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Mukoyama M, Kuwabara T. Pre- dialysis blood pressure and cardiovascular mortality in Japan: need for much stricter control? Hypertens Res 2024; 47:811-812. [PMID: 38062201 DOI: 10.1038/s41440-023-01523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/26/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Masashi Mukoyama
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
| | - Takashige Kuwabara
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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Neri L, Viglino G, Vizzardi V, Porreca S, Mastropaolo C, Marinangeli G, Cabiddu G. Role of the Opinions of the Nephrologist and Structural Factors in Dialysis Modality Selection. Results of a Peritoneal Dialysis Study Group Questionnaire. G Ital Nefrol 2024; 41:2024-vol1. [PMID: 38426674] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background. The use of PD depends on economic, structural and organizational factors. The nephrologist's opinion is that peritoneal dialysis is less used than it shold be. In Italy, PD is not carried out in private Centers, but neither is it in around one third of Public Centers. The aim of this study was to investigate the opinions of nephrologists on PD in Public Centers only, thereby nullifying the influence of the economic factors. Materials and Methods. The investigation was carried out by means of an online questionnaire (Qs) via mail, and during meetings and Congresses in 2006-07. The Qs investigated the characteristics of the Centers, the nephrologists interviewed, and opinions on the various aspects of the choice of Renal Replacement Therapy Renal Replacement Therapy (RRT) (26 questions). Responses were received from 454 nephrologists in 270 public Centers. Among these, 205 centers (370 Qs) report PD (PD-YES), 36 (42 Qs) do not (PD-NO) and 29 (42 Qs) do not use it but send patients selected for PD to other Centers (PD-TRANSF). Results. The PD-NO and PD-TRANSF Centers are significantly smaller, with greater availability of beds. In the PD-YES Centers the presence of a pre-dialysis pathway, early referral and nurses dedicated solely to PD are associated with a higher use of PD. The nephrologists in the PD-NO Centers rate PD more negatively in terms of both clinical and non-clinical factors. The belief that more than 40% of patients can do either PD or HD differs among the nephrologists in the PD-YES (74.3%), PD-TRANSF (45.2%) and PD-NO (28.6%) Centers. Likewise, the belief that PD can be used as a first treatment in more than 30% of cases differs among the nephrologists in PD-YES (49.2%), PD-TRANSF (33.3%) and PD-NO (14.3%) Centers. Conclusions. The use of PD in Public Centers is conditioned by both structural and organizational factors, and by the opinions of nephrologists on the use and effectiveness of the technique.
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Affiliation(s)
- Loris Neri
- Nefrologia e Dialisi, Ospedale "Michele e Pietro Ferrero", Verduno, Cuneo, Italy
| | | | | | - Silvia Porreca
- Nefrologia e Dialisi, Policlinico Università A. Moro, Bari, Italy
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Suh SH, Oh TR, Choi HS, Kim CS, Bae EH, Ma SK, Oh KH, Lee KB, Jeong JC, Jung JY, Kim SW. Circulating osteoprotegerin levels and cardiovascular outcomes in patients with pre- dialysis chronic kidney disease: results from the KNOW-CKD study. Sci Rep 2024; 14:4136. [PMID: 38374135 PMCID: PMC10876961 DOI: 10.1038/s41598-024-54335-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/12/2024] [Indexed: 02/21/2024] Open
Abstract
While the relationship between circulating osteoprotegerin (OPG) and cardiovascular events is well-established in the general population, its association with cardiovascular risks in chronic kidney disease (CKD) patients remains less robust. This study hypothesized that elevated circulating OPG levels might be associated with an increased risk of major adverse cardiac events (MACE) in CKD patients, a total of 2,109 patients with CKD stages 1 through pre-dialysis 5 from the KNOW-CKD cohort were categorized into quartiles based on serum OPG levels. The primary outcome of the study was 3-point MACE, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, or cardiac death. The median follow-up duration was 7.9 years. The cumulative incidence of 3-point MACE significantly varied across serum OPG levels in Kaplan-Meier curve analysis (P < 0.001, log-rank test), with the highest incidence observed in the 4th quartile. Cox regression analysis indicated that, relative to the 1st quartile, the risk of 3-point MACE was significantly higher in the 3rd (adjusted hazard ratio 2.901, 95% confidence interval 1.009 to 8.341) and the 4th quartiles (adjusted hazard ratio 4.347, 95% confidence interval 1.410 to 13.395). In conclusion, elevated circulating OPG levels are associated with adverse cardiovascular outcomes in pre-dialysis CKD patients.
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Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebongro, Gwangju, 61469, Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebongro, Gwangju, 61469, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebongro, Gwangju, 61469, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebongro, Gwangju, 61469, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebongro, Gwangju, 61469, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebongro, Gwangju, 61469, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyu-Beck Lee
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Cheol Jeong
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebongro, Gwangju, 61469, Korea.
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Edeki IR, Unuigbe EI, Okaka EI. Haematological Indices and Iron Status in Pre- Dialysis Chronic Kidney Disease Patients. West Afr J Med 2024; 41:48-54. [PMID: 38412204] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with haematological changes, the commonest being anaemia. The number and function of white blood cells (WBC) and platelets are equally affected. Iron deficiency is a common cause of anaemia in the CKD population and anaemia has been associated with reduced cardiac function, increased rates of hospitalization, morbidity and mortality. This study aimed to determine the haematological indices and iron status among pre-dialysis CKD patients. METHOD A hospital-based cross-sectional study involving 95 predialysis CKD patients and 95 age- and sex-matched apparently healthy controls. Full blood count, peripheral blood film, serum ferritin, transferrin saturation, C-reactive protein (CRP), electrolytes, urea and creatinine, serum folate and vitamin B12 were done in all study participants. Comparisons were made between results obtained from participants in both groups. RESULT The mean ages were 58.1 ± 14.9 years and 58.3 ± 15.0 years in the CKD group and controls, respectively. The male:female ratio was 1:0.9 in both groups. The prevalence of anaemia was 51.6% and 3% in patients with CKD and controls, respectively. There was no significant difference in the total WBC count, neutrophil and lymphocyte differentials, platelet count, serum vitamin B12 and folate in patients with CKD and controls. The prevalence of iron deficiency among patients with CKD was 32.6%, of which 62.5% were absolutely iron-deficient while 37.5% were functionally iron-deficient. The median ferritin and CRP were also higher in CKD. (p =0.001). CONCLUSION Anaemia and iron deficiency are common in predialysis CKD patients. Early diagnosis and treatment are important to avoid the problems associated with them. MOTS-CLÉS Maladie rénale chronique, Anémie, Carence en fer, Pré-dialyse.
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Affiliation(s)
- I R Edeki
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. . Phone Number: +234 7033034988
| | - E I Unuigbe
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. . Phone Number: +234 7033034988
| | - E I Okaka
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. . Phone Number: +234 7033034988
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Cambien G, Dupuis A, Belmouaz M, Bauwens M, Bacle A, Ragot S, Migeot V, Albouy M, Ayraud-Thevenot S. Bisphenol A and chlorinated derivatives of bisphenol A assessment in end stage renal disease patients: Impact of dialysis therapy. Ecotoxicol Environ Saf 2024; 270:115880. [PMID: 38159342 DOI: 10.1016/j.ecoenv.2023.115880] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/25/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
Patients with end stage kidney disease treated by dialysis (ESKDD) process dialysis sessions to remove molecules usually excreted by kidneys. However, dialysis therapy could also contribute to endocrine disruptors (ED) burden. Indeed, materials like dialyzer filters, ultrapure dialysate and replacement fluid could exposed ESKDD patients to Bisphenol A (BPA) and chlorinated derivatives of BPA (ClxBPAs). Thus, our aim was to compare BPA and ClxBPAs exposure between ESKDD patients, patients with stage 5 chronic kidney disease (CKD5) not dialyzed and healthy volunteers. Then we describe the impact of a single dialysis session, according to dialysis modalities (hemodialysis therapy (HD) versus online hemodiafiltration therapy (HDF)) and materials used with pre-post BPA and ClxBPAs concentrations. The plasma levels of BPA and four ClxBPAs, were assessed for 64 ESKDD patients in pre and post dialysis samples (32 treated by HD and 32 treated by HDF) in 36 CKD5 patients and in 24 healthy volunteers. BPA plasma concentrations were 22.5 times higher for ESKDD patients in pre-dialysis samples versus healthy volunteers (2.208 ± 5.525 ng/mL versus 0.098 ± 0.169 ng/mL) (p < 0.001). BPA plasma concentrations were 16 times higher for CKD5 patients versus healthy volunteers, but it was not significant (1.606 ± 3.230 ng/mL versus 0.098 ± 0.169 ng/mL) (p > 0.05). BPA plasma concentrations for ESKDD patients in pre-dialysis samples were 1.4 times higher versus CKD5 patients (2.208 ± 5.525 ng/mL versus 1.606 ± 3.230 ng/mL) (p < 0.001). For healthy volunteers, ClxBPAs were never detected, or quantified while for CKD5 and ESKDD patients one ClxBPAs at least has been detected or quantified in 14 patients (38.8%) and 24 patients (37.5%), respectively. Dialysis therapy was inefficient to remove BPA either for HD (1.983 ± 6.042 ng/mL in pre-dialysis versus 3.675 ± 8.445 ng/mL in post-dialysis) or HDF (2.434 ± 5.042 ng/mL in pre-dialysis versus 7.462 ± 15.960 ng/mL in post dialysis) regarding pre-post BPA concentrations (p > 0.05). The same result was observed regarding ClxBPA analysis. Presence of polysulfone in dialyzer fibers overexposed ESKDD patients to BPA in pre-dialysis samples with 3.054 ± 6.770 for ESKDD patients treated with a polysulfone dialyzer versus 0.708 ± 0.638 (p = 0.040) for ESKDD patients treated without a polysulfone dialyzer and to BPA in post-dialysis samples with 6.629 ± 13.932 for ESKDD patients treated with a polysulfone dialyzer versus 3.982 ± 11.004 (p = 0.018) for ESKDD patients treated without a polysulfone dialyzer. This work is to our knowledge the first to investigate, the impact of a dialysis session and materials used on BPA and ClxBPAs plasma concentrations and to compare these concentrations to those found in CKD5 patients and in healthy volunteers.
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Affiliation(s)
- Guillaume Cambien
- Université de Poitiers, CNRS, EBI, F-86000 Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation Clinique CIC1402, Axe santé Environnementale, Poitiers, France; CHU de Poitiers, Biology-Pharmacy-Public Health Department, F-86000 Poitiers, France.
| | - Antoine Dupuis
- Université de Poitiers, CNRS, EBI, F-86000 Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation Clinique CIC1402, Axe santé Environnementale, Poitiers, France; CHU de Poitiers, Biology-Pharmacy-Public Health Department, F-86000 Poitiers, France.
| | - Mohamed Belmouaz
- CHU de Poitiers, Digestiv, Urology, Nephrology, Endocrinology Department, F-86000 Poitiers, France.
| | - Marc Bauwens
- CHU de Poitiers, Digestiv, Urology, Nephrology, Endocrinology Department, F-86000 Poitiers, France.
| | - Astrid Bacle
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France; Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France.
| | - Stéphanie Ragot
- Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation Clinique CIC1402, Axe SCALE-EPI, Poitiers, France.
| | - Virginie Migeot
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France; CHU Rennes, Epidemiology and Public Health Department, F-35000 Rennes, France.
| | - Marion Albouy
- Université de Poitiers, CNRS, EBI, F-86000 Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation Clinique CIC1402, Axe santé Environnementale, Poitiers, France; CHU de Poitiers, Biology-Pharmacy-Public Health Department, F-86000 Poitiers, France.
| | - Sarah Ayraud-Thevenot
- Université de Poitiers, CNRS, EBI, F-86000 Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation Clinique CIC1402, Axe santé Environnementale, Poitiers, France; CHU de Poitiers, Biology-Pharmacy-Public Health Department, F-86000 Poitiers, France.
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Tsai MY, Huang YC, Cheng BC, Chin CY, Hsu YT, Lee WC. Prevalence and varieties of complementary and alternative medicine usage among individuals with pre- dialysis chronic kidney disease in Taiwan: an investigative cross-sectional analysis. BMC Complement Med Ther 2024; 24:11. [PMID: 38167149 PMCID: PMC10759758 DOI: 10.1186/s12906-023-04311-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is frequently used in the general population, yet only limited data are available regarding the prevalence of these medications in patients with chronic kidney disease (CKD). Hence, our study aimed to explore the prevalence and types of CAM in Taiwanese patients with CKD. METHODS A cross-sectional questionnaire survey was conducted by face-to-face interview of 275 pre-dialysis patients without dialysis treatment or kidney transplant at an outpatient nephrology clinic in Taiwan from March 2021 to June 2023. The study outcomes were the prevalence of CAM, CAM types, reasons for using CAM, and sources of information about CAM. RESULTS Overall, 128 patients (46.5%) were using CAM, but no significant differences from non-CAM users in the various CKD stages (p = 0.156) were found. CAM usage was high in the age range of 20-60 years and duration of CKD ≤ 5 years (p < 0.05). The most commonly used type of CAM was nutritional approaches (79.7%), followed by other complementary health approaches (26.6%). The most commonly utilized modalities of CAM were vitamins and minerals (38.3%), and only 27.1% of patients disclosed their CAM use to their physicians. The most common sources of information about CAM were family and friends, cited by 66% of the participants. Health promotion and a proactive attitude were reported by 40% of users as the reasons for using CAM. CONCLUSIONS The present study provides data on the CAM usage among CKD patients and adds to the increasing evidence on CAM use. Because some of these practices have safety concerns, better education from healthcare providers on the risks and benefits of CAM therapy is needed by CKD patients.
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Affiliation(s)
- Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, No. 123 Dapi Rd., Niaosong Dist., Kaohsiung, 83301, Taiwan.
| | - Yu-Chuen Huang
- Department of Medical Research, China Medical University Hospital and School of Chinese Medicine, China Medical University, Taichung, 41354, Taiwan
| | - Ben-Chung Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Chieh-Ying Chin
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, No. 123 Dapi Rd., Niaosong Dist., Kaohsiung, 83301, Taiwan
- Department of Nursing, MeiHo University, Pingtung, 912009, Taiwan
- Kaohsiung Municipal Feng Shan Hospital-Under the management of Chang Gung Medical Foundation, Kaohsiung, 830025, Taiwan
| | - Yung-Tang Hsu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, No. 123 Dapi Rd., Niaosong Dist., Kaohsiung, 83301, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan.
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Sakuma H, Ikeda M, Nakao S, Suetsugu R, Matsuki M, Hasebe N, Nakagawa N. Regional variation in pre- dialysis blood pressure and its association with cardiovascular mortality rates in Japanese patients undergoing dialysis. Hypertens Res 2024; 47:102-111. [PMID: 37710034 DOI: 10.1038/s41440-023-01415-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
Adequate blood pressure (BP) management poses a significant challenge in improving the prognosis of patients undergoing dialysis. We aimed to investigate the relationship between pre-dialysis systolic blood pressure (SBP) and underlying disease in Japanese patients undergoing dialysis, based on prefectural location, and assess the association between pre-dialysis SBP and cardiovascular disease (CVD) mortality rate. We extracted the basic information of 336,182 patients who were undergoing dialysis in 2021 from the Web-based Analysis of Dialysis Data Archives database. Data on average pre-dialysis SBP were analyzed according to sex, prefectural location, and diabetic status, and the CVD mortality rate for each prefecture was calculated. The mean pre-dialysis SBP of the patients (males, 66.3%; mean age, 69.7 ± 12.5 years) was 151.9 ± 24.7 mmHg. Overall, 133,037 patients had underlying diabetic kidney disease (DKD). The patients with DKD were younger, had a shorter dialysis duration, and a higher pre-dialysis SBP than those with non-DKD comorbidities. The prefecture-based mean pre-dialysis SBP values were all higher than 140 mmHg. At the prefectural level, CVD mortality rate was positively correlated with pre-dialysis SBP (r = 0.3127, p = 0.0324) and diastolic blood pressure (r = 0.3378, p = 0.0202) among female patients. At the prefectural level, pre-dialysis SBP is >140 mmHg in Japanese patients undergoing dialysis, especially in those with DKD. The positive association between pre-dialysis SBP and CVD mortality rate suggests that optimal BP management at the prefectural level may reduce CVD mortality rates. At the prefectural level, pre-dialysis SBP is higher than 140 mmHg in Japanese patients undergoing dialysis, especially higher in those with DKD.
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Affiliation(s)
- Hirofumi Sakuma
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Minori Ikeda
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Shiori Nakao
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Reina Suetsugu
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Motoki Matsuki
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
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Khan SR, Roy AS, Hoque MR, Das SK, Hossain MB, Miah MOF, Nira NH, Salahuddin AZM, Islam H, Datta P. Assessment of Dialysis Adequacy Using Small Solute Clearance Indices among Twice versus Thrice Weekly Maintenance Hemodialysis Patients in a Tertiary Care Hospital of Bangladesh. Mymensingh Med J 2024; 33:80-90. [PMID: 38163777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
This observational study was carried out in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020. A total of 179 patients were included in this study according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients were underwent detail history taking, thorough physical examination and relevant investigations. Data collection was conducted through a structured questionnaire. Collected data were analyzed using the statistical software SPSS 23.0. Mean age ±SD of the study patients was 47.06±14.1 with a majority in age group 41-50 years. Male predominance was observed with a male: female ratio of 2.19:1 and 68.7% male patients. Level of pre-dialysis, post-dialysis urea in the study population was 123.77±26.86mg/dl, 50.27±15.70mg/dl respectively and mean ±SD of Urea Reduction Ratio (URR) in hemodialysis (target >65.0%) was 67.2±1.9. Most of the 8 hours (two times) per week hemolysis patients could not achieve the target value of dialysis adequacy parameters. On the other hand, maximum people in 12 hours (three times) per week hemodialysis group achieved the target value of dialysis adequacy parameters. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.
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Affiliation(s)
- S R Khan
- Dr Suhel Rana Khan, Dialysis Medical Officer, Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh; E-mail:
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Tang L, Li S, Guo X, Lai J, Liu P, Fang J, Liu X. Combinative predictive effect of left ventricular mass index, ratio of HDL and CRP for progression of chronic kidney disease in non- dialysis patient. Int Urol Nephrol 2024; 56:205-215. [PMID: 37204678 DOI: 10.1007/s11255-023-03624-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE This current study scrutinized the association among left ventricular mass index (LVMI), ratio of high-density lipoprotein (HDL) and C-reactive protein (CRP), and renal function. Furthermore, we examined the predictive effects of left ventricular mass index and HDL/CRP on progression of non-dialysis chronic kidney disease. METHODS We enrolled adult patients with chronic kidney disease (CKD) who were not receiving dialysis and obtained follow-up data on them. We extracted and compared data between different groups. To investigate the relationship between left ventricular mass index (LVMI), high-density lipoprotein (HDL)/C-reactive protein (CRP) levels, and CKD, we employed linear regression analysis, Kaplan-Meier analysis, and Cox proportional hazards regression analysis. RESULTS Our study enrolled a total of 2351 patients. Compared with those in the non-progression group, subjects in the CKD progression group had lower ln(HDL/CRP) levels (- 1.56 ± 1.78 vs. - 1.14 ± 1.77, P < 0.001) but higher left ventricular mass index (LVMI) values (115.45 ± 29.8 vs. 102.8 ± 26.31 g/m2, P < 0.001). Moreover, after adjusting for demographic factors, ln(HDL/CRP) was found to be positively associated with estimated glomerular filtration rate (eGFR) (B = 1.18, P < 0.001), while LVMI was negatively associated with eGFR (B = - 0.15, P < 0.001). In the end, we found that both LVH (HR = 1.53, 95% CI 1.15 to 2.05, P = 0.004) and lower ln(HDL/CRP) (HR = 1.46, 95% CI 1.08 to 1.96, P = 0.013) independently predicted CKD progression. Notably, the combined predictive power of these variables was stronger than either variable alone (HR = 1.98, 95% CI 1.5 to 2.62, P < 0.001). CONCLUSION Our study findings indicate that in pre-dialysis patients, both HDL/CRP and LVMI are associated with basic renal function and are independently correlated with CKD progression. These variables may serve as predictors for CKD progression, and their combined predictive power is stronger than that of either variable alone.
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Affiliation(s)
- Leile Tang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shaomin Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Xinghua Guo
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiahui Lai
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Peijia Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Jia Fang
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China.
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Sakuma H, Matsuki M, Hasebe N, Nakagawa N. Real-world trends in pre- dialysis blood pressure levels of patients undergoing dialysis in Japan using a web-based national database. J Clin Hypertens (Greenwich) 2023; 25:1163-1171. [PMID: 37890860 PMCID: PMC10710555 DOI: 10.1111/jch.14736] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023]
Abstract
The prevalence of hypertension is high among patients undergoing dialysis. We extracted data of patients undergoing dialysis between 2012 and 2020 with recorded pre-dialysis systolic blood pressure (SBP) using a web-based national database in Japan. Following the 2019 Japanese Society of Hypertension guidelines, we classified SBP and assessed its trends over time based on sex, age, diabetes status, and the anti-hypertensive medication use. Using the 2020 database, we examined 336,759 Japanese patients undergoing dialysis (114,249 female; 222,510 male). The mean age was 69.4 ± 12.5 years, and the mean SBP was 152.3 ± 24.7 mm Hg. The prevalence rate of pre-dialysis hypertension was 70.2%, with 32.5%, 24.5%, and 13.2% of patients having grade I, grade II, and grade III hypertension, respectively. From 2014 to 2020, prevalence rate of pre-dialysis hypertension and absolute values of pre-dialysis SBP were higher in dialysis patients with diabetes than in those without diabetes across all age groups and sexes. Younger patients with diabetes or those on anti-hypertensive medication exhibited an SBP of approximately 160 mm Hg. Cerebrovascular death in patients with diabetes was associated with a higher rate of pre-dialysis hypertension than that in those without diabetes, and there was a significant difference in the prevalence of grade III hypertension between the two groups. In conclusion, the mean pre-dialysis SBP among patients undergoing dialysis remained high, and younger patients with diabetes or those receiving anti-hypertensive medications had poor blood pressure control. Optimal blood pressure management may be necessary to reduce the risk of cardiovascular mortality.
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Affiliation(s)
- Hirofumi Sakuma
- Division of Cardiology, Nephrology, Respiratory, and Neurology, Department of Internal MedicineAsahikawa Medical UniversityAsahikawaHokkaidoJapan
| | - Motoki Matsuki
- Division of Cardiology, Nephrology, Respiratory, and Neurology, Department of Internal MedicineAsahikawa Medical UniversityAsahikawaHokkaidoJapan
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Respiratory, and Neurology, Department of Internal MedicineAsahikawa Medical UniversityAsahikawaHokkaidoJapan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Respiratory, and Neurology, Department of Internal MedicineAsahikawa Medical UniversityAsahikawaHokkaidoJapan
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11
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Hasegawa T, Imaizumi T, Hamano T, Murotani K, Fujii N, Komaba H, Ando M, Maruyama S, Nangaku M, Nitta K, Hirakata H, Isaka Y, Wada T, Fukagawa M. Association between serum iron markers, iron supplementation and cardiovascular morbidity in pre- dialysis chronic kidney disease. Nephrol Dial Transplant 2023; 38:2713-2722. [PMID: 37202214 PMCID: PMC10689172 DOI: 10.1093/ndt/gfad096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The optimal range of serum iron markers and usefulness of iron supplementation are uncertain in patients with pre-dialysis chronic kidney disease (CKD). We investigated the association between serum iron indices and risk of cardiovascular disease (CVD) events and the effectiveness of iron supplementation using Chronic Kidney Disease Japan Cohort data. METHODS We included 1416 patients ages 20-75 years with pre-dialysis CKD. The tested exposures were serum transferrin saturation and serum ferritin levels and the outcome measures were any cardiovascular event. Fine-Gray subdistribution hazard models were used to examine the association between serum iron indices and time to events. The multivariable fractional polynomial interaction approach was used to evaluate whether serum iron indices were effect modifiers of the association between iron supplementation and cardiovascular events. RESULTS The overall incidence rate of CVD events for a median of 4.12 years was 26.7 events/1000 person-years. Patients with serum transferrin saturation <20% demonstrated an increased risk of CVD [subdistribution hazard ratio (HR) 2.13] and congestive heart failure (subdistribution HR 2.42). The magnitude of reduction in CVD risk with iron supplementation was greater in patients with lower transferrin saturations (P = .042). CONCLUSIONS Maintaining transferrin saturation >20% and adequate iron supplementation may effectively reduce the risk of CVD events in patients with pre-dialysis CKD.
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Affiliation(s)
- Takeshi Hasegawa
- Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
- Division of Nephrology, Department of Medicine, School of Medicine
- Department of Hygiene, Public Health, and Preventive Medicine, School of Medicine, Showa University, Tokyo, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medicine, Nagoya, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Naohiko Fujii
- Medical and Research Center for Nephrology and Transplantation, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, University of Tokyo Hospital, Tokyo, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Wada
- Division of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
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Hsu RK, Rubinsky AD, Shlipak MG, Johansen KL, Estrella MM, Lee BJ, Peralta CA, Hsu CY. Associations between abrupt transition, dialysis-requiring AKI, and early mortality in ESKD among U.S. veterans. BMC Nephrol 2023; 24:339. [PMID: 37964185 PMCID: PMC10647139 DOI: 10.1186/s12882-023-03387-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Mortality is high within the first few months of starting chronic dialysis. Pre-ESKD trajectory of kidney function has been shown to be predictive of early death after dialysis initiation. We aim to better understand how two key aspects of pre-dialysis kidney function-an abrupt transition pattern and an episode of dialysis-requiring AKI (AKI-D) leading directly to ESKD-are associated with early mortality after dialysis initiation. METHODS We extracted national data from U.S. Veterans Health Administration cross-linked with the United States Renal Data System (USRDS) to identify patients who initiated hemodialysis during 2009-2013. We defined abrupt transition as having a mean outpatient eGFR ≥ 30 ml/min/1.73m2 within 1 year prior to ESKD. AKI-D was identified using inpatient serum creatinine measurements (serum Cr increase by at least 50% from baseline) along with billing codes for inpatient receipt of dialysis for AKI within 30 days prior to the ESKD start date. We used multivariable proportional hazards models to examine the association between patterns of kidney function prior to ESKD and all-cause mortality within 90 days after ESKD. RESULTS Twenty-two thousand eight hundred fifteen patients were identified in the final analytic cohort of Veterans who initiated hemodialysis and entered the USRDS. We defined five patterns of kidney function decline. Most (68%) patients (N = 15,484) did not have abrupt transition and did not suffer an episode of AKI-D prior to ESKD (reference group). The remaining groups had abrupt transition, AKI-D, or both. Patients who had an abrupt transition with (N = 503) or without (N = 3611) AKI-D had the highest risk of early mortality after ESKD onset after adjustment for demographics and comorbidities (adjusted HR 2.10, 95% CI 1.66-2.65 for abrupt transition with AKI-D; adjusted HR 2.10, 95% CI 1.90-2.33 for abrupt transition without AKI-D). In contrast, patients who experienced AKI-D without an abrupt transition pattern (N = 2141 had only a modestly higher risk of early death (adjusted HR 1.19, 95% CI 1.01-1.40). CONCLUSIONS An abrupt decline in kidney function within 1 year prior to ESKD occurred in nearly 1 in 5 incident hemodialysis patients (18%) in this national cohort of Veterans and was strongly associated with higher early mortality after ESKD onset.
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Affiliation(s)
- Raymond K Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Anna D Rubinsky
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael G Shlipak
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kirsten L Johansen
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- Division of Nephrology, Hennepin Healthcare, Minneapolis, MN, USA
| | - Michelle M Estrella
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Benjamin J Lee
- Houston Methodist Institute for Academic Medicine, Houston, TX, USA
- Houston Kidney Consultants, Houston, TX, USA
| | - Carmen A Peralta
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Cricket Health, Inc, San Francisco, CA, USA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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13
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Öberg CM, Sternby J, Nilsson A, Storr M, Flieg R, Harenski K, Roos V, Källquist L, Hobro S. Experimental hemo dialysis in diet-induced ketosis and the potential use of dialysis as an adjuvant cancer treatment. Sci Rep 2023; 13:19476. [PMID: 37945638 PMCID: PMC10636042 DOI: 10.1038/s41598-023-46715-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
Numerous in vivo studies on the ketogenic diet, a diet that can induce metabolic conditions resembling those following extended starvation, demonstrate strong outcomes on cancer survival, particularly when combined with chemo-, radio- or immunological treatments. However, the therapeutic application of ketogenic diets requires strict dietary adherence from well-informed and motivated patients, and it has recently been proposed that hemodialysis might be utilized to boost ketosis and further destabilize the environment for cancer cells. Yet, plasma ketones may be lost in the dialysate-lowering blood ketone levels. Here we performed a single 180-min experimental hemodialysis (HD) session in six anesthetized Sprague-Dawley rats given ketogenic diet for five days. Median blood ketone levels pre-dialysis were 3.5 mmol/L (IQR 2.2 to 5.6) and 3.8 mmol/L (IQR 2.2 to 5.1) after 180 min HD, p = 0.54 (95% CI - 0.6 to 1.2). Plasma glucose levels were reduced by 36% (- 4.5 mmol/L), p < 0.05 (95% CI - 6.7 to - 2.5). Standard base excess was increased from - 3.5 mmol/L (IQR - 4 to - 2) to 0.5 mmol/L (IQR - 1 to 3), p < 0.01 (95% CI 2.0 to 5.0). A theoretical model was applied confirming that intra-dialytic glucose levels decrease, and ketone levels slightly increase since hepatic ketone production far exceeds dialytic removal. Our experimental data and in-silico modeling indicate that elevated blood ketone levels during ketosis are maintained during hemodialysis despite dialytic removal.
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Affiliation(s)
- Carl M Öberg
- Department of Clinical Sciences Lund, Skåne University Hospital, Njurmottagningen SUS Lund, Barngatan 2a, 221 85, Lund, Sweden.
| | - Jan Sternby
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
| | - Anders Nilsson
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
| | - Markus Storr
- Baxter International Inc., 72379, Hechingen, Germany
| | - Ralf Flieg
- Baxter International Inc., 72379, Hechingen, Germany
| | - Kai Harenski
- Baxter Deutschland GmbH., 85 716, Unterschleissheim, Germany
| | - Viktoria Roos
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden.
| | - Linda Källquist
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
| | - Sture Hobro
- Baxter International Inc., Magistratsvägen 10, 22643, Lund, Sweden
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14
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Furukawa E, Okuhara T, Okada H, Fujitomo Y, Osa M, Hashiba T, Kiuchi T. Evaluating the understandability and actionability of online educational videos on pre- dialysis chronic kidney disease. Nephrology (Carlton) 2023; 28:620-628. [PMID: 37591493 DOI: 10.1111/nep.14226] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
AIM It remains undetermined whether online education videos for Japanese patients with chronic kidney disease (CKD) are easy to understand and allow adoption of behavioural changes. This study quantitatively assessed the understandability and applicability of online education videos for patients with CKD. METHODS In September 2021, we identified 200 videos on YouTube using the Japanese translations of the keywords 'kidney,' 'kidney disease,' 'CKD,' and 'chronic kidney disease.' We used the Japanese version of the Patient Education Materials Assessment Tool to evaluate the understandability and usability of webpages on a scale of 0% to 100%. The cut-off was set at 70%. RESULTS A total of 54 videos were evaluated. The overall understandability and actionability of the materials were 57.6 (SD = 22.6) and 53.7 (SD = 33.4), respectively. Approximately 70% and 60% of the materials were considered insufficiently understandable and actionable, respectively. Most videos lacked a summary and had difficulty in using only everyday language. Most videos included at least one action for the audience to take. However, many failed to break down the action into sequential steps. They also lack visual aids to encourage the audience to take action. CONCLUSION Our results suggest that current information on pre-dialysis chronic kidney disease was not presented in a manner that can be applied by laypeople.
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Affiliation(s)
- Emi Furukawa
- Department of Health Communication, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yumiko Fujitomo
- Department of Health Communication, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Mari Osa
- Iguchi Nephrology-Urology Clinic Kameari, Tokyo, Japan
| | - Toyohiro Hashiba
- Division of Nephrology and Endocrinology, University of Tokyo Hospital, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
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15
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Kuningas K, Stringer S, Cockwell P, Khawaja A, Inston N. Is there a role of the kidney failure risk equation in optimizing timing of vascular access creation in pre- dialysis patients? J Vasc Access 2023; 24:1305-1313. [PMID: 35343295 DOI: 10.1177/11297298221084799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aims of this study were to assess the utility of using the Kidney Failure Risk Equation (KFRE) as an indicator to guide timing of vascular access creation in pre-dialysis patients. MATERIALS AND METHODS Patients referred for vascular access creation had KFRE calculated at the time of assessment and compared to standard criteria for referral. Receiver operating characteristic curves were produced for each parameter. The outcomes at 3 months, 6 months, and 1 year were used as time points for analysis. RESULTS Two hundred and three patients were assessed, and full data sets were available on 190 (94.6%). Access was created in 156 patients (82.1%) with a fistula in 153 (98.7%). Only 65.7% initiated dialysis within the follow up period. Those patients with an AV access created (n = 156) 37 (23.7%) did not reach end stage over the entire follow up period. Of the remaining patients (n = 119) that reached end stage 72.2% (n = 86) started on an AVF/AVG and 27.7% (n = 33) on a CVC. Using ROC analysis for referral eGFR, ACR and KFRE predicting dialysis initiation predictors resulted in C statistics for eGFR, ACR, and KFRE2 of 0.68 (0.58-0.79), 0.75 (0.65-0.84), and 0.72 (0.62-0.81) at 3 months; 0.73 (0.65-0.81), 0.70 (0.62-0.78), and 0.75 (0.67-0.81) at 6 months; and 0.65 (0.57-0.72); 0.67 (0.59-0.75), and 0.68 (0.61-0.77) at 12 months. CONCLUSIONS In a group of patients referred for vascular access creation the predictive models are relatively poor when applied to initiation of dialysis. The application of current guidelines to fistula creation appears to result in a high rate of unnecessary fistula formation and non-use. The study requires further evaluation in a test set of patients to confirm these findings and also identify where such risk based approaches may need modification.
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Affiliation(s)
- Külli Kuningas
- Department of Research and Development, Renal Research Institute, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stephanie Stringer
- Department of Nephrology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Cockwell
- Department of Nephrology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aurangzaib Khawaja
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicholas Inston
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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16
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Yang WC, Hsieh HM, Chen JP, Tsai SF, Chiu HF, Chung MC, Huang ST, Chen YY, Chen CH. Efficacy and Safety of a High-Energy, Low-Protein Formula Replacement Meal for Pre- Dialysis Chronic Kidney Disease Patients: A Randomized Controlled Trial. Nutrients 2023; 15:4506. [PMID: 37960159 PMCID: PMC10648072 DOI: 10.3390/nu15214506] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
High-energy, low-protein formulas (HE-LPFs) are commonly used as oral nutritional supplements (ONSs) to help provide extra calories to patients who are adhering to a low-protein diet (LPD) after diagnosis with chronic kidney disease (CKD). This randomized controlled trial aimed to evaluate the efficacy and safety of an HE-LPF as either a partial or a total replacement for one meal in pre-dialysis CKD patients. Stage 4-5 CKD patients received either a once-daily HE-LPF (HE-LPF group) or normal food (control group) for a period of 4 weeks while following an LPD. Overall, 73 patients who completed the study were included in the intention-to-treat population. After analyzing the 3-day food records, the HE-LPF group experienced a significant decrease in the percentage of energy derived from protein (p < 0.05) and an increase in the percentage of energy derived from fat (p < 0.05) compared to the control group. The two groups had no significant differences in body weight, body composition, grip strength, renal function, electrolytes, or metabolic markers. The HE-LPF group had a high adherence (94.9% at week 4), and no adverse effects were observed. HE-LPFs are safe to employ as meal replacements for pre-dialysis CKD patients adhering to an LPD.
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Affiliation(s)
- Wen-Ching Yang
- Department of Food and Nutrition, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (W.-C.Y.); (H.-M.H.)
| | - Hui-Min Hsieh
- Department of Food and Nutrition, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (W.-C.Y.); (H.-M.H.)
| | - Jun-Peng Chen
- Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-P.C.); (Y.-Y.C.)
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- Department of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University School of Medicine, Taichung 40227, Taiwan
| | - Hsien-Fu Chiu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
| | - Mu-Chi Chung
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
| | - Shih-Ting Huang
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
| | - Yun-Yu Chen
- Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-P.C.); (Y.-Y.C.)
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-F.T.); (H.-F.C.); (M.-C.C.); (S.-T.H.)
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University School of Medicine, Taichung 40227, Taiwan
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17
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Akbal Y, Nural N. The Effect of Health Literacy on Patient Outcomes in Stage 3b-4 Pre- Dialysis Patients: A Semi-Experimental Study. J Community Health Nurs 2023; 40:242-254. [PMID: 36999668 DOI: 10.1080/07370016.2023.2191593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
This study was conducted to investigate the effect of health literacy on patient outcomes in pre-dialysis patients. A semi-experimental study. The study was conducted with 45 intervention and 45 control patients with glomerular filtration rates between 15-44ml/min/1.73m2. The adequate health literacy of the patients in the intervention group increased from 2.2% to 31.1%. Increased health literacy led to a significant decrease in systolic and diastolic blood pressure values and the severity of symptoms. The study showed that increased health literacy in pre-dialysis patients improves patient outcomes. Nursing care is needed in pre-dialysis.
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Affiliation(s)
- Yağmur Akbal
- Faculty of Health Sciences, Department of Nursing, Department of Internal Medicine Nursing, Recep Tayyip Erdogan University, Rize, Turkey
| | - Nesrin Nural
- Faculty of Health Sciences, Department of Nursing, Department of Internal Medicine Nursing, Prof. Karadeniz Technical University, Trabzon, Turkey
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18
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Kandori S. Editorial Comment on "Tolerability of immune checkpoint inhibitor doublet for advanced renal cell carcinoma patients with pre- dialysis chronic kidney disease or end-stage renal disease". Int J Urol 2023; 30:933. [PMID: 37431801 DOI: 10.1111/iju.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Affiliation(s)
- Shuya Kandori
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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19
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Onabanjo OA, Nwhator SO, Arogundade FA. Association between periodontal inflamed surface area and systemic inflammatory biomarkers among pre- dialysis chronic kidney disease patients. Niger Postgrad Med J 2023; 30:299-304. [PMID: 38037786 DOI: 10.4103/npmj.npmj_124_23] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background Several studies have shown an association between chronic kidney disease (CKD) and periodontitis. However, only few studies have quantified the burden of periodontal inflammation in pre-dialysis CKD patients. The aim of this study was to determine the association between periodontal inflamed surface area (PISA) and systemic inflammatory biomarkers among pre-dialysis CKD patients. Materials and Methods 120 pre-dialysis CKD participants were recruited into this study. 60 participants constituted Group A (those with periodontitis) while 60 participants constituted Group B (those without periodontitis). Full periodontal examination was carried out in the participants for the estimation of PISA. Blood samples also collected to determine levels of high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) in all participants. Independent t-test was used to compare means of PISA, hsCRP and IL-6 levels in the two groups. Pearson correlation analysis was used to determine association between PISA and (hsCRP and IL-6). Results The mean value of hsCRP was significantly higher in Group A compared to Group B (3.41 mg/L vs. 2.18 mg/L). PISA moderately correlated with hsCRP (r = 0.4, P < 0.01) in both groups. hsCRP also moderately correlated with IL-6 (r = 0.6, P < 0.001) in both groups. Conclusion This study demonstrates that there was an association between PISA and hsCRP. Increased hsCRP level in Group A revealed the inflammatory burden imposed by periodontitis.
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Affiliation(s)
- Olusoji Ayodele Onabanjo
- Department of Preventive and Community Dentistry, Periodontics Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria
| | - Solomon Olusegun Nwhator
- Department of Preventive and Community Dentistry, Periodontology Unit, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Fatiu A Arogundade
- Department of Medicine, Nephrology Unit, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
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20
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Bekku K, Nagasaki N, Tsuboi I, Takamoto A, Katayama S, Araki M. Tolerability of immune checkpoint inhibitor doublet for advanced renal cell carcinoma patients with pre- dialysis chronic kidney disease or end-stage renal disease. Int J Urol 2023; 30:931-933. [PMID: 37278602 DOI: 10.1111/iju.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Kensuke Bekku
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naoya Nagasaki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Ichiro Tsuboi
- Department of Urology, Shimane University Hospital, Izumo, Japan
| | | | - Satoshi Katayama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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21
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Dumaine CS, Fox DE, Ravani P, Santana MJ, MacRae JM. Health related quality of life during dialysis modality transitions: a qualitative study. BMC Nephrol 2023; 24:282. [PMID: 37740177 PMCID: PMC10517513 DOI: 10.1186/s12882-023-03330-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Modality transitions represent a period of significant change that can impact health related quality of life (HRQoL). We explored the HRQoL of adults transitioning to new or different dialysis modalities. METHODS We recruited eligible adults (≥ 18) transitioning to dialysis from pre-dialysis or undertaking a dialysis modality change between July and September 2017. Nineteen participants (9 incident and 10 prevalent dialysis patients) completed the KDQOL-36 survey at time of transition and three months later. Fifteen participants undertook a semi-structured interview at three months. Qualitative data were thematically analyzed. RESULTS Four themes and five sub-themes were identified: adapting to new circumstances (tackling change, accepting change), adjusting together, trading off, and challenges of chronicity (the impact of dialysis, living with a complex disease, planning with uncertainty). From the first day of dialysis treatment to the third month on a new dialysis therapy, all five HRQoL domains from the KDQOL-36 (symptoms, effects, burden, overall PCS, and overall MCS) improved in our sample (i.e., those who remained on the modality). CONCLUSIONS Dialysis transitions negatively impact the HRQoL of people with kidney disease in various ways. Future work should focus on how to best support people during this time.
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Affiliation(s)
- Chance S Dumaine
- Division of Nephrology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Danielle E Fox
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Pietro Ravani
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Jennifer M MacRae
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada.
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22
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Wiltschko L, Roblegg E, Raml R, Birngruber T. Small volume rapid equilibrium dialysis (RED) measures effects of interstitial parameters on the protein-bound fraction of topical drugs. J Pharm Biomed Anal 2023; 234:115571. [PMID: 37527618 DOI: 10.1016/j.jpba.2023.115571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023]
Abstract
The importance of plasma protein binding in the early stages of drug development is well recognized. Free and bound drug fractions in plasma are routinely determined with well-established methods. However, for physiological fluids with a small accessible volume and low protein concentrations, such as dermal interstitial fluid (dISF) validated methods are currently missing. Due to the low protein concentration and highly dynamic processes in the dermis, protein binding data obtained from plasma samples may underestimate in-vivo efficacy. This study aimed to validate a small volume rapid equilibrium dialysis (RED) for low protein samples, as a tool to examine drug-protein binding directly in the biological fluid at the site of action. The sample volume required for RED was successfully downscaled to 50 µl and plasma protein binding values of the four model drugs were consistent with previous studies with an average recovery of 88 ± 8% which makes all tested drugs suitable for small volume RED. Inter- and intra-batch variability showed sufficient reproducibility across RED plates. Small volume RED was successfully applied to assess the effects of interstitial parameters, including the evaluation of the major binding protein and the effects of binding protein concentration, drug concentration, and pH on the protein-bound drug fraction using 2% HSA and/or diluted human plasma as a surrogate for dISF.
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Affiliation(s)
- Laura Wiltschko
- HEALTH - Institute for Biomedical Research and Technologies, Joanneum Research mbH, Neue Stiftingtalstrasse 2, 8010 Graz, Austria; University of Graz, Institute of Pharmaceutical Sciences, Pharmaceutical Technology & Biopharmacy, Universitaetsplatz 1, 8010 Graz, Austria
| | - Eva Roblegg
- University of Graz, Institute of Pharmaceutical Sciences, Pharmaceutical Technology & Biopharmacy, Universitaetsplatz 1, 8010 Graz, Austria
| | - Reingard Raml
- HEALTH - Institute for Biomedical Research and Technologies, Joanneum Research mbH, Neue Stiftingtalstrasse 2, 8010 Graz, Austria.
| | - Thomas Birngruber
- HEALTH - Institute for Biomedical Research and Technologies, Joanneum Research mbH, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
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23
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Ariyanopparut S, Metta K, Avihingsanon Y, Eiam-Ong S, Kittiskulnam P. The role of a low protein diet supplemented with ketoanalogues on kidney progression in pre- dialysis chronic kidney disease patients. Sci Rep 2023; 13:15459. [PMID: 37726370 PMCID: PMC10509207 DOI: 10.1038/s41598-023-42706-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
In slowing kidney progression, numerous pre-dialysis chronic kidney disease (CKD) patients could not adhere to the well-established dietary pattern, including a very low protein diet, 0.3-0.4 g/kg/day, plus a full dose ketoanalogues (KAs) of amino acids. We evaluated the role of a low protein diet (LPD), 0.6-0.8 g/kg/day, combined with KAs (LPD-KAs) on CKD progression. We extracted data in the retrospective cohort using electronic medical records (n = 38,005). Participants with LPD-KAs for longer than six months were identified. An unmatched control group, LPD alone, was retrieved from the same database. Cox proportional hazard models were performed to examine the associations between LPD-KAs and outcomes. The primary outcome was either a rapid estimated glomerular filtration rate (eGFR) decline > 5 mL/min/1.73m2/year or commencing dialysis. Other secondary outcomes include changes in proteinuria, serum albumin, and other metabolic profiles were also assessed. A total of 1042 patients were finally recruited (LPD-KAs = 543). Although patients with LPD-KAs had significantly lower eGFR and a prevalence of diabetes, age, and dietary protein intake were comparable between LPD-KAs (0.7 ± 0.2 g/kg/day) and LPD alone groups (0.7 ± 0.3 g/kg/day, p = 0.49). During a median follow-up of 32.9 months, patients treated with LPD-KAs had a significantly lower risk of kidney function decline (HR 0.13; 95% CI 0.09-0.19, p < 0.001) and dialysis initiation (HR 0.24; 95% CI 0.12-0.49, p < 0.001) than LPD alone after adjusting for confounders. The annual rate of eGFR decline in patients receiving LPD-KAs was 4.5 [3.4-5.5] mL/min/1.73m2 compared with 7.7 [6.0-9.4] mL/min/1.73m2 in LPD alone (p = 0.001). According to KAs dose-response analysis, the daily dose of ≤ 5 tablets was conversely associated with a higher risk of the primary endpoint, whereas the association disappeared among patients receiving a dose of > 6 tablets. The spot urine protein creatinine ratio and serum phosphate levels were not significantly different between groups. LPD-KAs could retard kidney progression compared with LPD alone. This favorable effect was significant among CKD patients receiving a daily KAs dose of more than six tablets. Future randomized controlled trials should be performed to verify these findings.
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Affiliation(s)
| | - Kamonchanok Metta
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyawan Kittiskulnam
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand.
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24
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Bozman DF, Bazin D, Lavainne F, Hamroun A, Couchoud C, Hannedouche T. Loop diuretics improve conditions of dialysis inception in advanced CKD: an observational cohort study. J Nephrol 2023; 36:2047-2056. [PMID: 37768547 DOI: 10.1007/s40620-023-01752-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/31/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Diuretics can reduce fluid overload but their effects on conditions of dialysis start remain elusive. We aimed to determine whether loop diuretics exposure in the year before inception can delay the need for dialysis, affect the conditions of dialysis start, and cause early mortality three months after initiation in pre-dialysis patients. METHODS All adult patients starting dialysis from 2009 to 2015 in the REIN registry were included. Three subgroups were defined according to diuretics exposure: "continuous", "stopped", or "no diuretics" over the year before inception and compared for pre-dialysis hospitalization rates, and 3-month mortality after dialysis. RESULTS Among 59,302 patients, we found fewer emergency initiations of dialysis in the continuous diuretics group than in the stopped diuretics and no diuretics groups: 9492 (27.5%) vs 1905 (32.3%) and 5226 (35.0%), respectively; p < 0.0001. In the continuous diuretics group, there were fewer starts on central venous catheters than in the stopped diuretics and no diuretics groups: 16,677 (49.4%) vs. 3246 (56.0%) vs. 8,639 (58.4%); p < 0.0001. Patients with continuous diuretic exposure had a lower hospitalization rate than the stopped diuretics group in the year prior to dialysis, except for heart failure. The unadjusted 3-month hazard ratio of mortality after dialysis inception was significantly higher in the "no diuretics" or "stopped diuretics" groups compared with "continuous diuretics", but the excess of risk was blunted after adjustment for emergency start and pre-dialysis visits to a nephrologist. CONCLUSION Continuous loop diuretics exposure in the year before dialysis was associated with better conditions of dialysis inception, and possibly lower mortality rates in the three months after inception.
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Affiliation(s)
- Dogan-Firat Bozman
- Department of Nephrology, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67 000, Strasbourg, France
| | - Dorothée Bazin
- Department of Nephrology, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67 000, Strasbourg, France
| | - Frédéric Lavainne
- Pôle Santé Atlantique-Association ECHO, Avenue Claude Bernard, 44800, Saint-Herblain, France
| | - Aghiles Hamroun
- Department of Nephrology, CHRU Lille, Rue Polonovski, 59800, Lille, France
| | - Cécile Couchoud
- Agence de Biomédecine, Registre REIN, 1 Avenue du Stade de France, 93212, Saint Denis La Plaine Cedex, France
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25
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Piveteau J, Raffray M, Couchoud C, Ayav C, Chatelet V, Vigneau C, Bayat S. Pre- dialysis care trajectory and post-dialysis survival and transplantation access in patients with end-stage kidney disease. J Nephrol 2023; 36:2057-2070. [PMID: 37505404 DOI: 10.1007/s40620-023-01711-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/18/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The pre-dialysis care trajectory impact on post-dialysis outcomes is poorly known. This study assessed survival, access to kidney transplant waiting list and to transplantation after dialysis initiation by taking into account the patients' pre-dialysis care consumption (inpatient and outpatient) and the conditions of dialysis start: initiation context (emergency or planned) and vascular access type (catheter or fistula). METHODS Adults who started dialysis in France in 2015 were included. Clinical data came from the French REIN registry and data on the care trajectory from the French National Health Data system (SNDS). The Cox model was used to assess survival and access to kidney transplantation. RESULTS We included 8856 patients with a mean age of 68 years. Survival was shorter in patients with emergency or planned dialysis initiation with a catheter compared to patients with planned dialysis with a fistula. The risk of death was lower in patients who were seen by a nephrologist more than once in the 6 months before dialysis than in those who were seen only once. The rate of kidney transplant at 1 year post-dialysis was lower for patients with emergency or planned dialysis initiation with a catheter (respectively, HR = 0.5 [0.4; 0.8] and HR = 0.7 [0.5; 0.9]) compared to patients with planned dialysis start with a fistula. Patients who were seen by a nephrologist more than three times between 0 and 6 months before dialysis start were more likely to access the waiting list 1 and 3 years after dialysis start (respectively, HR = 1.3 [1.1; 1.5] and HR = 1.2 [1.1; 1.4]). CONCLUSIONS Nephrological follow-up in the year before dialysis initiation is associated with better survival and higher probability of access to kidney transplantation. These results emphasize the importance of early patient referral to nephrologists by general practitioners.
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Affiliation(s)
- Juliette Piveteau
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U1309, French School of Public Health, 15 Avenue du Professeur Léon Bernard, Rennes, France.
| | - Maxime Raffray
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U1309, French School of Public Health, 15 Avenue du Professeur Léon Bernard, Rennes, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Carole Ayav
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Valérie Chatelet
- Centre Universitaire des Maladies Rénales, CHU Caen, Caen, France
- U1086 Inserm, ANTICIPE, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Sahar Bayat
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U1309, French School of Public Health, 15 Avenue du Professeur Léon Bernard, Rennes, France
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26
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Copur S, Berkkan M, Basile C, Cozzolino M, Kanbay M. Dialysis in Pregnancy: An Update Review. Blood Purif 2023; 52:686-693. [PMID: 37379824 DOI: 10.1159/000531157] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
Chronic kidney disease and end-stage kidney disease (ESKD) are important public health problems with increased rates of morbidity, mortality, and social costs. Pregnancy is rare in patients with ESKD, with reduced fertility rates in women undergoing dialysis. Although current advances have led to an increase in live births in pregnant dialysis patients, this modality still has an increased risk of multiple adverse events in pregnant women. Despite these existing risks, large-scale studies investigating the management of pregnant women on dialysis are lacking, resulting in the absence of consensus guidelines for this patient group. In this review, we aimed to present the effects of dialysis during pregnancy. We first discuss pregnancy outcomes in dialysis patients and the development of acute kidney injury during pregnancy. Then, we discuss our recommendations for the management of pregnant dialysis patients, including the maintenance of pre-dialysis blood urea nitrogen levels, the ideal frequency and duration of hemodialysis sessions, as well as the modality of renal replacement therapies, the difficulty of maintaining peritoneal dialysis in the third trimester of pregnancy, and optimization of prepregnancy modifiable risk factors. Finally, we present our recommendations for future studies investigating dialysis among pregnant patients.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Metehan Berkkan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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27
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Chen CY, Liou HH, Chang MY, Wang HH, Lee YC, Ho LC, Lin TM, Hung SY. The use of a low-flux hemo-dialyzer is associated with impaired platelet aggregation in patients undergoing chronic hemo dialysis. Medicine (Baltimore) 2022; 101:e31623. [PMID: 36316899 PMCID: PMC9622603 DOI: 10.1097/md.0000000000031623] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In patients with chronic hemodialysis (HD), both abnormal thrombotic and bleeding events are commonly observed. Uremic platelet dysfunction is one of the important attributing factors. Moreover, HD may also result in aggregation dysfunction of platelets during the therapeutic procedure. However, how the HD process affects platelet and coagulation function is unknown and dialyzer membrane flux could have an impact on it. We aimed to compare the impacts of low-flux and high-flux HD on the platelet function of patients undergoing chronic HD. This was a cross-sectional study conducted in the HD unit of E-Da hospital in Taiwan. A total of 78 patients with maintenance HD three times per week for more than one year, including 40 with high- and 38 with low-flux hemodialysis, were recruited. Their platelet functions were evaluated using an in vitro platelet function analyzer (PFA-100) before and after the HD session. Of the 78 patients undergoing HD, 60 (76%) had prolonged pre-dialysis collagen/epinephrine (CEPI) and collagen/adenosine diphosphate closure times. Those receiving low-flux dialyzer had a significant increase in CEPI closure time (pre-dialysis 212.3 ± 62.1 seconds. post-dialysis 241.5 ± 64.3 seconds, P = .01), but not collagen/adenosine diphosphate closure time, after HD. After adjusting confounding factors, only the low-flux dialyzer demonstrated an independent association with the prolonged CEPI closure time after HD therapy (odds ratio = 23.31, 95% CI: 1.94-280.61, P = .01). We observed that impaired platelet aggregation is prevalent in patients undergoing chronic HD. Therefore, the use of low-flux dialyzers may further worsen platelet aggregation after dialysis. Patients with uremic bleeding diathesis should take precautions. We suggest that further studies using flow cytometry should be conducted to explore the mechanism of dialysis flux and platelet activity during HD.
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Affiliation(s)
- Ching-Yang Chen
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Min-Yu Chang
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Hsi-Hao Wang
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Medical Quality, E-DA Hospital, Kaohsiung, Taiwan
| | - Yi-Che Lee
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, E-Da Dachang Hospital, Kaohsiung, Taiwan
| | - Li-Chun Ho
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tsun-Mei Lin
- Department of Medical Laboratory Science, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan
| | - Shih-Yuan Hung
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- *Correspondence: Shih-Yuan Hung, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan (e-mail: )
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28
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Ahn JW, Lee SM, Seo YH. Factors associated with self-care behavior in patients with pre- dialysis or dialysis-dependent chronic kidney disease. PLoS One 2022; 17:e0274454. [PMID: 36227926 PMCID: PMC9560058 DOI: 10.1371/journal.pone.0274454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022] Open
Abstract
Self-care behavior plays a pivotal role in the management of chronic kidney disease. Improved self-care behavior in patients with chronic kidney disease is a key factor in health management and treatment adherence. This study aimed to evaluate the participants’ general and medical condition-related characteristics, physiological indices and the level of health literacy affecting self-care behavior in patients with chronic kidney disease in South Korea. The data of 278 participants were analyzed using t-test, analysis of variance, correlation coefficient, and linear multiple regression analysis. There were significant differences in self-care behavior scores depending on participants’ age and cohabitation status, employment, and smoking status as well as having dialysis due to end-stage kidney disease; number of comorbidities; levels of serum hemoglobin, calcium, and creatinine; and estimated glomerular filtration rate. The results of regression analysis revealed that not currently working, non-smoker, end-stage kidney disease, and positive response to the “actively managing my health” scale of the Health Literacy Questionnaire significantly affected self-care behavior in patients with chronic kidney disease, and the explanatory power of the model was 32.7%. Therefore, it is necessary to identify each patient’s barriers or needs according to individual characteristics, such as age, cohabitation and employment status, and daily life circumstances, including smoking habits, comorbidities, social support, and level of health literacy to develop efficient support strategies for promoting adequate self-care behavior with CKD.
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Affiliation(s)
- Jung-Won Ahn
- Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, Korea
| | - Sun Mi Lee
- Department of Nursing Science, Pai Chai University, Seo-gu, Daejeon Metropolitan City, Korea
| | - Yon Hee Seo
- Department of Nursing, Yeoju Institute of Technology, Yeoju-si, Gyeonggi-do, Korea
- * E-mail:
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29
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Shashvatt U, Amurrio F, Blaney L. Ligand-Enabled Donnan Dialysis for Phosphorus Recovery from Alum-Laden Waste Activated Sludge. Environ Sci Technol 2022; 56:13945-13953. [PMID: 36095332 DOI: 10.1021/acs.est.2c02153] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While many nutrient recovery technologies target liquid waste streams, new strategies are required for effective phosphorus recovery from solid waste. This study reports an innovative ligand-enabled Donnan dialysis process to recover orthophosphate (P(V)) from alum-laden waste activated sludge (WAS). Four ligands, namely acetate, citrate, ethylenediaminetetraacetate (EDTA), and oxalate, were evaluated for P(V) release from a synthetic sludge containing 5 mM P(V) and 25 mM Al(III) and a real, alum-laden WAS with similar contents. Citrate and EDTA released more than 95% of P(V) at doses of 30 mM, outperforming acetate and oxalate. The ligand-based solubilization strategy was coupled with Donnan dialysis to recover P(V) into a clean sodium chloride draw solution. After Donnan dialysis with the synthetic sludge, the P(V) recovery's order was as follows: EDTA (54.4%) > citrate (41.7%) > oxalate (4.3%). The P(V) recovery efficiencies were slightly lower for Donnan dialysis with real, alum-laden WAS, namely 45.1% and 25.2% for EDTA and citrate addition, respectively, due to competitive effects exerted by other dissolved species. These promising results successfully demonstrated the proof-of-concept for ligand-enabled Donnan dialysis.
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Affiliation(s)
- Utsav Shashvatt
- Department of Chemical, Biochemical, and Environmental Engineering, University of Maryland Baltimore County, 1000 Hilltop Circle, Engineering Building, Room 314, Baltimore, Maryland 21250, United States
| | - Fabian Amurrio
- Department of Chemical, Biochemical, and Environmental Engineering, University of Maryland Baltimore County, 1000 Hilltop Circle, Engineering Building, Room 314, Baltimore, Maryland 21250, United States
| | - Lee Blaney
- Department of Chemical, Biochemical, and Environmental Engineering, University of Maryland Baltimore County, 1000 Hilltop Circle, Engineering Building, Room 314, Baltimore, Maryland 21250, United States
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30
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El-Sayed H, Abdelmohsen W, Abdelmegied S, Emara A, Sultan R, El-Sharkawy M. High-Flux dialyzer 2.6 m2 is promising for free light chains removal in high-flux hemo dialysis and in hemodiafiltration. Egypt J Immunol 2022; 29:106-114. [PMID: 36206153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Immunoglobulin light chains are classified as middle molecule uremic toxins and its removal through effective dialyzer is needed with less albumin loss. This study assessed the free light chains (FLC) removal using dialyzer surface area (SA) 2.6m2 in high-flux dialysis (HF-HD) versus hemodiafiltration (HDF) and its relation to cumulative dialysate albumin loss. This pilot cross-over study included 25 patients who underwent hemodialysis (HD) using dialyzer surface area 2.6m2 on HF-HD followed by online post-dilution HDF with washout period of 2 weeks using high-flux dialyzers (max 2.0 m2 SA). All patients were subjected to single session measurement of dialysate albumin every hour and pre/post dialysis levels of FLC Kappa (Κ) and Lambda (λ) by ELISA. Dialyzer (SA) 2.6m2 showed a significant reduction in post-dialysis kappa and lambda level in comparison to pre-dialysis level on HF-HD and hemodiafiltration (P<0.001). HDF showed higher kappa and lambda FLC reduction ratio (45.16 ± 6.53 %, 28.68 ± 4.36 %, respectively compared to HF-HD (29.52 ± 6.38 %, 19.48 ± 1.96, respectively, P<0.001 for both). Patients on HDF dialysis had significant total albumin loss in dialysate [median (IQR) 2.97; 1.98 - 3.37 gm] compared to HF-HD [median (IQR) 0.67; 0.49 - 1.13 gm] (P <0.001). In conclusion, high-flux dialyzer 2.6 m2 (SA) may be effective in free light chains removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.
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Affiliation(s)
- Hesham El-Sayed
- Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Waleed Abdelmohsen
- Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shaimaa Abdelmegied
- Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Emara
- Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Reem Sultan
- Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Magdy El-Sharkawy
- Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Stojsavljević A, Ristić-Medić D, Krstić Đ, Rovčanin B, Radjen S, Terzić B, Manojlović D. Circulatory Imbalance of Essential and Toxic Trace Elements in Pre- dialysis and Hemodialysis Patients. Biol Trace Elem Res 2022; 200:3117-3125. [PMID: 34586605 PMCID: PMC8479265 DOI: 10.1007/s12011-021-02940-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/23/2021] [Indexed: 02/08/2023]
Abstract
The status of essential and toxic trace elements in patients with different stages of chronic kidney disease (CKD) is still unclear and not well characterized. The present study examined the circulatory levels of a wide panel of trace elements (Al, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Rb, Sr, Cd, Pb, and U) in hemodialysis patients (HD group) and pre-dialysis patients with stage 3 CKD (PD group). Comparisons were made between groups of patients and healthy individuals from the control group (CG). The levels of Al, Mn, Co, Ni, Cu, As, Se, Sr, and Pb were higher, while the levels of Cr, Zn, Rb, Cd, and U were lower in HD patients than in our CG. Higher levels of Al and Se, as well as lower levels of As, Sr, Zn, Rb, and U were significant and distinguished HD from PD. Among other analyzed elements, Co, Se, and U are the only trace elements that did not distinguish PD from CG at a statistically significant level. The HD group had lower serum U levels than the PD group, and this could be a result of hemodialysis. This study also revealed that the Cu/Zn ratio could be used as a marker for early and late detection of renal failure. Marked changes of essential and toxic trace element levels in sera indicate additional pathophysiological events in CKD, which could additionally contribute to the preexisting increased morbidity of HD patients. Measurement of trace elements in HD patients should be performed routinely.
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Affiliation(s)
- Aleksandar Stojsavljević
- Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, Belgrade, Serbia.
- Innovation Center of the Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, Belgrade, Serbia.
| | - Danijela Ristić-Medić
- Group for Nutritional Biochemistry and Dietology, Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, 11000, Belgrade, Serbia
| | - Đurđa Krstić
- Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, Belgrade, Serbia
| | - Branislav Rovčanin
- Center for Endocrine Surgery, University Clinical Center of Serbia, Koste Todorovića 8, Belgrade, Serbia
| | - Slavica Radjen
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
- Institute of Hygiene, Military Medical Academy, Belgrade, Serbia
| | - Brankica Terzić
- Institute of Hygiene, Military Medical Academy, Belgrade, Serbia
- Clinic of Nephrology, Military Medical Academy, Belgrade, Serbia
| | - Dragan Manojlović
- Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, Belgrade, Serbia
- South Ural State University, Lenin Prospect 76, Chelyabinsk, Russia
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Azeem SM, Ehsan O, Khan MI. Patency and Complications of Arterio-venous Fistula Created in Pre- and Post- dialysis Settings. J Coll Physicians Surg Pak 2022; 32:510-513. [PMID: 35330526 DOI: 10.29271/jcpsp.2022.04.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To determine the difference in patency and complication rates of arterio-venous fistula (AVF) constructed in pre-dialysis versus post-dialysis settings. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY The Department of Vascular Surgery, Shifa International Hospital, Islamabad from January 2014 to August 2020. METHODOLOGY Computerised record of 726 patients, who had undergone vascular access surgery for haemodialysis, was collected. Patients were divided into two groups according to those who had undergone AVF surgery: a) prior to the commencement; or b) after the commencement of haemodialysis. Primary and secondary patency rates were determined clinically by using duplex scans. Complications and suitability of AV fistula were assessed in both the groups. Data was collected and analysed using SPSS version 25, considering p-value of less than 0.05 as statistically significant. RESULTS Early fistula failure was significantly higher in post-dialysis group compared with pre-dialysis group, while primary patency was higher in pre-dialysis (78.2%) group comparing with post-dialysis (66.1%) group. Secondary patency was 88.9% and 75.8% in pre- and post-dialysis groups, respectively. Early dialysis suitability failure rates were 12.2% and 15.1%; and late suitability failure rates were 7.9% and 16.1% in the pre- and post-dialysis groups, respectively. Higher rates of complications like maturation failure, low flow AVF, stenosis, thrombosis, venous hypertension, AV aneurysm, and infections were encountered in post-dialysis group compared to pre-dialysis group. CONCLUSION Surgical creation of AVF three months prior to commencement of haemodialysis is advantageous in terms of patient outcomes and healthcare resources. However, a multidisciplinary approach and timely referral of patients to a vascular clinic further enhances the outcome with respect to the suitability of vascular access for dialysis. KEY WORDS Arterio-venous fistula, Dialysis, Patency, Complications, Suitability.
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Affiliation(s)
| | | | - Mohammad Iqbal Khan
- Department of Vascular Surgery, Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Gonzalez P, Lozano P, Solano F. Unraveling the Metabolic Hallmarks for the Optimization of Protein Intake in Pre- Dialysis Chronic Kidney Disease Patients. Nutrients 2022; 14:nu14061182. [PMID: 35334840 PMCID: PMC8954715 DOI: 10.3390/nu14061182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
The daily amount and quality of protein that should be administered by enteral nutrition in pre-dialysis chronic kidney disease (CKD) patients is a widely studied but still controversial issue. This is due to a compromise between the protein necessary to maintain muscular proteostasis avoiding sarcopenia, and the minimal amount required to prevent uremia and the accumulation of nitrogenous toxic substances in blood because of the renal function limitations. This review underlines some intracellular and extracellular features that should be considered to reconcile those two opposite factors. On one hand, the physiological conditions and usual side effects associated with CKD, mTOR and other proteins and nutrients involved in the regulation of protein synthesis in the muscular tissue are discussed. On the other hand, the main digestive features of the most common proteins used for enteral nutrition formulation (i.e., whey, casein and soy protein) are highlighted, due to the importance of supplying key amino acids to serum and tissues to maintain their concentration above the anabolic threshold needed for active protein synthesis, thereby minimizing the catabolic pathways leading to urea formation.
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Affiliation(s)
- Patricia Gonzalez
- Project Manager, Fresenius Kabi España, Sociedad Anonima Unipersonal, Marina 16-18, 08005 Barcelona, Spain
- Correspondence: (P.G.); (F.S.)
| | - Pedro Lozano
- Department of Biochemistry and Molecular Biology “B” and Immunology, Faculty of Chemistry, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain;
| | - Francisco Solano
- Department of Biochemistry and Molecular Biology “B” and Immunology, IMIB (Murcian Institute of Health Research), Faculty of Medicine, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
- Correspondence: (P.G.); (F.S.)
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Manari F, Di Liberato L, Bonomini M. [Psychological evaluation of patient on chronic dialysis treatment: comparison between home and hospital replacement techniques]. G Ital Nefrol 2021; 38:38-06-2021-06. [PMID: 34919796] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The psychologist's work at the Nephrology and Dialysis Unit of SS. Annunziata Hospital in Chieti begins at the early stages of chronic kidney disease and continues in pre-dialysis and after renal replacement therapy begins. Psychological intervention aims to provide support to patients and caregivers facing a chronic organ disease, as well as to the health personnel constantly exposed to chronic patients. The perceptual and emotional experience of dialysis changes according to the different modalities of renal replacement therapy: hospital or home hemodialysis, peritoneal dialysis. These different emotional and perceptive experiences seem to emerge while the patient prepares for dialysis and influence the process of accepting and adapting to the disease and its therapy.
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Affiliation(s)
- Francesca Manari
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università degli Studi G. D'Annunzio di Chieti-Pescara, UOC Clinica Nefrologica, P.O. SS. Annunziata, Chieti, Italy
| | | | - Mario Bonomini
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università degli Studi G. D'Annunzio di Chieti-Pescara, UOC Clinica Nefrologica, P.O. SS. Annunziata, Chieti, Italy
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Abstract
The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.
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Affiliation(s)
- Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Fernando Martinez
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
| | - Christina Trakatelli
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Josep Redon
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, 46010 Valencia, Spain
- CIBERObn Carlos III Institute, 28029 Madrid, Spain
- Correspondence:
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Shirakawa M, Zaboronok A, Nakai K, Sato Y, Kayaki S, Sakai T, Tsurubuchi T, Yoshida F, Nishiyama T, Suzuki M, Tomida H, Matsumura A. A Novel Boron Lipid to Modify Liposomal Surfaces for Boron Neutron Capture Therapy. Cells 2021; 10:cells10123421. [PMID: 34943929 PMCID: PMC8699917 DOI: 10.3390/cells10123421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
Boron neutron capture therapy (BNCT) is a cancer treatment with clinically demonstrated efficacy using boronophenylalanine (BPA) and sodium mercaptododecaborate (BSH). However, tumor tissue selectivity of BSH and retention of BPA in tumor cells is a constant problem. To ensure boron accumulation and retention in tumor tissues, we designed a novel polyethylene glycol (PEG)-based boron-containing lipid (PBL) and examined the potency of delivery of boron using novel PBL-containing liposomes, facilitated by the enhanced permeability and retention (EPR) effect. PBL was synthesized by the reaction of distearoylphosphoethanolamine and BSH linked by PEG with Michael addition while liposomes modified using PBL were prepared from the mixed lipid at a constant molar ratio. In this manner, novel boron liposomes featuring BSH in the liposomal surfaces, instead of being encapsulated in the inner aqueous phase or incorporated in the lipid bilayer membrane, were prepared. These PBL liposomes also carry additional payload capacity for more boron compounds (or anticancer agents) in their inner aqueous phase. The findings demonstrated that PBL liposomes are promising candidates to effect suitable boron accumulation for BNCT.
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Affiliation(s)
- Makoto Shirakawa
- Department of Pharmaceutical Sciences, Fukuyama University, 1-985 Higashimuracho-Sanzo, Fukuyama, Hiroshima 729-0292, Japan; (Y.S.); (S.K.); (T.S.); (T.N.); (H.T.)
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.N.); (A.M.)
- Correspondence: ; Tel.: +81-84-936-2112
| | - Alexander Zaboronok
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan; (A.Z.); (T.T.); (F.Y.)
| | - Kei Nakai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.N.); (A.M.)
| | - Yuhki Sato
- Department of Pharmaceutical Sciences, Fukuyama University, 1-985 Higashimuracho-Sanzo, Fukuyama, Hiroshima 729-0292, Japan; (Y.S.); (S.K.); (T.S.); (T.N.); (H.T.)
| | - Sho Kayaki
- Department of Pharmaceutical Sciences, Fukuyama University, 1-985 Higashimuracho-Sanzo, Fukuyama, Hiroshima 729-0292, Japan; (Y.S.); (S.K.); (T.S.); (T.N.); (H.T.)
| | - Tomonori Sakai
- Department of Pharmaceutical Sciences, Fukuyama University, 1-985 Higashimuracho-Sanzo, Fukuyama, Hiroshima 729-0292, Japan; (Y.S.); (S.K.); (T.S.); (T.N.); (H.T.)
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan; (A.Z.); (T.T.); (F.Y.)
| | - Fumiyo Yoshida
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan; (A.Z.); (T.T.); (F.Y.)
| | - Takashi Nishiyama
- Department of Pharmaceutical Sciences, Fukuyama University, 1-985 Higashimuracho-Sanzo, Fukuyama, Hiroshima 729-0292, Japan; (Y.S.); (S.K.); (T.S.); (T.N.); (H.T.)
| | - Minoru Suzuki
- Institute for Integrated Radiation and Nuclear science, Kyoto University, 2 Asashiro-Nishi, Kumatori-cho, Sennan-gun, Osaka 590-0494, Japan; (M.S.)
| | - Hisao Tomida
- Department of Pharmaceutical Sciences, Fukuyama University, 1-985 Higashimuracho-Sanzo, Fukuyama, Hiroshima 729-0292, Japan; (Y.S.); (S.K.); (T.S.); (T.N.); (H.T.)
| | - Akira Matsumura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.N.); (A.M.)
- Ibaraki Prefectural University of Health Sciences, 4669-2 Amicho, Inashiki 300-0394, Ibaraki, Japan
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Noyes J, Roberts G, Williams G, Chess J, Mc Laughlin L. Understanding the low take-up of home-based dialysis through a shared decision-making lens: a qualitative study. BMJ Open 2021; 11:e053937. [PMID: 34845074 PMCID: PMC8634024 DOI: 10.1136/bmjopen-2021-053937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To explore how people with chronic kidney disease who are pre-dialysis, family members and healthcare professionals together navigate common shared decision-making processes and to assess how this impacts future treatment choice. DESIGN Coproductive qualitative study, underpinned by the Making Good Decisions in Collaboration shared decision-model. Semistructured interviews with a purposive sample from February 2019 - January 2020. Interview data were analysed using framework analysis. Coproduction of logic models/roadmaps and recommendations. SETTING Five Welsh kidney services. PARTICIPANTS 95 participants (37 patients, 19 family members and 39 professionals); 44 people supported coproduction (18 patients, 8 family members and 18 professionals). FINDINGS Shared decision-making was too generic and clinically focused and had little impact on people getting onto home dialysis. Preferences of where, when and how to implement shared decision-making varied widely. Apathy experienced by patients, caused by lack of symptoms, denial, social circumstances and health systems issues made future treatment discussions difficult. Families had unmet and unrecognised needs, which significantly influenced patient decisions. Protocols containing treatment hierarchies and standards were understood by professionals but not translated for patients and families. Variation in dialysis treatment was discussed to match individual lifestyles. Patients and professionals were, however, defaulting to the perceived simplest option. It was easy for patients to opt for hospital-based treatments by listing important but easily modifiable factors. CONCLUSIONS Shared decision-making processes need to be individually tailored with more attention on patients who could choose a home therapy but select a different option. There are critical points in the decision-making process where changes could benefit patients. Patients need to be better educated and their preconceived ideas and misconceptions gently challenged. Healthcare professionals need to update their knowledge in order to provide the best advice and guidance. There needs to be more awareness of the costs and benefits of the various treatment options when making decisions.
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Affiliation(s)
- Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Gareth Roberts
- Department of Nephrology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - James Chess
- Renal Unit, Swansea Bay University Health Board, Port Talbot, UK
| | - Leah Mc Laughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Montoya V, Conner N, Yan X, Thiamwong L. Determinants of Nephrology Provider Engagement in Comprehensive Pre- Dialysis Discussions with Older Adults: Scale Development and Psychometric Evaluation. Nephrol Nurs J 2021; 48:537-546. [PMID: 34935331] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Comprehensive pre-dialysis discussions between providers and older adults over age 75 years are needed but often lacking. The aim of this study was to develop an instrument to assess behavioral determinants of nephrology provider use of comprehensive pre-dialysis discussions with older adults. Study design consisted of cross-sectional development of the instrument and preliminary psychometric evaluation. Items were based on an integrated literature review, expert clinician input, and the Theory of Planned Behavior. Nephrologists, nurse practitioners, and physician assistants completed the instrument (n = 71). Baseline demographic data, exploratory factor analysis, and Cronbach's alpha were analyzed. Initial factor analysis using principal components analysis and subsequent orthogonal rotation revealed loading on a four-factor model. Cronbach's alphas for the instrument/items were 0.89/0.83 to 0.94. Variance explained by the four factors was 58%.
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Affiliation(s)
- Vicki Montoya
- Assistant Professor, Nursing Practice Department, College of Nursing, University of Central Florida, Orlando, FL
- Chair of ANNA's Research Committee (2020-2021)
- member of ANNA's Sunshine State Chapter
| | - Norma Conner
- Associate Dean for Academic Excellence, University of Central Florida, College of Nursing, Academic Health Sciences Center, Orlando, FL
| | - Xin Yan
- Professor, Department of Statistics and Data Science, University of Central Florida, Orlando, FL
| | - Ladda Thiamwong
- Associate Professor, Nursing Systems Department, College of Nursing, University of Central Florida, Orlando, FL
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Anversa L, Lara BR, Romani CD, Saeki EK, Nogueira Nascentes GA, Bonfietti LX, Melhem MDSC, da Silva Ruiz L, Camargo CH, Pereira VBR. Fungi in dialysis water and dialysate: occurrence, susceptibility to antifungal agents and biofilm production capacity. J Water Health 2021; 19:724-735. [PMID: 34665766 DOI: 10.2166/wh.2021.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to investigate the occurrence of fungi in dialysis water and dialysate, in addition to evaluating the susceptibility to antifungals and the biofilm production capacity of isolated microorganisms. The samples were collected in three hemodialysis units in Bauru (Brazil), every 15 days (July 2017-June 2018) at post-reverse osmosis, reuse, and dialysate points. The fungi were isolated by spread plate on Sabouraud dextrose agar. Filamentous fungi were phenotypically identified and yeasts were subjected to molecular evaluation of the ITS region. Susceptibility test to antifungals was carried out by the broth microdilution method and biofilm production capacity was evaluated in microtiter plates using crystal violet staining. Fungi were isolated in 52/216 (24.1%) samples, with an average count of 16.3 (10-40) CFU/mL. Overall, 61 microorganisms were identified, with 54 (88.5%) filamentous fungi and 7 (11.5%) yeasts. The main genera included were Penicillium, Cladosporium, Scedosporium, Rhinocladiella, Fusarium, and Emmonsia. Most isolates showed high values of minimum inhibitory concentration for 5-flucytosine and fluconazole and 35/45 (77.8%) isolates were classified as strong producers of biofilm. In order to increase the safety of the dialysis process, the adoption of control measures and monitoring of fungi in hemodialysis fluids is suggested.
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Affiliation(s)
- Laís Anversa
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | - Bruna Rossini Lara
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | | | - Erika Kushikawa Saeki
- Regional Laboratories Center Presidente Prudente, Adolfo Lutz Institute, Presidente Prudente, Brazil
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Gauly A, Fleck N, Kircelli F. Advanced hemo dialysis equipment for more eco-friendly dialysis. Int Urol Nephrol 2021; 54:1059-1065. [PMID: 34480255 PMCID: PMC9005388 DOI: 10.1007/s11255-021-02981-w] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022]
Abstract
Healthcare in general and dialysis care in particular are contributing to resource consumption and, thus, have a notable environmental footprint. Dialysis is a life-saving therapy but it entails the use of a broad range of consumables generating waste, and consumption of water and energy for the dialysis process. Various stakeholders in the healthcare sector are called upon to develop and to take measures to save resources and to make healthcare and dialysis more sustainable. Among these stakeholders are manufacturers of dialysis equipment and water purification systems. Dialysis equipment and consumables, together with care processes need to be advanced to reduce waste generation, enhance recyclability, optimize water purification efficiency and water use. Joint efforts should thus pave the way to enable delivering green dialysis and to contribute to environmentally sustainable health care.
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Affiliation(s)
- Adelheid Gauly
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Else-Kröner-Strasse 3, 61352, Bad Homburg, Germany.
| | - Nicole Fleck
- Fresenius Medical Care, Application Training and Clinical Support, Bad Homburg, Germany
| | - Fatih Kircelli
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Else-Kröner-Strasse 3, 61352, Bad Homburg, Germany
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Huang Y, Jia M, Li S, Lu G, Shen Y. The effects of pre- dialysis blood pressure targets on prognosis and health-related quality of life in haemodialysis patients. Int J Clin Pract 2021; 75:e14177. [PMID: 33759333 DOI: 10.1111/ijcp.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of the study is to investigate the effects of pre-dialysis blood pressure targets on health-related quality of life and prognosis and to determine the optimal target for pre-dialysis blood pressure in haemodialysis patients. METHODS A total of 58 haemodialysis patients undergoing dialysis for more than 3 months were enrolled in the study from 1 January 2018 to 31 December 2018. The subjects were divided into two groups according to their pre-dialysis blood pressure: a standard target group (pre-dialysis systolic blood pressure of 110-140 mm Hg) and a relaxed target group (pre-dialysis systolic blood pressure of 155-165 mm Hg). The Quality Metrics SF-36 survey instrument was used to assess health-related quality of life in the study participants. In addition, general clinical data and biochemical indicators including heart rate, respiration rate, blood pressure and ultrafiltration volume and rate during dialysis were observed and recorded. Patients were followed-up for 12 months, and prognostic data were recorded. Death was regarded as the endpoint. RESULTS Scores on the SF-36 in the standard target group were significantly higher than those in the relaxed target group, with the exception of the role-emotional (RE) and mental health (MH) dimensions. At the end of the study, the number of mortality events in the relaxed target group was higher than in the standard target group. There were no other significant differences between the two groups. CONCLUSION The scores from the health-related quality of life survey were higher in standard target group, but no differences in mortality risk between the two groups were observed.
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Affiliation(s)
- Ying Huang
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengting Jia
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shenghong Li
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoyuan Lu
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanping Shen
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Meng X, Wu C, Liu H, Tang Q, Nie X. Dietary fibers fractionated from gardenia (Gardenia jasminoides Ellis) husk: structure and in vitro hypoglycemic effect. J Sci Food Agric 2021; 101:3723-3731. [PMID: 33305370 DOI: 10.1002/jsfa.11003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/25/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Gardenia (Gardenia jasminoides Ellis) husk rich in dietary fiber is a byproduct of fructus processing, and commonly discarded as waste. The husk was fractionated by sequential extraction into four fractions: water-soluble fiber (W-SF), acid-soluble fiber (Ac-SF), alkali-soluble fiber (Al-SF) and insoluble residue fiber (IRF). The aim of this study was to investigate the differences in structure and in vitro hypoglycemic effect of these fibers. RESULTS Monosaccharide composition and Fourier transform infrared spectra showed that the major component might be pectin for W-SF and Ac-SF, xylan as well as pectin for Al-SF and cellulose for IRF. These fibers offered excellent water-holding capacity and swelling capacity, except that IRF was only slightly swellable in water. W-SF exhibited significantly higher capacities to adsorb glucose (2.408 mmol g-1 at a glucose concentration of 200 mmol L-1 ) and inhibit α-amylase activity (29.48-49.45% inhibition rate at a concentration of 4-8 mg mL-1 ), probably caused by the higher viscosity and hydration properties; while Ac-SF, Al-SF and IRF (especially Al-SF) were more effective in retarding the glucose diffusion across a dialysis membrane (34.97-41.67% at 20-30 min), which might be attributed to particle size and specific surface area. All the fibers could quench the intrinsic fluorescence of α-amylase to some degree. CONCLUSIONS Dietary fiber from gardenia husk, especially W-SF, can be used as a potential hypoglycemic ingredient in diabetic functional foods. © 2020 Society of Chemical Industry.
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Affiliation(s)
- Xianghe Meng
- College of Food Science and Technology, Zhejiang University of Technology, Zhejiang, China
| | - Congcong Wu
- College of Food Science and Technology, Zhejiang University of Technology, Zhejiang, China
| | - Haizhen Liu
- College of Food Science and Technology, Zhejiang University of Technology, Zhejiang, China
| | - Qiwen Tang
- College of Food Science and Technology, Zhejiang University of Technology, Zhejiang, China
| | - Xiaohua Nie
- College of Food Science and Technology, Zhejiang University of Technology, Zhejiang, China
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de Moraes CS, Fernandes NMDS, Colugnati FAB. Multidisciplinary treatment for patients with chronic kidney disease in pre- dialysis minimizes costs: a four-year retrospective cohort analysis. J Bras Nefrol 2021; 43:330-339. [PMID: 33843942 PMCID: PMC8428638 DOI: 10.1590/2175-8239-jbn-2020-0226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) can progress to end-stage renal disease (ESRD), and clinical studies show that this progression can be slowed. The objective of this study was to estimate the costs to Brazil's public health system (SUS) throughout the course of CKD in the pre-dialysis stage compared to the costs to the SUS of dialysis treatment (DT). METHODS A retrospective cohort study was conducted to analyze clinical and laboratory variables; the outcome analyzed was need for DT. To assess cost, a microcosting survey was conducted according to the Methodological Guidelines for Economic Evaluations in Healthcare and the National Program for Cost Management, both recommended by the Brazilian Ministry of Health for economic studies. RESULTS A total of 5,689 patients were followed between 2011 and 2014, and 537 met the inclusion criteria. Average costs increased substantially as the disease progressed. The average cost incurred in stage G1 in Brazilian reals was R$ 7,110.78, (US$1,832.06) and in stage G5, it was R$ 26,814.08 (US$6,908.53), accumulated over the four years. CONCLUSION A pre-dialysis care program may reduce by R$ 33,023.12 ± 1,676.80 (US$ 8,508.26 ± 432.02) the average cost for each year of DT avoided, which is sufficient to cover the program's operation, minimizing cost. These results signal to public health policy makers the real possibility of achieving significant cost reduction in the medium term for CKD care (4 years), to a program that disbursed R$ 24 billion (US$ 6.8 billion) for DT in Brazil between 2009 and 2018.
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Affiliation(s)
- Celso Souza de Moraes
- Universidade Federal de Juiz de Fora, Programa de Pós-Graduação
em Saúde Brasileira, Juiz de Fora, MG, Brasil
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Ahmad S, Baker D, Murnane D, Spooner N, Gerhard U. Solid-phase microextraction for assessment of plasma protein binding, a complement to rapid equilibrium dialysis. Bioanalysis 2021; 13:1101-1111. [PMID: 34275331 DOI: 10.4155/bio-2021-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Determination of plasma protein binding (PPB) is considered vital for better understanding of pharmacokinetic and pharmacodynamic activities of drugs due to the role of free concentration in pharmacological response. Methodology & results: Solid-phase microextraction (SPME) was investigated for measurement of PPB from biological matrices and compared with a gold standard approach (rapid equilibrium dialysis [RED]). Discussion & conclusion: SPME-derived values of PPB correlated well with literature values, and those determined by RED. Respectively, average protein binding across three concentrations by RED and SPME was 33.1 and 31.7% for metoprolol, 89.0 and 86.6% for propranolol and 99.2 and 99.0% for diclofenac. This study generates some evidence for SPME as an alternative platform for the determination of PPB.
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Affiliation(s)
- Sheelan Ahmad
- Research & Development, GlaxoSmithKline, Stevenage, UK
- Department of Clinical, School of Life & Medical Sciences, Pharmaceutical & Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Daniel Baker
- Department of Clinical, School of Life & Medical Sciences, Pharmaceutical & Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Darragh Murnane
- Department of Clinical, School of Life & Medical Sciences, Pharmaceutical & Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Neil Spooner
- Department of Clinical, School of Life & Medical Sciences, Pharmaceutical & Biological Sciences, University of Hertfordshire, Hatfield, UK
- Spooner Bioanalytical Solutions Ltd., Hertford, UK
| | - Ute Gerhard
- Department of Clinical, School of Life & Medical Sciences, Pharmaceutical & Biological Sciences, University of Hertfordshire, Hatfield, UK
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Saallah S, Roslan J, Julius FS, Saallah S, Mohamad Razali UH, Pindi W, Sulaiman MR, Pa’ee KF, Mustapa Kamal SM. Comparative Study of The Yield and Physicochemical Properties of Collagen from Sea Cucumber ( Holothuria scabra), Obtained through Dialysis and the Ultrafiltration Membrane. Molecules 2021; 26:molecules26092564. [PMID: 33924820 PMCID: PMC8124349 DOI: 10.3390/molecules26092564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Collagen was extracted from the body wall of sea cucumber (Holothuria scabra) using the pepsin-solubilized collagen method followed by isolation using dialysis and the ultrafiltration membrane. The yield and physicochemical properties of the collagen obtained from both isolation methods, denoted as D-PSC and UF-PSC, were compared. The ultrafiltration method affords a higher yield of collagen (11.39%) than that of the dialysis (5.15%). The isolated collagens have almost the same amino acid composition, while their functional groups, referred to as amide A, B, I, II, and III bands, were in accordance with commercial collagen, as verified by Fourier Transform Infrared (FT-IR) spectroscopy. The UV-Vis absorption peaks at 240 nm and 220 nm, respectively, indicated that the collagens produced are type-I collagen. The D-PSC showed interconnecting sheet-like fibrils, while the UF-PSC exhibited a flaky structure with flat-sheets arranged very close to each other. The higher yield and comparable physicochemical properties of the collagen obtained by ultrafiltration as compared with dialysis indicate that the membrane process has high potential to be used in large-scale collagen production for food and pharmaceutical applications.
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Affiliation(s)
- Suryani Saallah
- Biotechnology Research Institute, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia;
| | - Jumardi Roslan
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia; (F.S.J.); (S.S.); (U.H.M.R.); (W.P.); (M.R.S.)
- Correspondence: ; Tel.: +60-088-320-000 (ext. 102680)
| | - Flavian Sheryl Julius
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia; (F.S.J.); (S.S.); (U.H.M.R.); (W.P.); (M.R.S.)
| | - Sharinee Saallah
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia; (F.S.J.); (S.S.); (U.H.M.R.); (W.P.); (M.R.S.)
| | - Umi Hartina Mohamad Razali
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia; (F.S.J.); (S.S.); (U.H.M.R.); (W.P.); (M.R.S.)
| | - Wolyna Pindi
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia; (F.S.J.); (S.S.); (U.H.M.R.); (W.P.); (M.R.S.)
| | - Mohd Rosni Sulaiman
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia; (F.S.J.); (S.S.); (U.H.M.R.); (W.P.); (M.R.S.)
| | - Khairul Faizal Pa’ee
- Section of Food Engineering Technology, Malaysian Institute of Chemical and Bioengineering Technology, Universiti Kuala Lumpur, Alor Gajah 78000, Malacca, Malaysia;
| | - Siti Mazlina Mustapa Kamal
- Department of Process and Food Engineering, Faculty of Engineering, Universiti Putra Malaysia, UPM Serdang, Shah Alam 43400, Selangor, Malaysia;
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Mo Z, Pang Y, Yu L, Shen X. Membrane-protected covalent organic framework fiber for direct immersion solid-phase microextraction of 17beta-estradiol in milk. Food Chem 2021; 359:129816. [PMID: 33934028 DOI: 10.1016/j.foodchem.2021.129816] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 01/12/2023]
Abstract
17beta-estradiol (E2) could accumulate in human body through milk and cause various diseases by interfering with the endocrine system. Herein, we coated stainless steel wire with covalent organic framework LZU1 (COF-LZU1) and Nafion protected by dialysis membrane for direct immersion solid phase microextraction (DI-SPME) and coupled with gas chromatography-flame ionization detection (GC-FID) for the detection of trace E2 in milk samples. With dialysis membrane protection, the stability of SPME fiber was improved and the extraction efficiency was only reduced by 7% after repeated use of 160 times. The extraction efficiency of E2 with the home-made fiber COF-LZU1 was 22.1, 8.4, 3.6 times higher than that of bare stainless steel wire, PDMS/DVB and PDMS, respectively. The method had been successfully applied to milk samples, and the relative recoveries were between 77.27% and 108.26%. It can provide an effective and general method for the pretreatment of complex matrix samples.
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Affiliation(s)
- Zhenglian Mo
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; Institute of Analytical Food Safety, School of Food Science and Technology, Jiangnan University, Wuxi, 214122, China
| | - Yuehong Pang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Lihong Yu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; Institute of Analytical Food Safety, School of Food Science and Technology, Jiangnan University, Wuxi, 214122, China
| | - Xiaofang Shen
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; Institute of Analytical Food Safety, School of Food Science and Technology, Jiangnan University, Wuxi, 214122, China.
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Myles IA, Datta SK. Frontline Science: Breast milk confers passive cellular immunity via CD8-dependent mechanisms. J Leukoc Biol 2021; 109:709-715. [PMID: 32881103 DOI: 10.1002/jlb.3hi0820-406rr] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
Most modern research into the immune effects of breast milk has focused on the impacts of immunoglobulin or oligosaccharide content. However, immediately prior to parturition, the cell populations of breast milk become selectively enriched for CD8+ T cells of an effector memory subtype. Despite this observation that the cellular content of breast milk contains a distinct leukocyte population when compared to peripheral blood, the physiologic role of these CD8+ effector memory cells is unknown. Research encompassing animal models and humans has demonstrated that leukocytes are capable of transferring antigen-specific immunity even when lysed, dialyzed to enrich for fractions less than 10 kDa, and orally administered. Our previous work built upon these reports to elucidate several aspects of this dialyzable leukocyte extract (DLE) activity: only DLE from T effector memory CD8+ cells was capable of transferring antigen-specific immunity; the DLE activity was TCRβ dependent; dendritic cells (DCs) were the cellular target of DLE; and DLE enhanced immune activity in epithelial challenge models via induction of IL-6 from DCs. Herein, we reveal that breast milk dialysate activates similar cytokine and genetic pathways as DLE taken from peripheral blood and murine spleens through TCRβ- and CD8-dependent mechanisms. These findings suggest that the CD8+ memory T cells enriched in breast milk, even after potential lysis in the infant gut, may represent a mechanism for passive transfer of cellular immunity from mother to child.
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Affiliation(s)
- Ian A Myles
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandip K Datta
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Davis J, Zuber K. The changing landscape of PAs and NPs in nephrology. JAAPA 2021; 34:1-8. [PMID: 33332839 DOI: 10.1097/01.jaa.0000723944.52480.d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. PURPOSE To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade. METHODS Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. RESULTS Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. CONCLUSIONS PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.
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Affiliation(s)
- Jane Davis
- Jane Davis is an NP in the Division of Nephrology at the University of Alabama at Birmingham. Kim Zuber is executive director of the American Academy of Nephrology PAs in St. Petersburg, Fla. Ms. Davis is on the Amgen Speakers Bureau and the ANNA-Amgen chapter programs bureau. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Hong H, Lee OJ, Lee YJ, Lee JS, Ajiteru O, Lee H, Suh YJ, Sultan MT, Kim SH, Park CH. Cytocompatibility of Modified Silk Fibroin with Glycidyl Methacrylate for Tissue Engineering and Biomedical Applications. Biomolecules 2020; 11:35. [PMID: 33383963 PMCID: PMC7824185 DOI: 10.3390/biom11010035] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 11/23/2022] Open
Abstract
Hydrogel with chemical modification has been used for 3D printing in the biomedical field of cell and tissue-based regeneration because it provides a good cellular microenvironment and mechanical supportive ability. As a scaffold and a matrix, hydrogel itself has to be modified chemically and physically to form a β-sheet crosslinking structure for the strength of the biomaterials. These chemical modifications could affect the biological damage done to encapsulated cells or surrounding tissues due to unreacted chemical residues. Biological assessment, including assessment of the cytocompatibility of hydrogel in clinical trials, must involve testing with cytotoxicity, irritation, and sensitization. Here, we modified silk fibroin and glycidyl methacrylate (Silk-GMA) and evaluated the physical characterizations, residual chemical detection, and the biological effect of residual GMA depending on dialysis periods. Silk-GMA depending on each dialysis period had a typical β-sheet structure in the characterization analysis and residual GMA decreased from dialysis day 1. Moreover, cell proliferation and viability rate gradually increased; additionally, necrotic and apoptotic cells decreased from dialysis day 2. These results indicate that the dialysis periods during chemical modification of natural polymer are important for removing unreacted chemical residues and for the potential application of the manufacturing standardization for chemically modified hydrogel for the clinical transplantation for tissue engineering and biomedical applications.
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Affiliation(s)
- Heesun Hong
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Ok Joo Lee
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Young Jin Lee
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Ji Seung Lee
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Olatunji Ajiteru
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Hanna Lee
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Ye Ji Suh
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Md Tipu Sultan
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Soon Hee Kim
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
| | - Chan Hum Park
- Nano-Bio Regenrative Medical Institute, College of Medicine, Hallym University, Chuncheon 24252, Korea; (H.H.); (O.J.L.); (Y.J.L.); (J.S.L.); (O.A.); (H.L.); (Y.J.S.); (M.T.S.); (S.H.K.)
- Departments of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Chuncheon 24253, Korea
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Roy AS, Ahammed AU, Das SK, Asadujjaman M, Hossain MB, Salahuddin AZ, Khan SI. Prevalence of Subclinical Hypothyroidism in Hospitalized Pre- dialysis Patients with Chronic Kidney Disease. Mymensingh Med J 2020; 29:764-770. [PMID: 33116075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Among general population sub-clinical primary hypothyroidism is common. The cross sectional descriptive type of observational study was conducted in medicine and allied wards in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2010 to December 2010; among 230 purposively selected hospitalized pre-dialysis patients with chronic kidney disease. The purpose of the study was to find out the prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease. Data were collected from the patients using a case record form by face to face interview, clinical examination and laboratory investigations. The collected data were entered into SPSS version 20.0 and analyzed accordingly. Mean age of the patients was 47.2 years with a SD of ±2.05 years. Maximum patients were male with a male female ratio of 5:1. A significant number of patients were smoker- 11.8% of sub-clinical hypothyroidism group and 13.6% of euthyroid group. Among the patients 40 (17.40%) had sub-clinical hypothyroidism while the majority 190 (82.60%) did not have it. Estimated prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease was 17.40%. Co-morbidities found in the patients were hypertension, diabetes mellitus, chronic glomerulonephritis and obstructive uropathy. All the patients (40, 100.0%) with sub-clinical hypothyroidism were hypertensive. On the other hand, 184 (97.1%) patients without sub-clinical hypothyroidism were hypertensive. Presence of co-morbidities in patients with sub-clinical hypothyroidism did not differ significantly (p>0.05) from patients without sub-clinical hypothyroidism. Patients in group with sub-clinical hypothyroidism were more over weight in comparison to patients without sub-clinical hypothyroidism (p<0.05). Biochemical parameters of patients with sub-clinical hypothyroidism differed significantly (p<0.05) from those of patients without sub-clinical hypothyroidism. There was no significant difference between urinary albumin of two groups of patients (p>0.05). Stage 4 CKD patients were more in sub-clinical hypothyroidism group in comparison to euthyroid group. As this study may not reflect the actual picture, further large scale multi-centric study is recommended to explore the real situation of sub-clinical hypothyroidism in patients with chronic kidney disease.
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Affiliation(s)
- A S Roy
- Dr Ashutosh Saha Roy, Associate Professor, Department of Nephrology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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