate prevention and management approaches are essential. This study aimed to evaluate the reduction of inflammatory biomarkers, especially homocysteine, by omega-3 fatty acids in peritoneal dialysis patients. Methods This study enrolled 60 peritoneal dialysis patients who met specified inclusion and exclusion criteria and were randomized to intervention or placebo groups. Omega-3 capsules were given at a dose of 3 g/d for 8 weeks. Inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), homocysteine, albumin, and lipid profile measured before and after the study. Findings Results of this trial revealed that the levels of homocysteine, hs-CRP, and albumin did not change significantly during the study. Analysis of lipid profiles before and after intervention showed omega-3 has no significant effect on the level of total cholesterol or low-density lipoprotein cholesterol; However, the level of triglyceride reduced remarkably (P = 0.002). In addition, serum levels of high-density lipoprotein cholesterol increased at the end of the study (P < 0.001). Conclusion Omega-3 does not seem to be able to change the inflammatory markers significantly, particularly homocysteine. More extensive trials must be conducted to better understand the impact of omega-3 on inflammatory and nutritional markers, particularly in peritoneal dialysis patients.
Collapse
Affiliation(s)
- Tahereh Gholipur-Shahraki
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Vahdat
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Seirafian
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Pourfarzam
- Department of Clinical Biochemistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirinsadat Badri
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Shirinsadat Badri, E-mail:
| |
Collapse
|
7
|
Barbagallo CM, Cefalù AB, Giammanco A, Noto D, Caldarella R, Ciaccio M, Averna MR, Nardi E. Lipoprotein Abnormalities in Chronic Kidney Disease and Renal Transplantation. Life (Basel) 2021; 11:life11040315. [PMID: 33916487 PMCID: PMC8067409 DOI: 10.3390/life11040315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/15/2022] Open
Abstract
Chronic kidney disease (CKD) is one of the most important risk factors for cardiovascular disease (CVD). Despite the kidney having no direct implications for lipoproteins metabolism, advanced CKD dyslipidemia is usually present in patients with CKD, and the frequent lipid and lipoprotein alterations occurring in these patients play a role of primary importance in the development of CVD. Although hypertriglyceridemia is the main disorder, a number of lipoprotein abnormalities occur in these patients. Different enzymes pathways and proteins involved in lipoprotein metabolism are impaired in CKD. In addition, treatment of uremia may modify the expression of lipoprotein pattern as well as determine acute changes. In renal transplantation recipients, the main lipid alteration is hypercholesterolemia, while hypertriglyceridemia is less pronounced. In this review we have analyzed lipid and lipoprotein disturbances in CKD and also their relationship with progression of renal disease. Hypolipidemic treatments may also change the natural history of CVD in CKD patients and may represent important strategies in the management of CKD patients.
Collapse
Affiliation(s)
- Carlo Maria Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties—University of Palermo, Via del Vespro, 127, 90127 Palermo, Italy; (C.M.B.); (A.B.C.); (A.G.); (D.N.); (R.C.); (M.R.A.)
| | - Angelo Baldassare Cefalù
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties—University of Palermo, Via del Vespro, 127, 90127 Palermo, Italy; (C.M.B.); (A.B.C.); (A.G.); (D.N.); (R.C.); (M.R.A.)
| | - Antonina Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties—University of Palermo, Via del Vespro, 127, 90127 Palermo, Italy; (C.M.B.); (A.B.C.); (A.G.); (D.N.); (R.C.); (M.R.A.)
| | - Davide Noto
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties—University of Palermo, Via del Vespro, 127, 90127 Palermo, Italy; (C.M.B.); (A.B.C.); (A.G.); (D.N.); (R.C.); (M.R.A.)
| | - Rosalia Caldarella
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties—University of Palermo, Via del Vespro, 127, 90127 Palermo, Italy; (C.M.B.); (A.B.C.); (A.G.); (D.N.); (R.C.); (M.R.A.)
| | - Marcello Ciaccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), Section of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, 90127 Palermo, Italy;
| | - Maurizio Rocco Averna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties—University of Palermo, Via del Vespro, 127, 90127 Palermo, Italy; (C.M.B.); (A.B.C.); (A.G.); (D.N.); (R.C.); (M.R.A.)
| | - Emilio Nardi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties—University of Palermo, Via del Vespro, 127, 90127 Palermo, Italy; (C.M.B.); (A.B.C.); (A.G.); (D.N.); (R.C.); (M.R.A.)
- Correspondence: ; Tel.: +39-916-554-316
| |
Collapse
|
8
|
Tai H, Jiang XL, Lan ZM, Li Y, Kong L, Yao SC, Song N, Lv MJ, Wu J, Yang P, Xiao XS, Yang GL, Kuang JS, Jia LQ. Tanshinone IIA combined with CsA inhibit myocardial cell apoptosis induced by renal ischemia-reperfusion injury in obese rats. BMC Complement Med Ther 2021; 21:100. [PMID: 33752661 PMCID: PMC7986523 DOI: 10.1186/s12906-021-03270-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/07/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute myocardial injury (AMI), which is induced by renal ischemia-reperfusion (IR), is a significant cause of acute kidney injury (AKI)-related associated death. Obesity increases the severity and frequency of AMI and AKI. Tanshinone IIA (TIIA) combined with cyclosporine A (CsA) pretreatment was used to alleviate myocardial cell apoptosis induced by renal IR, and to determine whether TIIA combined with CsA would attenuate myocardial cell apoptosis by modulating mitochondrial function through the PI3K/Akt/Bad pathway in obese rats. METHODS Male rates were fed a high fat diet for 8 weeks to generate obesity. AKI was induced by 30 min of kidney ischemia followed 24 h of reperfusion. Obese rats were given TIIA (10 mg/kg·d) for 2 weeks and CsA (5 mg/kg) 30 min before renal IR. After 24 h of reperfusion, the rats were anaesthetized, the blood were fetched from the abdominal aorta and kidney were fetched from abdominal cavity, then related indicators were examined. RESULTS TIIA combined with CsA can alleviate the pathohistological injury and apoptosis induced by renal IR in myocardial cells. TIIA combined with CsA improved cardiac function after renal ischemia (30 min)-reperfusion (24 h) in obese rats. At the same time, TIIA combined with CsA improved mitochondrial function. Abnormal function of mitochondria was supported by decreases in respiration controlling rate (RCR), intracellular adenosine triphosphate (ATP), oxygen consumption rate, and mitochondrial membrane potential (MMP), and increases in mitochondrial reactive oxygen species (ROS), opening of the mitochondrial permeability transition pore (mPTP), mitochondrial DNA damage, and mitochondrial respiratory chain complex enzymes. The injury of mitochondrial dynamic function was assessed by decrease in dynamin-related protein 1 (Drp1), and increases in mitofusin1/2 (Mfn1/2), and mitochondrial biogenesis injury was assessed by decreases in PPARγ coactivator-1-α (PGC-1), nucleo respiratory factor1 (Nrf1), and transcription factor A of mitochondrial (TFam). CONCLUSION We used isolated mitochondria from rat myocardial tissues to demonstrate that myocardial mitochondrial dysfunction occurred along with renal IR to induce myocardial cell apoptosis; obesity aggravated apoptosis. TIIA combined with CsA attenuated myocardial cell apoptosis by modulating mitochondrial function through the PI3K/Akt/Bad pathway in obese rats.
Collapse
Affiliation(s)
- He Tai
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xiao-Lin Jiang
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China.,Department of Nephrology, The fourth of Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Shenzhen Traditional Chinese Medicine Hospital), Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Zhi-Ming Lan
- Department of Medical laboratory, The fourth of Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine (Shenzhen Traditional Chinese Medicine Hospital), Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Yue Li
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Liang Kong
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine, Dalian, China
| | - Si-Cheng Yao
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Nan Song
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Mei-Jun Lv
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Jin Wu
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Ping Yang
- Department of Cardiovascular Medicine, The Affiliated Hospital of Liaoning Traditional Chinese Medicine, Shenyang, China
| | - Xuan-Si Xiao
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Guan-Lin Yang
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Jin-Song Kuang
- Department of Endocrinology and Metabolic, Shenyang the Fourth Hospital of People, Shenyang, China
| | - Lian-Qun Jia
- Key Laboratory of Ministry of Education for Traditional Chinese Medicine Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang, China.
| |
Collapse
|
9
|
Pireaux V, Delporte C, Rousseau A, Desmet JM, Van Antwerpen P, Raes M, Zouaoui Boudjeltia K. M2 Monocyte Polarization in Dialyzed Patients Is Associated with Increased Levels of M-CSF and Myeloperoxidase-Associated Oxidative Stress: Preliminary Results. Biomedicines 2021; 9:biomedicines9010084. [PMID: 33467199 PMCID: PMC7830480 DOI: 10.3390/biomedicines9010084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular diseases represent a major issue in terms of morbidity and mortality for dialysis patients. This morbidity is due to the accelerated atherosclerosis observed in these patients. Atherosclerosis is a chronic inflammatory disease characterized by key players such as monocytes, macrophages, or oxidized LDLs. Monocytes-macrophages are classified into subsets of polarized cells, with M1 and M2 macrophages considered, respectively, as pro- and anti-inflammatory. (1) Methods: The monocyte subsets and phenotypes were analyzed by flow cytometry. These data were completed by the quantification of plasma M-CSF, IL-8, CRP, Mox-LDLs, Apo-B, Apo-AI, chloro-tyrosine, and homocitrulline concentrations. The statistical differences and associations between two continuous variables were assessed using the Mann-Whitney U test and Spearman's correlation coefficient, respectively. (2) Results: Hemodialyzed patients showed a significant increase in their concentrations of CRP, M-CSF, and IL-8 (inflammation biomarkers), as well as chloro-tyrosine and homocitrulline (myeloperoxidase-associated oxidative stress biomarkers). Moreover, we observed a higher percentage of M2 monocytes in the plasma of hemodialysis patients as compared to the controls. (3) Conclusions: Our data suggest that oxidative stress and an inflammatory environment, which is amplified in hemodialysis patients, seems to favor an increase in the concentration of circulating M-CSF, therefore leading to an increase in M2 polarization among circulating monocytes.
Collapse
Affiliation(s)
- Valérie Pireaux
- URBC-Narilis, University of Namur, 61 rue de Bruxelles, 5000 Namur, Belgium; (V.P.); (M.R.)
| | - Cédric Delporte
- Laboratory of Pharmaceutical Chemistry and Analytical Platform, Faculty of Pharmacy, Université libre de Bruxelles (Campus de la Plaine) CP205/05, Boulevard du Triomphe, 1050 Brussels, Belgium; (C.D.); (P.V.A.)
| | - Alexandre Rousseau
- Laboratory of Experimental Medicine (ULB 222 Unit), CHU-Charleroi, ISPPC Hôpital Vésale, Université libre de Bruxelles, 6110 Montigny-Le-Tilleul, Belgium;
| | - Jean-Marc Desmet
- Nephrology-Hemodialysis Unit, CHU-Charleroi, ISPPC Hôpital Vésale, 6110 Montigny-Le-Tilleul, Belgium;
| | - Pierre Van Antwerpen
- Laboratory of Pharmaceutical Chemistry and Analytical Platform, Faculty of Pharmacy, Université libre de Bruxelles (Campus de la Plaine) CP205/05, Boulevard du Triomphe, 1050 Brussels, Belgium; (C.D.); (P.V.A.)
| | - Martine Raes
- URBC-Narilis, University of Namur, 61 rue de Bruxelles, 5000 Namur, Belgium; (V.P.); (M.R.)
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medicine (ULB 222 Unit), CHU-Charleroi, ISPPC Hôpital Vésale, Université libre de Bruxelles, 6110 Montigny-Le-Tilleul, Belgium;
- Correspondence: ; Tel.: +32-71-92-47-05; Fax: +32-71-92-47-10
| |
Collapse
|
10
|
Fang J, Su H, Song A, Tong Y, Huang Z, Ding F, Liu Y. Evaluation of inflammatory and cardiac-electrophysiological markers in patients undergoing peritoneal dialysis. Biomark Med 2020; 14:1641-1649. [PMID: 33336590 DOI: 10.2217/bmm-2020-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The Tp-e/QT (peak to end of T-wave duration/QT interval) ratio is a promising marker of myocardial repolarization and ventricular arrhythmogenesis. Its elevation is associated with sudden cardiac death in different clinical conditions. This study was designed to assess the possible association between increased Tp-e/QT ratio and clinical factors in peritoneal dialysis patients. Materials & methods: We devised a prospective cross-sectional study, which included 107 patients who were divided into groups according to their Tp-e/QT ratio. The association of an increased Tp-e/QT ratio with related factors was analyzed with multivariate logistic regression. Results: Thirty-one patients, who had an elevated Tp-e/QT ratio, showed higher values of IL-6, left ventricular end-systolic diameter, Tp-e, percentage of diabetes mellitus, coronary artery calcification, and left ventricular ejection fraction. Multivariate analysis revealed that IL-6 was an independent risk factor for a higher Tp-e/QT ratio after adjustments. Conclusion: Our study revealed that a high serum IL-6 level in peritoneal dialysis patients increased the risk of a higher Tp-e/QT ratio, which indicated a potentially hazardous interplay between inflammation and arrhythmogenesis.
Collapse
Affiliation(s)
- Junyan Fang
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Haixia Su
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Ahui Song
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yan Tong
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Zehui Huang
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Feng Ding
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yingli Liu
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| |
Collapse
|
11
|
Herzog AL, Kalogirou C, Wanner C, Lopau K. Comparison of different algorithms for the assessment of cardiovascular risk after kidney transplantation by the time of entering waiting list. Clin Kidney J 2020; 13:150-158. [PMID: 32296518 PMCID: PMC7147301 DOI: 10.1093/ckj/sfz041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence of cardiovascular disease is high among patients with chronic kidney disease and cardiovascular events (CVE) remain the leading cause of death after kidney transplantation (KT). We performed a retrospective analysis of 389 KT recipients to assess if the European Society of Cardiology Score (ESC-Score), Framingham Heart Study Score (FRAMINGHAM), Prospective Cardiovascular Munster Study Score (PROCAM-Score) or Assessing cardiovascular risk using Scottish Intercollegiate Guidelines Network Score (ASSIGN-Score) algorithms can predict cardiovascular risk after KT at the time of entering the waiting list. METHODS 389 KT candidates were scored by the time of entering the waiting list. Pearsons chi-square test, cox regression analysis and survival estimates were performed to evaluate the reliability of the cardiovascular scoring models after successful KT. RESULTS During a follow-up of 8 ± 5.8 years, 96 patients (30%) died due to cardiovascular problems, whereas 13.9% suffered non-fatal CVE. Graft loss occurred in 84 patients (21.6%). Predictors of CVE, survival and graft loss were age and the length of end-stage kidney disease. All scores performed well in assessing the risk for CVE (P < 0.01). Receiver-operating characteristic analysis using the ESC-SCORE, as an example, suggested a cut-off for risk stratification and clinical decisions. CONCLUSIONS We found all tested scores were reliable for cardiovascular assessment. We suggest using cardiac scores for risk assessment before KT and then taking further steps according to current guidelines.
Collapse
Affiliation(s)
- Anna Laura Herzog
- Division of Nephrology, Transplantationszentrum, University of Würzburg, Würzburg, Germany
| | - Charis Kalogirou
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Christoph Wanner
- Division of Nephrology, Medizinische Klinik I, University of Würzburg, Würzburg, Germany
| | - Kai Lopau
- Division of Nephrology, Medizinische Klinik I, University of Würzburg, Würzburg, Germany
| |
Collapse
|
12
|
Zhang RN, Hao HF, Zhang W, Li Q, Ren LJ, Jia L, Wei F, Chen HY, Wang Z, Bi XQ, Pang HY, Jiang AL, Wei YL. Clinical characterization and prognostic implications of metabolic syndrome in patients undergoing peritoneal dialysis at a Chinese center. J Int Med Res 2019; 47:5573-5583. [PMID: 31533550 PMCID: PMC6862897 DOI: 10.1177/0300060519875335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective Metabolic syndrome (MS) is a common clinical condition associated with cardiovascular disease in patients undergoing peritoneal dialysis (PD); however, its prognostic implication among patients receiving PD remains controversial. Methods In a prospective study from January 2013 and June 2016, we enrolled 190 patients undergoing PD and followed them for 46.4 ± 30.7 months. We assessed the associations of clinical characteristics and measurements with diabetes mellitus (DM) status, MS, and prognostic outcomes among the included patients. Results We found that DM was associated with shortened duration of dialysis and poor survival. The prevalence of MS was 58.9% among all patients. We found significant differences in age, body weight, body mass index, triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, leukocytes, platelets, neutrophil percentage, and pre-albumin between patients with and without MS. We found a negative correlation trend between serum intact parathyroid hormone and MS among our patients. The arteriosclerosis index was significantly elevated in the MS group compared with the non-MS group. Serum calcium concentration and frequency of hospital admissions were significantly associated with mortality and technique failure. Conclusions MS was positively associated with cardiovascular disease. DM, and hypocalcemia. Frequent hospital admissions can predict poor prognosis in patients undergoing PD.
Collapse
Affiliation(s)
- Rui-Ning Zhang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hui-Fang Hao
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China.,Department of Nephrology, Tianjin TEDA Hospital, Tianjin, China
| | - Wei Zhang
- Department of Immunology, Biochemistry and Molecular Biology, 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Key Laboratory of Medical Epigenetics, Tianjin Medical University, Tianjin, China.,Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin Medical University, Tianjin, China
| | - Qing Li
- Department of Nephrology, Tianjin TEDA Hospital, Tianjin, China
| | - Li-Jie Ren
- Department of Immunology, Biochemistry and Molecular Biology, 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Key Laboratory of Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Lan Jia
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fang Wei
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hai-Yan Chen
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhe Wang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xue-Qing Bi
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hai-Yan Pang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ai-Li Jiang
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yi-Liang Wei
- Department of Kidney Disease and Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin, China.,Department of Immunology, Biochemistry and Molecular Biology, 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Key Laboratory of Medical Epigenetics, Tianjin Medical University, Tianjin, China
| |
Collapse
|
13
|
Stepanova N, Burdeyna O. Association between Dyslipidemia and Peritoneal Dialysis Technique Survival. Open Access Maced J Med Sci 2019; 7:2467-2473. [PMID: 31666849 PMCID: PMC6814482 DOI: 10.3889/oamjms.2019.664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: A large body of research has investigated the effects of pro-atherogenic lipid profile on cardiovascular diseases (CVD) in peritoneal dialysis (PD) patients. However, there is a general lack of research on the association between atherogenic dyslipidemia and PD technique survival. AIM: The study aimed to define the association between dyslipidemia and PD technique survival. METHODS: It was a prospective single-centre observational study involving 40 outpatients on continuous ambulatory PD treatment for more than 3 months between 2010 and 2016 in a single centre in Ukraine. There were 27 males and 13 females. The mean age of the participants was 49.3 ± 12.2 years. The primary outcome measures were all-cause technique failure. RESULTS: Atherogenic dyslipidemia was identified in 28/40 (70 %) patients and correlated with PD adequacy parameters. During the 36-month- follow-up period technique failure occurred in 2/12 (16.6 %) patients with atherogenic dyslipidemia compared with 12 / 28 (42.9 %) patients without atherogenic dyslipidemia (χ2 = 2.5; p = 0.12). In the univariate Cox regression model, atherogenic dyslipidemia at baseline was significantly associated with a higher risk of all-cause PD technique failure (HR 4.5; 95% CI 1.6 to 12.9; χ2 = 5.5, p = 0.019). CONCLUSION: The presence of atherogenic dyslipidemia was significantly associated with a higher risk of technique failure in PD patients. This is an important issue for future research. Further well-designed clinical trials are needed to determine the impact of dyslipidemia on PD adequacy and technique survival.
Collapse
Affiliation(s)
- Natalia Stepanova
- Department of Nephrology and Dialysis, State Institution "Institute of Nephrology of the National Academy of Medical Sciences of Ukraine"Kiev, Ukraine
| | - Olena Burdeyna
- Department of Nephrology and Dialysis, State Institution "Institute of Nephrology of the National Academy of Medical Sciences of Ukraine"Kiev, Ukraine
| |
Collapse
|
14
|
Selby NM, Kazmi I. Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn't it better than hemodialysis? Semin Dial 2018; 32:3-8. [PMID: 30352482 DOI: 10.1111/sdi.12752] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Rates of cardiovascular mortality are disproportionately high in patients with end stage kidney disease receiving dialysis. However, it is now generally accepted that patient survival is broadly equivalent between the two most frequently used forms of dialysis, in-center hemodialysis (HD) and peritoneal dialysis (PD). This equivalent patient survival is notable when considering how specific aspects of HD have been shown to contribute to morbidity and mortality. These include more rapid loss of residual renal function (RRF), HD-induced myocardial and cerebral ischemia, and risk factors associated with the intermittent delivery of HD. Potential mechanisms specific to PD that may drive cardiovascular disease include the metabolic consequences of excessive absorption of glucose and glucose degradation products (GDPs), inadequate volume control, and high rates of hypokalemia. The aim of this review is to compare and contrast the different drivers of adverse outcomes between the dialysis modalities, as greater understanding of this may help in patient-centered decision-making when considering options for renal replacement therapy.
Collapse
Affiliation(s)
- Nicholas M Selby
- Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | - Isma Kazmi
- Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| |
Collapse
|
15
|
Urea Memory: Transient Cell Exposure to Urea Causes Persistent Mitochondrial ROS Production and Endothelial Dysfunction. Toxins (Basel) 2018; 10:toxins10100410. [PMID: 30314315 PMCID: PMC6215169 DOI: 10.3390/toxins10100410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 12/22/2022] Open
Abstract
Urea at post-dialysis levels induces increased ROS in a number of cell types. The aim of this study was to determine whether urea-induced production of ROS remains elevated after urea is no longer present, and, if it does, to characterize its origin and effects. Human arterial endothelial cells were incubated with 20 mM urea for two days, and then cells were incubated for an additional two days in medium alone. Maximal ROS levels induced by initial urea continued at the same level despite urea being absent. These effects were prevented by either MnSOD expression or by Nox1/4 inhibition with GKT13781. Sustained urea-induced ROS caused a persistent reduction in mtDNA copy number and electron transport chain transcripts, a reduction in transcription of mitochondrial fusion proteins, an increase in mitochondrial fission proteins, and persistent expression of endothelial inflammatory markers. The SOD-catalase mimetic MnTBAP reversed each of these. These results suggest that persistent increases in ROS after cells are no long exposed to urea may play a major role in continued kidney damage and functional decline despite reduction of urea levels after dialysis.
Collapse
|
16
|
Genderen AM, Jansen J, Cheng C, Vermonden T, Masereeuw R. Renal Tubular- and Vascular Basement Membranes and their Mimicry in Engineering Vascularized Kidney Tubules. Adv Healthc Mater 2018; 7:e1800529. [PMID: 30091856 DOI: 10.1002/adhm.201800529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/18/2018] [Indexed: 01/09/2023]
Abstract
The high prevalence of chronic kidney disease leads to an increased need for renal replacement therapies. While there are simply not enough donor organs available for transplantation, there is a need to seek other therapeutic avenues as current dialysis modalities are insufficient. The field of regenerative medicine and whole organ engineering is emerging, and researchers are looking for innovative ways to create (part of) a functional new organ. To biofabricate a kidney or its functional units, it is necessary to understand and learn from physiology to be able to mimic the specific tissue properties. Herein is provided an overview of the knowledge on tubular and vascular basement membranes' biochemical components and biophysical properties, and the major differences between the two basement membranes are highlighted. Furthermore, an overview of current trends in membrane technology for developing renal replacement therapies and to stimulate kidney regeneration is provided.
Collapse
Affiliation(s)
- Anne Metje Genderen
- Division of PharmacologyUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
| | - Jitske Jansen
- Division of PharmacologyUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
| | - Caroline Cheng
- Regenerative Medicine Center UtrechtUniversity Medical Center Utrecht 3584 CT Utrecht The Netherlands
- Department of Nephrology and HypertensionUniversity Medical Center Utrecht 3508 GA Utrecht The Netherlands
- Department of Experimental CardiologyErasmus Medical Center 3015 GD Rotterdam The Netherlands
| | - Tina Vermonden
- Division of PharmaceuticsUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
| | - Rosalinde Masereeuw
- Division of PharmacologyUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
| |
Collapse
|
17
|
Liu C, Sun X, Lin H, Zheng R, Ruan L, Sun Z, Zhu Y. Association between hyperhomocysteinemia and metabolic syndrome with early carotid artery atherosclerosis: A cross-sectional study in middle-aged Chinese population. Nutrition 2018; 53:115-119. [PMID: 29778949 DOI: 10.1016/j.nut.2018.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Homocysteine is a modifiable, independent risk factor for cardiovascular disease. The association between hyperhomocysteinemia and metabolic syndrome with the presence of early carotid artery atherosclerosis remains unknown in middle-aged Chinese adults. METHODS Chinese adults (n = 1607) of Han ethnicity, age 35 to 65 y, and living in their communities >2 y were surveyed. Hyperhomocysteinemia was defined as homocysteine concentrations >15 µmol/L. Carotid intima-media thickness and carotid plaque were examined by ultrasonography. All participants were classified into four groups by hyperhomocysteinemia and metabolic syndrome status. RESULTS Participants with both hyperhomocysteinemia and metabolic syndrome had the highest levels of waist circumference and systolic blood pressure compared with the three other groups. The highest proportion of increased carotid intima-media thickness (61.3%) was in the subgroup of both hyperhomocysteinemia and metabolic syndrome. After adjustments for the covariates, the risk of increased carotid intima-media thickness was only significantly higher in the group with metabolic syndrome but without hyperhomocysteinemia (odds ratio: 1.47; 95% confidence interval, 1.13-1.93) compared with people without hyperhomocysteinemia and metabolic syndrome. Furthermore, statistically significant variances of prevalence of plaque among the four subgroups were not discovered. CONCLUSIONS Our study demonstrated that metabolic syndrome had a strong effect on carotid intima-media thickness However, the increased homocysteine levels were not significantly associated with early carotid artery atherosclerosis in middle-aged Chinese people.
Collapse
Affiliation(s)
- Chengguo Liu
- Department of Endocrinology and Institute of Cardiovascular Diseases, Zhejiang Putuo Hospital, Zhoushan, Zhejiang, China
| | - Xiaohui Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hanli Lin
- Department of Cardiology, Zhejiang Putuo Hospital, Zhoushan, Zhejiang, China
| | - Ruizhi Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liansheng Ruan
- Department of Endocrinology and Institute of Cardiovascular Diseases, Zhejiang Putuo Hospital, Zhoushan, Zhejiang, China
| | - Zhanhang Sun
- Department of Endocrinology and Institute of Cardiovascular Diseases, Zhejiang Putuo Hospital, Zhoushan, Zhejiang, China
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China.
| |
Collapse
|
18
|
Genovesi S, Porcu L, Luise MC, Riva H, Nava E, Contaldo G, Stella A, Pozzi C, Ondei P, Minoretti C, Gallieni M, Pontoriero G, Conte F, Torri V, Bertoli S, Vincenti A. Sudden Death in End Stage Renal Disease: Comparing Hemodialysis versus Peritoneal Dialysis. Blood Purif 2017; 44:77-88. [PMID: 28365692 DOI: 10.1159/000464347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/18/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS This study aimed to evaluate total and sudden death (SD) in a cohort of dialysis patients, comparing hemodialysis (HD) vs. peritoneal dialysis (PD). METHODS This is a multicenter retrospective cohort study. RESULTS Deaths were 626 out of 1,823 in HD and 62 of 249 in PD patients. HD patients had a greater number of comorbidities (p < 0.05). PD patients had a lower risk of death than HD patients (p < 0.001); however, the advantage decreased with time (p < 0.001). Mortality predictors were left ventricular ejection fraction (LVEF) ≤35%, older age, ischemic heart disease, diabetes mellitus, previous stroke, and atrial fibrillation (p < 0.03). SDs were 84:71 in HD and 13 in PD population (12.1 and 22.8% of all causes of death, respectively). A non-significant risk of SD among PD compared to HD patients was detected. SD predictors were older age, ischemic heart disease, and LVEF ≤35% (p < 0.05). CONCLUSIONS HD patients showed a greater presence of comorbidities and reduced survival compared to PD patients; however, the incidence of SD does not differ in the 2 populations. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=464347.
Collapse
|
19
|
Guadalupe N, Molina Alv M, Tulio Reyn M, Cecilia Al C, del Carmen E, Maria Rodr J, Lizeth Gon J, Consuelo H A, Mendieta Z H. Serum Homocysteine Levels and its Methylenetetrahydrofolate Gene (MTHFR) C677t Polymorphism in Patients with Hemodialysis. JOURNAL OF MEDICAL SCIENCES 2017. [DOI: 10.3923/jms.2017.89.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
20
|
Cirino-Silva R, Kmit FV, Trentin-Sonoda M, Nakama KK, Panico K, Alvim JM, Dreyer TR, Martinho-Silva H, Carneiro-Ramos MS. Renal ischemia/reperfusion-induced cardiac hypertrophy in mice: Cardiac morphological and morphometric characterization. JRSM Cardiovasc Dis 2017; 6:2048004016689440. [PMID: 28228941 PMCID: PMC5308538 DOI: 10.1177/2048004016689440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023] Open
Abstract
Background Tissue remodeling is usually dependent on the deposition of extracellular matrix that may result in tissue stiffness and impaired myocardium contraction. Objectives We had previously demonstrated that renal ischemia/reperfusion (I/R) is able to induce development of cardiac hypertrophy in mice. Therefore, we aimed to characterize renal I/R-induced cardiac hypertrophy. Design C57BL/6 J mice were subjected to 60 minutes’ unilateral renal pedicle occlusion, followed by reperfusion (I/R) for 5, 8, 12 or 15 days. Gene expression, protein abundance and morphometric analyses were performed in all time points. Results Left ventricle wall thickening was increased after eight days of reperfusion (p < 0.05). An increase in the number of heart ventricle capillaries and diameter after 12 days of reperfusion (p < 0.05) was observed; an increase in the density of capillaries starting at 5 days of reperfusion (p < 0.05) was also observed. Analyses of MMP2 protein levels showed an increase at 15 days compared to sham (p < 0.05). Moreover, TGF-β gene expression was downregulated at 12 days as well TIMP 1 and 2 (p < 0.05). The Fourier-transform infrared spectroscopy analysis showed that collagen content was altered only in the internal section of the heart (p < 0.05); such data were supported by collagen mRNA levels. Conclusions Renal I/R leads to impactful changes in heart morphology, accompanied by an increase in microvasculature. Although it is clear that I/R is able to induce cardiac remodeling, such morphological changes is present in only a section of the heart tissue.
Collapse
Affiliation(s)
| | - Fernanda V Kmit
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Brazil
| | | | - Karina K Nakama
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Brazil
| | - Karine Panico
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Brazil
| | - Juliana M Alvim
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Brazil
| | - Thiago R Dreyer
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Brazil
| | | | | |
Collapse
|
21
|
Fontana F, Ballestri M, Makomi C, Morandi R, Cappelli G. Hemorheologic alterations in peritoneal dialysis. Clin Hemorheol Microcirc 2016; 65:175-183. [PMID: 27340762 DOI: 10.3233/ch-16152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dialysis patients present a cardiovascular risk substantially higher than general population, due to both traditional and non-traditional risk factors. Hemorheologic alterations have been extensively described in hemodialysis patients (HD), while little data on hemorheology exist about peritoneal dialysis patients (PD). Aim of our study is to characterize the hemorheological profile of 49 PD, and to compare these data with HD and healthy volunteers. PD showed an improvement of parameters related to macro-circulation (plasma viscosity, whole blood viscosity at 1-Hz, erythrocyte aggregation index and yield stress) when compared to HD, while microcirculatory function resulted severely impaired, as expressed by high values for whole blood viscosity 200-Hz shear rate and lower erythrocyte deformability (ED). In conclusion, we found hemorheologic alterations in PD, with substantial differences with respect to HD; in particular, PD showed profound dysfunction in microcirculatory flow with impaired ED. This alterations may act as a risk factor for accelerated atherosclerosis and precipitate cardiovascular events, and it may have a detrimental effect in the peritoneal microcirculation promoting endothelial activation with subsequent fibrosis, leading to peritoneal membrane malfunctioning.
Collapse
Affiliation(s)
- Francesco Fontana
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ballestri
- Divisione di Nefrologia, Dialisi e Trapianto Renale, Dipartimento di Medicina e Specialitá Mediche, Policlinico di Modena, Modena, Italy
| | - Clarisse Makomi
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Morandi
- Department of Oncology and Haematology, Section of Transfusion Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
22
|
Okuda Y, Omoto S, Taniura T, Shouzu A, Nomura S. Effects of teneligliptin on PDMPs and PAI-1 in patients with diabetes on hemodialysis. Int J Gen Med 2016; 9:65-71. [PMID: 27110135 PMCID: PMC4835142 DOI: 10.2147/ijgm.s102070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the main cause of death among hemodialysis (HD) patients. The effects of the dipeptidyl peptidase-4 inhibitor teneligliptin on CVD-related biomarkers in patients with type 2 diabetes mellitus (T2DM) receiving HD treatment are poorly understood. To determine whether teneligliptin has anti-CVD properties, we assessed its effects on soluble P-selectin (sP-selectin), platelet-derived microparticles (PDMPs), plasminogen activator inhibitor 1 (PAI-1), soluble E-selectin (sE-selectin), soluble vascular adhesion molecule 1 (sVCAM-1), and adiponectin plasma levels in HD and non-HD patients with T2DM. Methods Patients with T2DM eligible for teneligliptin monotherapy or combination therapy (eg, teneligliptin plus a sulfonylurea) were administered teneligliptin (20 mg/d) once daily for 6 months. Plasma levels of sP-selectin, PDMPs, PAI-1, sE-selectin, sVCAM-1, and adiponectin were measured by enzyme-linked immunosorbent assay at baseline and after 3 months and 6 months of treatment. Results Teneligliptin therapy significantly reduced plasma levels of sP-selectin, PDMPs, and PAI-1 compared with baseline levels, while significantly increasing adiponectin levels. sE-selectin and sVCAM-1 levels were significantly decreased only at 6 months. The reduction in sP-selectin, PDMPs, and PAI-1 was more significant in HD patients than in non-HD patients. However, the improvement in adiponectin levels was unchanged with HD treatment. Conclusion By modulating PDMPs or PAI-1, teneligliptin shows an antiatherothrombotic effect that may be beneficial in the primary prevention of CVD in patients with T2DM on HD.
Collapse
Affiliation(s)
- Yoshinori Okuda
- Division of Internal Medicine, Meisei Memorial Hospital, Osaka, Japan
| | - Seitaro Omoto
- Division of Internal Medicine, Kohrigaoka Yukeikai Hospital, Osaka, Japan
| | | | - Akira Shouzu
- Division of Internal Medicine, Saiseikai Izuo Hospital, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| |
Collapse
|