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Shen Y, Schmaderer C, Ossadnik A, Hammitzsch A, Carbajo-Lozoya J, Bachmann Q, Bonell V, Braunisch MC, Heemann U, Pham D, Kemmner S, Lorenz G. Immunophenotypic Characterization of Citrate-Containing A Concentrates in Maintenance Hemodialysis: A Pre-Post Study. Int J Nephrol 2023; 2023:7772677. [PMID: 37809041 PMCID: PMC10551471 DOI: 10.1155/2023/7772677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 06/07/2023] [Accepted: 06/21/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Due to chronic inflammation, maintenance hemodialysis (MHD) patients continue to show excess mortality. Acetate-free citrate-buffered A concentrates could be a way to improve the biocompatibility of the procedure, reduce chronic inflammation, and thus in the long term improve the prognosis of patients. Methods Using a pre-post design (3 months of acetate followed by 3 months of citrate-acidified A concentrates in standard bicarbonate-based dialysate hemodialysis, CiaHD) and linear mixed model analysis in 61 stable HD patients, we assessed the impact of CiaHD on counts and phenotypes of peripheral T cells and monocytes by flow cytometry. Results Switching to CiaHD left C-reactive protein (CRP) levels and leucocyte counts unaffected. However, CiaHD increased lymphocyte counts ex vivo. Furthermore, we found a decrease in total CD3+CD4+CD69+ ((109/L), mean ± SD: acetate, 0.04 ± 1.0 versus citrate, 0.02 ± 0.01; P = 0.02) activated cells, while the number of CD28+ T cells remained stable. No differences were noted regarding T-cell exhaustion marker expression, CD14+CD16+ monocyte counts, and PMN-MDSCs. Conclusion Compared with acetate, CiaHD has a minor impact on lymphocyte counts and CD4+T-cell activation, which was independent of systemic CRP and ionized magnesium, calcium levels, and other dialysis prescription modalities.
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Affiliation(s)
- Yuli Shen
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
- Nephrology and Rheumatology Department of the Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen 518172, China
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Andreas Ossadnik
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Arianne Hammitzsch
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Javier Carbajo-Lozoya
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Quirin Bachmann
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Vera Bonell
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Matthias Christoph Braunisch
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Dang Pham
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
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Bonell V, Mongera N, Passler W, Bonincontro ML, Tabbì MG. [SARS-CoV-2 mRNA-based vaccine in hemodialysis patients: a single center-experience]. G Ital Nefrol 2023; 40:2023-vol3. [PMID: 37427909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Hemodialysis patients have an increased risk of severe complications when infected with SARS-CoV-2. The introduction of the SARS-CoV-2 vaccine represented an important progress in limiting severe forms of the disease. The focus of our study is the detection of the antibody titer in chronic hemodialysis patients vaccinated with the mRNA vaccine BNT162b2 (Comirnaty, Pfizer-BioNTech). The antibody titers were measured in 57 hemodialysis patients, vaccinated with 3 doses according to ministerial criteria, by ElectroChemiLuminescence ImmunoAssay (ECLIA). The response was defined as an antibody titer above the dosable level > 0,8 UI/ml. A good antibody response was defined as titer > 250 UI/ml. Infections with SARS-CoV-2 and adverse effects to the vaccine were recorded. Our study showed in 93% of the hemodialysis patients a dosable antibody response after the second dose of the vaccine. After the third dose of the vaccine, 100% of the hemodialysis patients reached a dosable antibody titer. The vaccine proved to be safe, no serious adverse events were observed. After the third dose, SARS-CoV-2 infections were still observed, but with reduced severity. A vaccination course against SARS-CoV-2 infection with three doses of BNT162b2 in the dialysis patient is associated with a good immune response and protects against severe infections.
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Affiliation(s)
- Vera Bonell
- Reparto di Nefrologia e Dialisi, Ospedale Centrale di Bolzano, Italia
| | - Nicola Mongera
- Reparto di Nefrologia e Dialisi, Ospedale Centrale di Bolzano, Italia
| | - Werner Passler
- Reparto di Nefrologia e Dialisi, Ospedale Centrale di Bolzano, Italia
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Bonell V, Lorenz G, Kessler T, Heemann U, Schmaderer C, Kemmner S. MO739EX VIVO THROMBOCYTE FUNCTION IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab097.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Coagulation disorders with both risk for bleeding and thrombotic events are common in hemodialysis (HD) patients. Altered thrombocyte counts and function may account for that. Here, we sought to better characterize thrombocyte function in hemodialysis patients.
Method
Platelet function was investigated using the Multiplate analyzer (Roche) based on impedance aggregometry. Adenosine diphosphate (ADP) was used to induce platelet aggregation and area under the curve (AUC) was used as primary endpoint. Platelet counts and C-reactive protein (CRP) levels were measured. Hospitalization was the primary clinical outcome. Pearson regression was used to test for associations of thrombocyte function and the primary endpoint.
Results
In total 60 chronic HD patients undergoing dialysis 3 times per week, and 67 healthy controls were included. In general, HD patients presented with significantly lower thrombocyte numbers compared to healthy controls (Median: 221 vs. 245 G/l, p=0.029). Further, thrombocyte function as determined by AUC was significantly altered in HD patients versus healthy controls (Median: 455 vs. 677 AU*min, p<0.001; figure 1) with a significant correlation for platelet count and platelet function (r=0.42, p=0.001).
Platelet function also correlated with the inflammatory state as seen by systemic CRP levels (r=0.28, p=0.033). Regarding the clinical outcome, platelet function correlated with hospitalization rates for infectious disease (r=0.27; p=0.040) and cardiovascular events (r=0.30; p=0.022). In case of hospitalization rates for infectious disease this correlation remained stable irrespective of adjustment for thrombocyte counts (r=0.27, p=0.036).
Conclusion
Lower platelet counts and altered function in HD patients was associated with risk of hospitalization and markers of inflammation in this cohort. The Multiplate analyzer appeared to be a valid and easily accessible method to assess thrombocyte function. Further studies are needed to determine whether assessment of thrombocyte function in clinical routine should be used to stratify risk in the vulnerable population of HD patients.
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Affiliation(s)
- Vera Bonell
- Klinikum rechts der Isar, Technical University Munich, Nephrology, Munich, Germany
| | - Georg Lorenz
- Klinikum rechts der Isar, Technical University Munich, Nephrology, Munich, Germany
| | | | - Uwe Heemann
- Klinikum rechts der Isar, Technical University Munich, Nephrology, Munich, Germany
| | - Christoph Schmaderer
- Klinikum rechts der Isar, Technical University Munich, Nephrology, Munich, Germany
| | - Stephan Kemmner
- University Hospital Munich, Ludwig-Maximilians-University, Transplant Center, Munich, Germany
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