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Affiliation(s)
| | | | | | - E. Ritz
- Department of Internal Medicine University of Heidelberg 6900 Heidelberg FRG
| | - J. Rau
- Department of Surgery St. Josefs-Krankenhaus Heidelberg FRG
| | - S. Pomer
- Department of Urology University of Heidelberg 6900 Heidelberg FRG
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2
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Abstract
A 47-year-old man was treated by continuous ambulatory peritoneal dialysis (CAPD) because of chronic glomerulonephritis. One year later he developed skin friability and bullous dermatosis resembling porphyria cutanea tarda. The skin lesions were associated with an elevation of serum aminotransferases, most probably due to a blood transfusion-induced, non-A non-B hepatitis. Urinary, fecal and blood porphyrins including the activity of red cell uroporphyrinogen decarboxylase were normal. Thus we accepted the diagnosis of pseudoporphyria cutanea tarda in view of the relatively frequent association of cutaneous disease with maintenance dialysis.
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Affiliation(s)
- Martin Zeier
- Department of Internal Medicine/Nephrology, University of Heidelberg, D-6900 Heidelberg
| | - Manfred Doss
- Department of Clinical Biochemistry, Faculty of Medicine of the Philipp University, D. 3550 Marburg an der Lahn, Federal Republic of Germany
| | - Traugott Ziegler
- Department of Internal Medicine/Nephrology, University of Heidelberg, D-6900 Heidelberg
| | - Eberhard Ritz
- Department of Internal Medicine/Nephrology, University of Heidelberg, D-6900 Heidelberg
| | - Michael Rambausek
- Department of Internal Medicine/Nephrology, University of Heidelberg, D-6900 Heidelberg
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3
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Affiliation(s)
- M. Rambausek
- Department Internal Medicine University of Heidelberg
| | - T. Ziegler
- Department Internal Medicine University of Heidelberg
| | - E. Ritz
- Department Internal Medicine University of Heidelberg
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Weinreich T, Ritz E, Passlick-Deetjen J, Colombi A, Echterhoff H, Geberth S, Mandelbaum A, Kiefer T, Mayer-Wehrstein R, Hild P, Leydig M, Birkner IL, Mielke G, Schillinger-Pokorny C, Nebel M, Rieden K. Long Term Dialysis with Low-Calcium Solution (1.0 Mmol/L) in Capd: Effects on Bone Mineral Metabolism. Perit Dial Int 2020. [DOI: 10.1177/089686089601600308] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Peritoneal dialysate solutions with conventionally high-calcium (Ca) concentrations (1.75 mmol/L) are now widely replaced by solutions with a lower, more physiological calcium content to prevent hypercalcemia in patients treated with oral calcium-containing phosphate binders and/or calcitriol. While there is still debate on how far the dialysate calcium should be lowered (1.25 mmol/L or less), little information is available concerning the effects of a long-term treatment with low-calcium solutions on secondary hyperparathyroidism and bone mineral metabolism in general. Design A prospective, randomized, controlled multicenter study to compare the effects of low-calcium (LCa, dialysate calcium 1.0 mmol/L) versus standard calcium dialysate solution (SCa, dialysate calcium 1.75 mmol/L)on bone mineral metabolism in continuous ambulatory peritoneal dialysis (CAPD) patients over 2 years of treatment. Setting Nephrology and dialysis units of primary and tertiary hospitals in Germany and Switzerland. Patients All CAPD patients in the participating centers between 18 and 80 years of age, stable on CAPD for at least 1 month, free of aluminum bone disease or prior parathyroidectomy were invited to enter the study. Sixty-four patients could be randomly allotted to LCa (n = 35) or SCa (n = 29) treatment in a 2-year protocol; 34 finished the study as planned. Interventions Calcium carbonate (CaCO3) was given as oral phosphate binder to maintain serum phosphate <2.0 mmol/L. If hypercalcemia supervened, CaCO3 was exchanged stepwise for aluminium hydroxide (AI(OH)3)’ until normocalcemia was obtained. Patients received calcitriol (0.25 μg/day per os) if parathyroid hormone (PTH) exceeded the upper limit of normal by a factor of 2 or more. Main Outcome Measures We assessed total and ionized serum calcium, phosphate, serum aluminum, alkaline phosphatase, osteocalcin, PTH (intact molecule), and phosphate binder intake at regular intervals. Measurements of bone mineral density and hand skeleton x-rays were obtained at the start and after 6 months and 2 years, respectively. Results With LCa, mean total and ionized serum calcium levels were within the normal range (total Ca: 2.0 2.6 mmol/L; ionized Ca: 1.19–1.32 mmol/L), but throughout the treatment period were significantly lower than with SCa. The incidence of hypercalcemia (>2.8 mmol/L) was three times higher in patients on SCa, despite the significantly higher amount of AI(OH)3 and less CaCO3 given in this group. In parallel, serum aluminum increased with SCa throughout the study, whereas it was slowly decreasing with LCa. Median PTH levels remained stable at about two times the upper limit of normal over the 2 years of study with LCa. However, 23% of the patients on LCa developed severe hyperparathyroidism, with PTH levels exceeding ten times the upper limit of normal compared to only 10.3% of the patients on SCa. With SCa, median PTH decreased towards near normal levels. Alkaline phosphatase and serum osteocalcin correlated positively with PTH levels. Bone mineral density was in the lower normal range in both groups a n d remained unchanged at the end of the study. Skeletal x-ray films showed only minor alterations in very few patients in both groups with no correlation to serum PTH or treatment modality. Conclusion In CAPD patients low-calcium dialysate solutions can be used successfully over prolonged periods of time with stable control of serum calcium. The risk of hypercalcemia resulting from calcium-containing phosphate binders and the need to use aluminum-containing phosphate binders is markedly diminished. However, there is a certain risk that severe secondary hyperparathyroidism with long-term LCa therapy will develop, even if normocalcemia is maintained. Thus, LCa dialysis requires closeand continuous monitoring of PTH and bone metabolism.
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Affiliation(s)
- Thomas Weinreich
- Department of Internal Medicine, Nephrology Unit, University Hospital, Zurich, Switzerland
| | | | | | - A. Colombi
- (Kantonsspital Luzern)Luzern, Switzerland
| | | | - S. Geberth
- (University of Heidelberg, Department of Nephrology), Heidelberg, Germany
| | - A. Mandelbaum
- (University of Heidelberg, Department of Nephrology), Heidelberg, Germany
| | - T. Kiefer
- (Robert -Bosch Krankenhaus Stuttgart), Stuttgart, Germany
| | | | - P. Hild
- (University Erlangen-Nürnberg, Städtisches Klinikum IV), N ürnberg, Germany
| | - M. Leydig
- (University Erlangen-Nürnberg, Städtisches Klinikum IV), N ürnberg, Germany
| | - I. Lubrich Birkner
- (University of Freiburg/Breisgau, Clinic for Internal Medicine), Freiburg/Breisgau, Germany
| | - G. Mielke
- (Kreiskrankenhaus Offenburg), Offenburg, Germany
| | | | - M. Nebel
- (Städtisches Krankenhaus Merheim), Köln, Germany
| | - K. Rieden
- (Krankenhaus Holweide), Köln, Germany
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5
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Abstract
The use of calcium-containing oral phosphate binders, introduced in an effort to avoid aluminum-containing compounds, has led to more frequent episodes of hypercalcemia. This prompted the introduction of continuous ambulatory peritoneal dialysis (CAPD) solutions with diminished calcium content. The problems raised by such solutions included stimulation of parathyroid hormone (PTH) secretion and long-term maintenance of calcium balance. Some of these issues can today be answered on the basis of controlled prospective trials. Variability of the rate of intestinal calcium uptake of bone turnover, of baseline parathyroid activity, and other factors make it necessary to individualize the indication for the use of CAPD solutions with low calcium content.
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Affiliation(s)
- Eberhard Ritz
- Department of Internal Medicine, Ruperto Carola University, Heidelberg, and Fresenius AG, Bad Homburg v.d.H, Germany
| | - Jutta Passlick-Deetjen
- Department of Internal Medicine, Ruperto Carola University, Heidelberg, and Fresenius AG, Bad Homburg v.d.H, Germany
| | - Martin Zeier
- Department of Internal Medicine, Ruperto Carola University, Heidelberg, and Fresenius AG, Bad Homburg v.d.H, Germany
| | - Adam Stefanski
- Department of Internal Medicine, Ruperto Carola University, Heidelberg, and Fresenius AG, Bad Homburg v.d.H, Germany
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Bloom J, Tolekidis G, Blumenfeld P, Ritz E, Marwaha G. Dosimetric Association with Toxicity in Patients Undergoing Multiple Lung SBRT Courses. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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Ritz E, Schmidt-Gayk H, Möhring K. Pathophysiology and Therapy of Hypercalciuria in Patients
who Form Recurrent Stones. Eur Urol 2019. [DOI: 10.1159/000455604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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8
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Bechtold H, Andrassy K, Jähnchen E, Koderisch J, Koderisch H, Weilemann LS, Sonntag HG, Ritz E. Evidence for Impaired Hepatic Vitamin K1 Metabolism in Patients Treated with N-Methyl-Thiotetrazole Cephalosporins. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661101] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn 8 patients on no oral intake and with parenteral alimentation, administration of cephalosporins with N-methyl-thiotetrazole side chain (moxalactam, cefamandole), was associated with prolongation of prothrombin time, appearance in the circulation of descarboxy-prothrombin (counter immunoelectrophoresis and echis carinatus assay) and diminution of protein C. Acute administration of 10 mg vitamin Ki was followed by the transient appearance of vitamin K1 2,3-epoxide, indicating an impaired hepatocellular regeneration of vitamin K1 from the epoxide. Impaired hepatic vitamin K1 metabolism, tentatively ascribed to the N-methyl-thiotetrazole group, is one (but possibly not the only) cause of bleeding complications and depression of vitamin K1dependent procoagulants in patients treated with the new class of cephalosporins.
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Affiliation(s)
- H Bechtold
- The II. Medizinische Klinik und Poliklinik, Federal Republic of Germany
| | - K Andrassy
- The Medizinische Universitäts-Klinik Heidelberg, Federal Republic of Germany
| | - E Jähnchen
- The Pharmakologisches Institut der Universität Mainz, Federal Republic of Germany
| | - J Koderisch
- The Medizinische Universitäts-Klinik Heidelberg, Federal Republic of Germany
| | - H Koderisch
- The Medizinische Universitäts-Klinik Heidelberg, Federal Republic of Germany
| | - L S Weilemann
- The II. Medizinische Klinik und Poliklinik, Federal Republic of Germany
| | - H-G Sonntag
- The Hygiene-Institut der Univ. Heidelberg - Abt. Allgemeine Hygiene und Umwelthygiene, Federal Republic of Germany
| | - E Ritz
- The Medizinische Universitäts-Klinik Heidelberg, Federal Republic of Germany
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9
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Affiliation(s)
- K Andrassy
- Medizinische univ.-Klinik Heidelbrg, Bergheimer str. 56a D-6900 Heidelberg, FRG
| | - J Koderisch
- Medizinische univ.-Klinik Heidelbrg, Bergheimer str. 56a D-6900 Heidelberg, FRG
| | - B Kern
- Medizinische univ.-Klinik Heidelbrg, Bergheimer str. 56a D-6900 Heidelberg, FRG
| | - E Ritz
- Medizinische univ.-Klinik Heidelbrg, Bergheimer str. 56a D-6900 Heidelberg, FRG
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10
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Abstract
SummaryHemorrhagic diathesis was observed in patients with renal insufficiency after carbenicillin at serum levels > 300 μg/ml. Normal coagulation factors (F. I, II, V, VII, VIII, X), normal PTT, normal platelet counts, negative ethanol gelation test (fibrin monomers) were found as well as a prolongation of thromboplastin time (Quick), thrombin time, reptilase time and thrombin coagulase time. Platelet function was disturbed. In addition, the plasmatic system was involved: inhibition of fibrinogen-fibrin conversion (Belitser assay) and enhanced antithrombin III activity; in vivo the latter was ascribed to a heparin-like activity. In vitro, abnormal fibrinogen-fibrin conversion and a modified electrophoretic mobility of antithrombin III was seen: however an enhanced antithrombin III activity in vitro was not found with carbenicillin and various penicillin derivatives.This study demonstrates that carbenicillin, in addition to its known effect on platelet function, also disturbs the plasmatic coagulation system. This additional effect of carbenicillin is clinically important since protamin chloride effectively blocks bleeding without interfering with antibacterial activity.Both penicillin and penicillin derivatives have been shown to interfere with hemostasis and to cause clinically manifest hemorrhagic diathesis (Fleming and Fish 1947, Lurie et al. 1970a, b, McClure et al. 1970, Yudis et al. 1972, Demos 1971, Waisbren et al. 1971). Carbenicillin interferes with ADP-, collagen- or thrombin-induced platelet aggregation and with the release reaction both in vivo (McClure et al. 1970, Cazenave et al. 1973) and in vitro (McClure et al. 1970, Cazenave et al. 1973). In addition Lurie and colleagues (1970b) concluded that an inhibition of the conversion of fibrinogen to fibrin is involved although no experimental details were given. Later Brown and colleagues (1974) concluded that carbenicillin at usual dose levels “only affects the platelet component of hemostasis and has little effect on fibrin formation or other phases of coagulation in patients with normal renal function”.
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Kuczera P, Kwiecień K, Adamczak M, Bączkowska T, Gozdowska J, Madziarska K, Augustyniak-Bartosik H, Klinger M, Durlik M, Ritz E, Wiecek A. Different Relevance of Peripheral, Central or Nighttime Blood Pressure Measurements in the Prediction of Chronic Kidney Disease Progression in Patients with Mild or No-Proteinuria. Kidney Blood Press Res 2018; 43:735-743. [PMID: 29763910 DOI: 10.1159/000489749] [Citation(s) in RCA: 6] [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: 01/20/2018] [Accepted: 05/03/2018] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND/AIMS Arterial hypertension is one of the leading factors aggravating the course of chronic kidney disease (CKD). It seems that the novel parameters used in the assessment of the blood pressure (BP) load (i.e. central blood pressure, nighttime blood pressure) may be more precise in predicting the cardiovascular risk and the progression of CKD in comparison with the traditional peripheral blood pressure measurements in the office conditions. The aim of the study was to assess the impact of the central, or nighttime blood pressure on the progression of CKD in patients with mild or no-proteinuria (autosomal, dominant polycystic kidney disease or IgA nephropathy). METHODS In each of the enrolled 46 patients with CKD stage 3 or 4, serum creatinine concentration was assessed, eGFR (MDRD) was calculated, also central blood pressure and pulse wave velocity (PWV) was assessed and the 24-hour ambulatory blood pressure monitoring (ABPM) was conducted at the beginning of the study and then repeated after one-year observation period. RESULTS During the observation period mean eGFR decreased from 44.1 (33.2-50.6) mL/min to 36.7 (29.7-46.3) mL/min. No significant differences were observed in the peripheral blood pressure or central blood pressure parameters. After one-year observation period the values of diastolic blood pressure dipping during the night significantly decreased from 16 (13-19) mmHg to 12 (10-15) mmHg; p< 0.05. The values of systolic dipping during the night or the mean BP values recorded in ABPM did not change significantly. Additionally, no significant differences in the PWV values were found. In the multivariate regression model the change of serum creatinine concentration was explained by the initial diastolic dipping values. CONCLUSION 1. In patients with CKD stages 3 or 4 and mild or no- proteinuria, peripheral and central blood pressure did not change significantly during a one-year observation period despite the significant decline of eGFR and seems not to participate in the CKD progression. 2. Reduced magnitude of the diastolic dipping, which reflects the increase of diastolic blood pressure load during the nighttime, may play an important role in the pathogenesis of deterioration of kidney function in these patients.
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Affiliation(s)
- Piotr Kuczera
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Kwiecień
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Marcin Adamczak
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Teresa Bączkowska
- Department of Transplant Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplant Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Durlik
- Department of Transplant Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Eberhard Ritz
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland,
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12
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Affiliation(s)
- A. Kettner
- Rehabilitationsklinik Heidelberg-Wieblingen and Department Internal Medicine, University of Heidelberg, Heidelberg, Germany (FRG)
| | - E. Ritz
- Rehabilitationsklinik Heidelberg-Wieblingen and Department Internal Medicine, University of Heidelberg, Heidelberg, Germany (FRG)
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13
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Affiliation(s)
- E. Ritz
- Medizinische Universitätsklinik und Rehabilitationsklinik Heidelberg, Germany (FRG)
| | - A. Kettner
- Medizinische Universitätsklinik und Rehabilitationsklinik Heidelberg, Germany (FRG)
| | - J. Bommer
- Medizinische Universitätsklinik und Rehabilitationsklinik Heidelberg, Germany (FRG)
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14
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Affiliation(s)
- E. Ritz
- Department of Internal Medicine, Heidelberg - Germany
| | - A. Szabo
- Department of Internal Medicine, Heidelberg - Germany
| | - H. Reichel
- Department of Internal Medicine, Heidelberg - Germany
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Humpert P, Isermann B, Rudofsky G, Ziegler R, Bierhaus A, Ritz E, Nawroth P. The 20210 G to A Prothrombin Polymorphism and Late Complications in Type 1 Diabetes Mellitus. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schulman G, Berl T, Beck GJ, Remuzzi G, Ritz E, Shimizu M, Kikuchi M, Shobu Y. Risk factors for progression of chronic kidney disease in the EPPIC trials and the effect of AST-120. Clin Exp Nephrol 2017; 22:299-308. [PMID: 28741050 PMCID: PMC5838144 DOI: 10.1007/s10157-017-1447-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/11/2017] [Indexed: 12/02/2022]
Abstract
Background Two randomized, double-blind, placebo-controlled trials (EPPIC-1 and EPPIC-2) investigated the efficacy and safety of AST-120, an oral spherical carbon adsorbent, in adults with chronic kidney disease (CKD). While the benefit of adding AST-120 to standard therapy was not supported by these trials, we performed a post hoc analysis to focus on CKD progression and to determine the risk factors for the primary endpoint in the EPPIC trial population. Methods In the EPPIC trials, patients were randomly assigned 1:1 to treatment with AST-120 or placebo. The primary endpoint was a composite of dialysis initiation, kidney transplantation, or doubling of serum creatinine. The EPPIC trial pooled population was evaluated with the same statistical methods used for analysis of the primary and secondary efficacy endpoints. The trials were registered on ClinicalTrials.gov (NCT00500682 [EPPIC-1] and NCT00501046 [EPPIC-2]). Results An analysis of the placebo population suggested baseline urinary protein to urinary creatinine ratio (UP/UCr) ≥1.0 and hematuria were independent risk factors for event occurrence and eGFR lowering. Analysis of the high risk patients revealed a difference in the primary endpoint occurrence between treatment groups, if angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers were administered (hazard ratio 0.74, 95% confidence interval 0.56–0.96). Also, the eGFR changes from baseline in the AST-120 group were smaller than that in the placebo group (P = 0.035). Conclusions CKD progression may have an association with baseline UP/UCr and hematuria. Treatment with AST-120 may delay the time to the primary endpoint in patients with progressive CKD receiving standard therapy, thus warranting further investigation. Electronic supplementary material The online version of this article (doi:10.1007/s10157-017-1447-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gerald Schulman
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Tomas Berl
- University of Colorado Health Sciences Center, Denver, CO, USA
| | | | - Giuseppe Remuzzi
- Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.,IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Miho Shimizu
- Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Mami Kikuchi
- Kureha Corporation, 3-26-2, Hyakunin-cho, Shinjuku-ku, Tokyo, 169-8503, Japan.
| | - Yuko Shobu
- Kureha Corporation, 3-26-2, Hyakunin-cho, Shinjuku-ku, Tokyo, 169-8503, Japan
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17
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Schulman G, Berl T, Beck GJ, Remuzzi G, Ritz E, Shimizu M, Shobu Y, Kikuchi M. The effects of AST-120 on chronic kidney disease progression in the United States of America: a post hoc subgroup analysis of randomized controlled trials. BMC Nephrol 2016; 17:141. [PMID: 27716149 PMCID: PMC5045594 DOI: 10.1186/s12882-016-0357-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The orally administered spherical carbon adsorbent AST-120 is used on-label in Asian countries to slow renal disease progression in patients with progressive chronic kidney disease (CKD). Recently, two multinational, randomized, double-blind, placebo-controlled, phase 3 trials (Evaluating Prevention of Progression in Chronic Kidney Disease [EPPIC] trials) examined AST-120's efficacy in slowing CKD progression. This study assessed the efficacy of AST-120 in the subgroup of patients from the United States of America (USA) in the EPPIC trials. METHODS In the EPPIC trials, 2035 patients with moderate to severe CKD were studied, of which 583 were from the USA. The patients were randomly assigned to two groups of equal size that were treated with AST-120 or placebo (9 g/day). The primary end point was a composite of dialysis initiation, kidney transplantation, or serum creatinine doubling. RESULTS The Kaplan-Meier curve for the time to achieve the primary end point in the placebo-treated patients from the USA was similar to that projected before the study. The per protocol subgroup analysis of the population from the USA which included patients with compliance rates of ≥67 % revealed a significant difference between the treatment groups in the time to achieve the primary end point (Hazard Ratio, 0.74; 95 % Confidence Interval, 0.56-0.97). CONCLUSIONS This post hoc subgroup analysis of EPPIC study data suggests that treatment with AST-120 might delay the time to primary end point in CKD patients from the USA. A further randomized controlled trial in progressive CKD patients in the USA is necessary to confirm the beneficial effect of adding AST-120 to standard therapy regimens. TRIAL REGISTRATION ClinicalTrials.gov NCT00500682 ; NCT00501046 .
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Affiliation(s)
- Gerald Schulman
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Tomas Berl
- University of Colorado Health Sciences Center, Denver, CO, USA
| | | | - Giuseppe Remuzzi
- Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.,IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Miho Shimizu
- Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Yuko Shobu
- Kureha Corporation, 3-26-2, Hyakunin-cho, Shinjuku-ku, Tokyo, 169-8503, Japan
| | - Mami Kikuchi
- Kureha Corporation, 3-26-2, Hyakunin-cho, Shinjuku-ku, Tokyo, 169-8503, Japan.
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Seckinger J, Dschietzig W, Leimenstoll G, Rob PM, Kuhlmann MK, Pommer W, Fraass U, Ritz E, Schwenger V. Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study. Clin Kidney J 2016; 9:839-848. [PMID: 27994865 PMCID: PMC5162412 DOI: 10.1093/ckj/sfw087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 07/27/2016] [Indexed: 11/19/2022] Open
Abstract
Background The physical–functional and social–emotional health as well as survival of the elderly (≥75 years of age) haemodialysis patient is commonly thought to be poor. In a prospective, multicentre, non-interventional, observational study, the morbidity, mortality and quality of life (QoL) in this patient group were examined and compared with a younger cohort. Methods In 92 German dialysis centres, 2507 prevalent patients 19–98 years of age on haemodialysis for a median of 19.2 months were included in a drug monitoring study of darbepoetin alfa. To examine outcome and QoL parameters, 24 months of follow-up data in the age cohorts <75 and ≥75 years were analysed. Treatment parameters, adverse and intercurrent events, hospitalizations, morbidity and mortality were assessed. QoL was evaluated by means of the 47-item Functional Assessment of Chronic Illness Therapy–Anaemia score (FACT-An, version 4). Results The 2-year mortality rate was 34.7% for the older cohort and 15.8% for the younger cohort. The mortality rate for the haemodialysed elderly patients was 6.2% higher in absolute value compared with the age-matched background population. A powerful predictor of survival was the baseline FACT-An score and a close correlation with the 20-item anaemia subscale (AnS) was demonstrated. While the social QoL in the elderly patients was more stable than in the younger cohort (leading to equivalent values at the end of the study period), a pronounced deterioration of physical and functional status was observed. The median number of all-cause hospital days per patient-year was 12.3 for the elderly cohort and 8.9 for the younger patient population. The overall 24-month hospitalization rate was only marginally higher in the elderly cohort (34.0 versus 33.3%). Conclusions In this observational study, the mortality rate of elderly haemodialysis patients was not exceedingly high compared with the age-matched background population. Furthermore, the hospitalization rate was only slightly higher compared with the younger age group and the median yearly hospitalization time trended lower compared with registry data. The social well-being of elderly haemodialysis patients showed a less pronounced decline over time and was equal to the score of the younger cohort at the end of the study period. The physical and functional status in the elderly patients was lower and showed a sharper decline over time. The baseline FACT-An score correlated closely with the 24-month survival probability.
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Affiliation(s)
- Joerg Seckinger
- Division of Nephrology, Department of Internal Medicine, Zug Cantonal Hospital, Landhausstrasse 11, 6340 Baar, Switzerland.,Division of Nephrology, Department of Internal Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany
| | - Wilfried Dschietzig
- Nephrologicum Lausitz, Ambulantes Zentrum fuer Nieren- und Hochdruckerkrankungen, Cottbus, Germany
| | - Gerd Leimenstoll
- Nieren- und Gefaesszentrum Kiel, Ambulanz fuer Nieren- und Hochdruckerkrankungen, Dialyse und Transplantationsmedizin, Kiel, Germany
| | - Peter M Rob
- Sana Kliniken Luebeck, Nierenzentrum, Luebeck, Germany
| | - Martin K Kuhlmann
- Division of Nephrology, Department of Internal Medicine, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Wolfgang Pommer
- KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., Bildungszentrum, Neu-Isenburg, Germany
| | | | - Eberhard Ritz
- Division of Nephrology, Department of Internal Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany
| | - Vedat Schwenger
- Division of Nephrology, Department of Internal Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany.,Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
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Heidland A, Ritz E, Lang F. The Joint Society of Nephrology in Germany, Switzerland and Austria - Five Decades of Successful Activities. G Ital Nefrol 2016; 33 Suppl 66:33.S66.23. [PMID: 26913891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The joint Society of Nephrology in Germany, Switzerland and Austria was founded on April 10th, 1961 in Wiesbaden. Board members were Hans Sarre, Kurt Kramer, Klaus Rother, Francois Reubi, Bruno Watschinger, Wolfgang Dutz, Ernst Wollheim and Karl Ullrich. The mission of the society was an intensive interaction between basic science of the kidney (anatomy, physiology, pathophysiology, biochemistry and molecular biology) and clinical research in nephrology and hypertension. Every year scientific symposia took place in different venues in one of the three countries, except in the years between 1963-1987, when the congresses of the International Society of Nephrology took place. Practical issues of clinical nephrology, in particular renal replacement therapy (dialysis and transplantation), were covered since 1971 by a specific Working Group. In 1994 the Advisory Board (Kuratorium) of the Society of Nephrology was founded as a result of an initiative of Peter Weidmann (Bern). Its main goals were Update Seminars in Nephrology and Hypertensionin Eastern Europe, in part together with the Joint Action of Nephrology and an Eastern European ScholarshipProgram. Despite the prosperous work of this European society within nearly five decades in Germany a national society was founded as well, which combined all activities of nephrology in one organization. The German Society of Nephrology was founded in 2009.
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Kollerits B, Drechsler C, Krane V, Lamina C, März W, Dieplinger H, Ritz E, Wanner C, Kronenberg F. Lipoprotein(a) concentrations, apolipoprotein(a) isoforms and clinical endpoints in haemodialysis patients with type 2 diabetes mellitus: results from the 4D Study. Nephrol Dial Transplant 2016; 31:1901-1908. [DOI: 10.1093/ndt/gfv428] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
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21
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Rossignol P, Massy ZA, Azizi M, Bakris G, Ritz E, Covic A, Goldsmith D, Heine GH, Jager KJ, Kanbay M, Mallamaci F, Ortiz A, Vanholder R, Wiecek A, Zoccali C, London GM, Stengel B, Fouque D. The double challenge of resistant hypertension and chronic kidney disease. Lancet 2015; 386:1588-98. [PMID: 26530623 DOI: 10.1016/s0140-6736(15)00418-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [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] [Indexed: 01/14/2023]
Abstract
Resistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3-5 (ie, patients with an estimated glomerular filtration rate below 60 mL/min per 1·73 m(2) and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.
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Affiliation(s)
- Patrick Rossignol
- INSERM Centre d'Investigations Cliniques (CIC)-1433, and INSERM U1116, Nancy, France; Institut Lorrain du Cœur et des Vaisseaux, CHU Nancy, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; Association Lorraine pour le Traitement de l'Insuffisance Rénale, Vandoeuvre lès Nancy, France.
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital (APHP), University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt, Paris, France; INSERM U1018, Research Centre in Epidemiology and Population Health (CESP), UVSQ, Villejuif, France
| | - Michel Azizi
- APHP, Hôpital Européen Georges Pompidou, Unité d'Hypertension artérielle, Paris, France; Université Paris Descartes, Paris, France; INSERM CIC-1418, Paris, France
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Eberhard Ritz
- Department Internal Medicine, Ruperto Carola University of Heidelberg, Germany
| | - Adrian Covic
- Parhon University Hospital, Grigore T Popa University of Medicine, Iasi, Romania
| | - David Goldsmith
- Renal and Transplantation Department, Guy's and St Thomas' Hospitals, London, UK
| | - Gunnar H Heine
- Internal Medicine IV-Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Francesca Mallamaci
- Nephrology, Hypertension and Renal Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy; CNR (National Research Council of Italy) Institute of Clinical Physiology (IFC), Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Alberto Ortiz
- Division of Nephrology, IIS-Fundacion Jimenez Diaz, Madrid, Spain; School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; Red de Investigacion Renal (REDINREN), Madrid, Spain; Insituto Reina Sofia de Investigaciones Nefrológicas (IRSIN), Madrid, Spain
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Carmine Zoccali
- CNR (National Research Council of Italy) Institute of Clinical Physiology (IFC), Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | | | | | - Denis Fouque
- Department of Nephrology, Nutrition, and Dialysis, Centre Hospitalier Lyon Sud, Carmen-CENS, Université de Lyon, Lyon, France
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Drechsler C, Delgado G, Wanner C, Blouin K, Pilz S, Tomaschitz A, Kleber ME, Dressel A, Willmes C, Krane V, Krämer BK, März W, Ritz E, van Gilst WH, van der Harst P, de Boer RA. Galectin-3, Renal Function, and Clinical Outcomes: Results from the LURIC and 4D Studies. J Am Soc Nephrol 2015; 26:2213-21. [PMID: 25568176 PMCID: PMC4552104 DOI: 10.1681/asn.2014010093] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [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: 01/24/2014] [Accepted: 11/02/2014] [Indexed: 12/30/2022] Open
Abstract
Galectin-3 has been linked to incident renal disease, experimental renal fibrosis, and nephropathy. However, the association among galectin-3, renal function, and adverse outcomes has not been described. We studied this association in two large cohorts of patients over a broad range of renal function. We measured galectin-3 concentrations in baseline samples from the German Diabetes mellitus Dialysis (4D) study (1168 dialysis patients with type 2 diabetes mellitus) and the Ludwigshafen Risk and Cardiovascular Health (LURIC) study (2579 patients with coronary angiograms). Patients were stratified into three groups: eGFR of ≥90 ml/min per 1.73 m(2), 60-89 ml/min per 1.73 m(2), and <60 ml/min per 1.73 m(2). We correlated galectin-3 concentrations with demographic, clinical, and biochemical parameters. The association of galectin-3 with clinical end points was assessed by Cox proportional hazards regression within 10 years (LURIC) or 4 years (4D) of follow-up. Mean±SD galectin-3 concentrations were 12.8±4.0 ng/ml (eGFR≥90 ml/min per 1.73 m(2)), 15.6±5.4 ng/ml (eGFR 60-89 ml/min per 1.73 m(2)), 23.1±9.9 ng/ml (eGFR<60 ml/min per 1.73 m(2)), and 54.1±19.6 ng/ml (dialysis patients of the 4D study). Galectin-3 concentration was significantly associated with clinical end points in participants with impaired kidney function, but not in participants with normal kidney function. Per SD increase in log-transformed galectin-3 concentration, the risks of all-cause mortality, cardiovascular mortality, and fatal infection increased significantly. In dialysis patients, galectin-3 was associated with the combined end point of cardiovascular events. In conclusion, galectin-3 concentrations increased with progressive renal impairment and independently associated with cardiovascular end points, infections, and all-cause death in patients with impaired renal function.
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Affiliation(s)
- Christiane Drechsler
- Division of Nephrology, Department of Internal Medicine 1 and Comprehensive Heart Failure Centre, University Hospital of Würzburg, Würzburg, Germany;
| | - Graciela Delgado
- Fifth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Wanner
- Division of Nephrology, Department of Internal Medicine 1 and Comprehensive Heart Failure Centre, University Hospital of Würzburg, Würzburg, Germany
| | - Katja Blouin
- Division of Nephrology, Department of Internal Medicine 1 and Comprehensive Heart Failure Centre, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Pilz
- Division of Endocrinology and Metabolism, Departments of Internal Medicine and
| | - Andreas Tomaschitz
- Cardiology, Medical University of Graz, Graz, Austria; Specialist Clinic for Rehabilitation PV Bad Aussee, Bad Aussee, Austria; Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Berlin, Germany
| | - Marcus E Kleber
- Fifth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alexander Dressel
- Fifth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Willmes
- Division of Nephrology, Department of Internal Medicine 1 and Comprehensive Heart Failure Centre, University Hospital of Würzburg, Würzburg, Germany
| | - Vera Krane
- Division of Nephrology, Department of Internal Medicine 1 and Comprehensive Heart Failure Centre, University Hospital of Würzburg, Würzburg, Germany
| | - Bernhard K Krämer
- Fifth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Winfried März
- Fifth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Synlab Academy, Synlab Services GmbH, Mannheim, Germany
| | - Eberhard Ritz
- Division of Nephrology, Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany; and
| | - Wiek H van Gilst
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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Slabiak-Blaz N, Adamczak M, Gut N, Grajoszek A, Nyengaard JR, Ritz E, Wiecek A. Administration of Cyclosporine A in Pregnant Rats - the Effect on Blood Pressure and on the Glomerular Number in Their Offspring. Kidney Blood Press Res 2015; 40:413-23. [DOI: 10.1159/000368515] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 11/19/2022] Open
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24
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Silbernagel G, Fauler G, Genser B, Drechsler C, Krane V, Scharnagl H, Grammer TB, Baumgartner I, Ritz E, Wanner C, März W. Intestinal Cholesterol Absorption, Treatment With Atorvastatin, and Cardiovascular Risk in Hemodialysis Patients. J Am Coll Cardiol 2015; 65:2291-8. [DOI: 10.1016/j.jacc.2015.03.551] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/02/2015] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
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Dembowska M, Slabiak-Blaz N, Nieszporek T, Ritz E, Schirmacher P, Wiecek A, Piecha G. FP074THE INFLUENCE OF CYCLOSPORINE A IN PREGNANT RATS ON HEART STRUCTURE IN THE ADULT OFFSPRING. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv168.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Rambausek M, Kollmar S, Mall G, Ritz E. Blood pressure and uremic cardiomyopathy. Contrib Nephrol 2015; 60:230-5. [PMID: 3278857 DOI: 10.1159/000414807] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- M Rambausek
- Médizinische Universitätsklinik, Universität Heidelberg, BRD
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28
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Affiliation(s)
- E Ritz
- Department of Internal Medicine, University of Heidelberg, FRG
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29
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Affiliation(s)
- D Fliser
- Department of Internal Medicine, Ruperto-Carola University, Heidelberg, FRG
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Ritz E, Jones E, Waldherr R, Zeier M. The patient with ADPKD on maintenance hemodialysis. Contrib Nephrol 2015; 115:33-8. [PMID: 8585916 DOI: 10.1159/000424393] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- E Ritz
- Department of Internal Medicine and Pathology, Ruperto Carola University, Heidelberg, Germany
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31
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Kreusser W, Klooker P, Rambausek M, Ritz E. Digitalis treatment in uremic patients. Contrib Nephrol 2015; 41:255-61. [PMID: 6098414 DOI: 10.1159/000429290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Bommer J, Barth HP, Zeier M, Mandelbaum A, Bommer G, Ritz E, Reichel H, Novack R. Efficacy comparison of intravenous and subcutaneous recombinant human erythropoietin administration in hemodialysis patients. Contrib Nephrol 2015; 88:136-43. [PMID: 2040175 DOI: 10.1159/000419523] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Bommer
- I. Medizinische Universitätsklinik Heidelberg, FRG
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Kreusser W, Rambausek M, Klooker P, Brückner U, Ritz E. Hemodynamics and cardiac metabolism in experimental uremia. Contrib Nephrol 2015; 41:262-5. [PMID: 6098415 DOI: 10.1159/000429291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Ritz E, Merke J. Recent findings on 1,25(OH)2 vitamin D3 may provide new concepts for understanding the pathogenesis of uremia. Contrib Nephrol 2015; 50:109-18. [PMID: 3026725 DOI: 10.1159/000412992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Affiliation(s)
- K Andrassy
- Department of Internal Medicine, University of Heidelberg, FRG
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36
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37
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Bommer J, Frosch P, Schindele A, Barth HP, Ritz E, Reitinger J. Ethylene oxide sterilization--a risk for hemodialysis patients. Contrib Nephrol 2015; 59:154-61. [PMID: 3442985 DOI: 10.1159/000414624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- J Bommer
- Department of Internal Medicine, University of Heidelberg, FRG
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38
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Affiliation(s)
- O Mehls
- Department of Pediatrics, University of Heidelberg, FRG
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39
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Küster S, Andrassy K, Waldherr R, Ritz E. Contrasting clinical course of Henoch-Schönlein purpura in younger and elderly patients. Contrib Nephrol 2015; 105:93-7. [PMID: 8252878 DOI: 10.1159/000422476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- S Küster
- Department of Internal Medicine and Pathology, Ruperto-Carola University, Heidelberg, FRG
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41
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Abstract
Acquired multicystic renal transformation of diseased kidneys is a problem known since the early 19th century which has recently regained interest. Such cysts were known before dialysis was established, are seen prior to hemodialysis and in patients on peritoneal dialysis, and can therefore not be a consequence of hemodialysis. It is concluded that an increased incidence of renal cell carcinoma in such kidneys is not established, although, theoretically, several mechanisms might promote carcinogenesis in end-stage kidneys.
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42
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Affiliation(s)
- E Ritz
- Department Internal Medicine, University of Heidelberg, FRG
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43
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Affiliation(s)
- E Ritz
- Department of Internal Medicine, University of Heidelberg, FRG
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44
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Affiliation(s)
- O Mehls
- Department of Pediatrics, University of Heidelberg, FRG
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45
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Mann JF, Hausen M, Jacobs KH, Kutter A, Nagel W, Rascher W, Schick M, Sudhoff R, Ritz E. Adrenergic responsiveness in experimental uremia. Contrib Nephrol 2015; 41:108-12. [PMID: 6098410 DOI: 10.1159/000429271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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48
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Heidland A, Ritz E, Hörl WH, Deppermann D. Lactic acidosis. Contrib Nephrol 2015; 14:175-89. [PMID: 720082 DOI: 10.1159/000402359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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49
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Krempien B, Ritz E, Tschöpe W. The effect of 1,25 (OH)2D3 on bone mineralization: ultrastructural studies in patients with renal osteodystrophy. Contrib Nephrol 2015; 18:122-34. [PMID: 7353371 DOI: 10.1159/000403279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The acute effects (15-50 days) of 1,25(OH)2D3 (0.5-2 microgram/day) on the histological, fluorescence-microscopical and ultrastructural appearance of mineralizing osteoid in iliac crest spongiosa were studied in 6 uremic patients on maintenance hemodialysis. While there was a marked decrease on endosteal fibrosis and osteoclast counts, volumetric and surface densities of osteoid continued to stay elevated during the observation period. The number of osteoid seams with tetracycline double label increased in 4/6 patients but no such seams appeared in 2 patients who had shown only nonlabeled seams with diffuse staining of osteoid prior to therapy. In studies with transmission electron microscopy, the interface between non-mineralized osteoid and mineralized bone was irregularly outlined and broad. In contrast to normals, coarse mineral deposits were widely scattered in the nonmineralized osteoid. The mineral deposits had two different appearances, presumable depending on the plane of section relative to the direction of collagen fiber bundles: patches of microcristalline deposits encircling perpendicularly cut non-mineralized collagen bundles and needle- or plate-shaped crystals following the striation pattern of collagen fibers. The findings point to close interaction between the pattern of mineral deposition and collagen texture. The latter was highly irregular (woven) in all uremic patients. Mineral deposits were in part normal and in part highly abnormal in texture, the latter particularly in sites with irregular collagen texture. Upon therapy, no consistent change of the ultrastructure of the mineralizing osteoid/bone interface was observed by transmission or scanning and electron microscopy.
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50
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Affiliation(s)
- K Andrassy
- Department of Medicine, University of Heidelberg, FRG
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