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Cohen-Hagai K, Goldman S, Wald R, Frajewicki V, Chernin G, Iaina NL, Beckerman P, Antebi A, Haviv YS, Benchetrit S, Rozen-Zvi B. Delivering Dialysis during Wartime: The Israeli Experience. Kidney360 2024; 5:615-617. [PMID: 38317277 PMCID: PMC11093536 DOI: 10.34067/kid.0000000000000385] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Goldman
- Department of Nephrology and Hypertension, Rabin Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Victor Frajewicki
- Department of Nephrology and Hypertension, Carmel Medical Center and Rappaport Faculty of Medicine, Haifa, Israel
| | - Gil Chernin
- Department of Nephrology and Hypertension, Kaplan Medical Center and Hebrew University School of Medicine, Rehovot, Israel
| | - Nomy Levin Iaina
- Department of Nephrology and Hypertension, Barzilai Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Pazit Beckerman
- Department of Nephrology and Hypertension, Sheba Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yosef S. Haviv
- Department of Nephrology and Hypertension, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Breslavsky A, Al Qaied A, Tsenter P, Mukaseev N, Alamor M, Cohen-Hagai K, Wand O. Comparison of clinical remission criteria for severe asthma patients receiving biologic therapy. Respir Med 2024; 222:107528. [PMID: 38199287 DOI: 10.1016/j.rmed.2024.107528] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND The concept of remission on biological treatment has been suggested as a therapeutic target for patients with severe asthma, composed of 1. no chronic use of systemic steroids, 2. no exacerbations, 3. minimal symptoms, and 4. optimized lung function, for a significant time. However, the criteria for remission are not clearly defined. OBJECTIVE Our objective was to compare different criteria for remission in subjects receiving biologicals for severe asthma. METHODS A cross-sectional study of adult subjects who receive a stable regimen of a biological for severe asthma for at least 6-months. We compared the proportion of subjects who fulfilled different specific criteria in the four domains, as well as those who achieved different composite outcome measures of clinical remission. RESULTS Of 39 subjects, 28 were females (71.8%), mean age 60.4. Twelve were current or past smokers (30.8%). Twelve had prior different biological treatment (30.8%), and 3/39 had more than one previous treatment (7.7%). Current biological included mepolizumab 12/39 (30.8%), dupilumab 11/39 (28.2%), benralizumab 10/39 (25.6%), omalizumab 5/39 (12.8%), reslizumab 1/39 (2.6%). Different specific criteria were achieved in 39-80% of subjects, being highest for no chronic steroid use and lowest for symptoms control and lung function. Overall remission was obtained by 20-41%, depending on definition, with significant variability in agreement between different sets of remission criteria (Cohen's kappa 0.33-0.89). CONCLUSION Clinical remission is achievable in real-world severe asthmatics on biological therapies. The core criteria for remission should be better defined.
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Affiliation(s)
- Anna Breslavsky
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ahsen Al Qaied
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Philip Tsenter
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nikita Mukaseev
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mohamed Alamor
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Vital A, Siman-Tov M, Shlomai G, Davidov Y, Cohen-Hagai K, Shashar M, Askenasy E, Ghinea R, Mor E, Hod T. Assessing Health-Related Quality of Life in Non-Directed Versus Directed Kidney Donors: Implications for the Promotion of Non-Directed Donation. Transpl Int 2024; 37:12417. [PMID: 38283057 PMCID: PMC10811092 DOI: 10.3389/ti.2024.12417] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
Living kidney donation has increased significantly, but little is known about the post-donation health-related quality of life (HRQoL) of non-directed donors (NDs) vs. directed donors (DDs). We thus examined the outcomes of 112 living kidney donors (82 NDs, 30 DDs). For the primary outcomes-namely, the mean physical component summary (PCS) and mental component summary (MCS) scores of the 12-item Short Form Survey (SF-12) questionnaire-scores were significantly higher for the NDs vs. the DDs (PCS: +2.69, MCS: +4.43). For secondary outcomes, NDs had shorter hospital stays (3.4 vs. 4.4 days), returned to physical activity earlier (45 vs. 60 days), exercised more before and after donation, and continued physical activity post-donation. Regression analyses revealed that donor type and white blood cell count were predictive of the PCS-12 score, and donor type was predictive of the MCS-12 score. Non-directed donation was predictive of a shorter hospital stay (by 0.78 days, p < 0.001) and the odds of having PCS-12 and MCS-12 scores above 50 were almost 10 and 16 times higher for NDs, respectively (p < 0.05). These findings indicate the safety and potential benefits of promoting non-directed donation. However, careful selection processes must be maintained to prevent harm and exploitation.
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Affiliation(s)
- Assaf Vital
- Arrow Program for Medical Research Education, Sheba Medical Center, Tel-Hashomer, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Maya Siman-Tov
- Department of Emergency and Disaster Management, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gadi Shlomai
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D and Hypertension Unit, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yana Davidov
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Liver Disease Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Keren Cohen-Hagai
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Enosh Askenasy
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ronen Ghinea
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Eytan Mor
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Tammy Hod
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
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Einbinder Y, Rozenberg I, Benchetrit S, Raigorodetsky M, Cohen-Hagai K. Age-based comparison of vascular access outcomes in maintenance hemodialysis population. J Vasc Access 2024; 25:280-286. [PMID: 35791072 DOI: 10.1177/11297298221109659] [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: 11/17/2022] Open
Abstract
INTRODUCTION The hemodialysis population is aging, worldwide. In Israel, more than half of the dialysis population is older than 68 years. The policy for vascular access among this population is still a matter of debate, with several studies demonstrating conflicting results. This study compared vascular access outcomes across age groups (<65, 65-75, >75 years) in a single hemodialysis center in Israel. METHODS This was a retrospective, single center analysis of all vascular accesses created in adult hemodialysis patients in our institution, from January 1, 2006, through December 31, 2012. Patient characteristics, primary and secondary access failure, and complications were collected from electronic medical records. Follow-up was until death or up to 5 years. RESULTS A total of 612 vascular accesses created among maintenance hemodialysis patients were included, of which 196 were in patients >75 years, 184 in patients 65-75 years, and 232 in patients <65 years. Mean age of the >75 years group was 80.5 ± 4.3 years and 60.7% were men. Vascular access site was the most important predicator for primary access failure (odds ratio for primary failure of radiocephalic arteriovenous fistula was 3.5 (95% CI 2.1-6), whereas age did not affect the primary failure rate (odds ratio 1.5, p = 0.648). Radiocephalic fistulas were more prone to secondary failure than other vascular access sites were. Complications were slightly more common in the oldest group. Eight percent of the patients >75 years died before access was used. CONCLUSIONS In our cohort, age did not affect vascular outcomes, whereas VA site seemed to be the most important parameter in primary and secondary VA failures. Our results support considering VA on an individual basis and supply valuable information regarding complication and failure rates of VA among patients >75 years.
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Affiliation(s)
- Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Raigorodetsky
- Department of Anesthesiology and Critical Care Medicine, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cohen D, Osadchy A, Cohen-Hagai K, Jarchowsky Dolberg O, Israeli-Shani L, Lishner M, Breslavsky A, Shitrit D, Wand O. Bronchiectasis in Subjects With Chronic Lymphocytic Leukemia. Arch Bronconeumol 2023; 59:839-841. [PMID: 37827951 DOI: 10.1016/j.arbres.2023.09.012] [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] [Received: 07/13/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Dovev Cohen
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexandra Osadchy
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Radiology Department, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Osnat Jarchowsky Dolberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine Department A, Meir Medical Center, Kfar Saba, Israel; Hematology Institute, Meir Medical Center, Kfar Saba, Israel
| | - Lilach Israeli-Shani
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Lishner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine Department A, Meir Medical Center, Kfar Saba, Israel
| | - Anna Breslavsky
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Shitrit
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Visan SR, Baruch R, Schwartz D, Schwartz IF, Goykhman Y, Raz MA, Shashar M, Cohen-Hagai K, Nacasch N, Kliuk-Ben-Bassat O, Grupper A. The Long-Term Outcome of Kidney Transplant Recipients in the Eighth Decade Compared With Recipients in the Seventh Decade of Life. Transplant Proc 2023; 55:2063-2070. [PMID: 37748966 DOI: 10.1016/j.transproceed.2023.08.023] [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] [Received: 04/06/2023] [Revised: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND With the aging of the population, more older patients are being considered for kidney transplantation; therefore, it is crucial to evaluate the risks and benefits of transplantation in this population. This study aimed to assess long-term outcomes of kidney transplantation in a cohort of patients who underwent kidney transplantation at age >70 years, compared with patients aged 60 to 69 years at transplantation. METHODS Included in the study were 261 consecutive kidney transplant recipients: 52 were aged >70 years, and 209 were aged 60 to 69 years at transplantation. Data were collected retrospectively and analyzed using multivariate logistic regression to identify potential outcome risk factors. RESULTS The number of transplants in both groups increased during the study period. Mortality after transplantation was strongly correlated to age (hazard ratio [HR] = 1.11; 95% CI, 1.05-1.18; P < .001), deceased donor (HR = 2.0; 95% CI, 1.1-3.8; P = .034), and pretransplant diabetes (HR = 2.9; 95% CI, 1.7-4.9; P = .001). Recipients aged >70 years had an increased risk of death censored graft failure (HR = 2.98; 95% CI, 1.56-5.74; P = .001). In living donor transplants, 3-year survival was 80% in recipients age >70 years, compared with 98% in the 60- to 69-year group. Five-year survival was 71% and 92%, respectively. In deceased donor transplants, 3-year survival was 63% and 78%, and 5-year survival was 58% and 72%, respectively. The risk of malignancy (excluding nonmelanotic skin cancer) was nearly triple in the age >70 years group (HR = 2.96; 95% CI, 1.3-6.8; P = .01). CONCLUSIONS Patient and graft survival in kidney recipients in the eighth decade is worse compared with recipients in the seventh decade of life. However, it is improved with living kidney donation.
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Affiliation(s)
- Shirley Rahel Visan
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Roni Baruch
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Doron Schwartz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Idit F Schwartz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yaacov Goykhman
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Michal Ariela Raz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Naomi Nacasch
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Orit Kliuk-Ben-Bassat
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ayelet Grupper
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel.
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Fanadka F, Rozenberg I, Nacasch N, Einbinder Y, Benchetrit S, Wand O, Hod T, Cohen-Hagai K. Intra-Cranial Arterial Calcifications in Hemodialysis Patients. Medicina (Kaunas) 2023; 59:1706. [PMID: 37893424 PMCID: PMC10608215 DOI: 10.3390/medicina59101706] [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: 07/24/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023]
Abstract
Background and objectives: Vascular calcification is an integral part of atherosclerosis and has been reported to be an independent risk factor for cardiovascular diSsease. Intra Cranial Arterial Calcifications (ICAC) in maintenance hemodialysis (MHD) is highly prevalent. Materials and Methods: The aim of this retrospective study was to assess the predictors and outcomes of ICAC in MHD patients compared to a control group without kidney disease. A blinded neuroradiologist graded ICAC in brain imaging (computerized tomography) of MHD patients. Age- and sex-matched patients with normal kidney function served as the control group. Results: A total of 280 patients were included in the cohort; 140 of them were MHD patients with a mean ICAC score of 2.3 ± 0.2 versus a mean ICAC score of 1.4 ± 0.2 in the control group (p < 0.01). More than 90% of hemodialysis patients in our study had some degree of ICAC. Lower albumin and higher phosphorus and CRP levels were associated with increased ICACs. The multivariate analysis model for predictors of 1-year mortality demonstrated an increased odds ratio for mortality as the ICAC score increased. Conclusions: ICAC is very prevalent among MHD patients and results not simply from passive deposition of calcium and phosphate but rather from complex and active processes involving inflammation and structural changes in blood vessels. ICAC independently predicted all-cause mortality and may help with risk stratification of this high-risk population.
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Affiliation(s)
- Feda Fanadka
- Department of Radiology, Meir Medical Center, Kfar Saba 4428164, Israel;
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 4428164, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 4428164, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 4428164, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 4428164, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ori Wand
- Pulmonary Division, Barzilai Medical Center, Ashkelon 7830604, Israel
| | - Tammy Hod
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan 5262000, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 4428164, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Nacasch N, Sarel E, Rozenberg I, Ayzenfeld RH, Greenberg M, Erez D, Benchetrit S, Cohen-Hagai K. Acute Kidney Injury and Rehabilitation Outcomes among Elderly Patients with Chronic Kidney Disease. Kidney Blood Press Res 2023; 48:777-784. [PMID: 37742616 DOI: 10.1159/000534013] [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: 02/20/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION The incidence of chronic kidney disease (CKD) is growing rapidly, along with the increasing geriatric population. CKD patients have higher incidence of fractures, stroke, and hospitalizations requiring rehabilitation. This is accompanied with the need for suitable rehabilitation programs to decrease disability and improve functionality to help elderly CKD patients maintain independence in activities of daily living. Considering that survivors of acute kidney injury (AKI) tend to experience decreased quality of life with increased frailty, rehabilitation in the elderly with kidney injury becomes even more complex. The aim of this study was to examine the impact of AKI on the outcomes of rehabilitation among elderly patients with CKD. METHODS For this retrospective, observational study, the electronic medical records of all patients who were hospitalized in the rehabilitation department were reviewed. We assessed functional status at the beginning and end of rehabilitation, renal outcome, and all-cause mortality among elderly patients with CKD who experienced an AKI and compared them to those who did not have an AKI. RESULTS The study cohort included 183 elderly patients with non-dialysis-dependent CKD. Patients with AKI (23% of study cohort) had a higher prevalence of heart failure and lower baseline estimated glomerular filtration rate, as compared with patients who did not have AKI. They were admitted to rehabilitation at a poorer functional capacity and were also discharged with lower functional independence measure scores. Overall odds ratio for all-cause death among patients with AKI versus without AKI was 3.2 (95% CI: 1.6-6.5; p = 0.001). CONCLUSION AKI and CKD are interrelated syndromes. AKI was prevalent among elderly CKD patients and was associated with worse rehabilitation outcomes and higher mortality compared to similar patients without AKI.
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Affiliation(s)
- Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Sarel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Anesthesiology and Intensive Care, Meir Medical Center, Kfar Saba, Israel
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Heffez Ayzenfeld
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Geriatric Medicine and Rehabilitation, Meir Medical Center, Kfar Saba, Israel
| | - Meidad Greenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Erez
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cohen-Hagai K, Hornik-Lurie T, Benchetrit S, Nacasch N, Grupper A, Einbinder Y, Wand O, Shashar M. Clinical efficacy of the fourth dose of the BNT162b2 vaccine in maintenance dialysis patients. J Nephrol 2023; 36:1957-1964. [PMID: 37326951 DOI: 10.1007/s40620-023-01667-z] [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: 02/14/2023] [Accepted: 04/29/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Highly effective vaccines against severe acute respiratory syndrome virus 2 have been developed and administered worldwide. However, protection from coronavirus disease 2019 is not absolute and an optimal vaccination regimen needs to be established. This study assessed the clinical efficacy of the coronavirus disease 2019 vaccine among dialysis patients receiving 3 or 4 doses of vaccine. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS This retrospective study was conducted using the electronic database of Clalit Health Maintenance Organization in Israel. Chronic dialysis patients treated with either hemodialysis or peritoneal dialysis during the coronavirus disease 2019 pandemic were included. We compared clinical outcomes of patients who had received three or four doses of the severe acute respiratory syndrome virus 2 vaccine. RESULTS This study included 1,030 patients on chronic dialysis, with a mean age of 68 ± 13 years. Among them, 502 patients had received 3 doses of the vaccine and 528 received 4 doses. Severe acute respiratory syndrome virus 2 infection rates, severe COVID-19 that resulted in hospitalizations, COVID-19-related mortality and all-cause mortality rates were lower among chronic dialysis patients who received a fourth dose of vaccine as compared to those who received only 3 doses (after controlling for age, sex and comorbidities). Despite lower mortality rates observed with the Omicron variant, the fourth dose was significantly associated with reduced COVID-19-related mortality (1.7% vs. 3.8%, p = 0.04). Odds ratio for COVID-19-related mortality was 0.44 with 95% CI 0.2-0.98. CONCLUSIONS As seen in the general population and with previous vaccine boosters, the fourth dose of the BNT162b2 vaccine reduced rates of severe COVID-19-related hospitalization and mortality among chronic dialysis patients. Further studies are needed to establish the optimal regimens of vaccination for patients on chronic dialysis.
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Affiliation(s)
- Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Department of Pulmonology, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel.
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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Mudrik-Zohar H, Alon D, Nacasch N, Sternschuss A, Greenberg M, Benchetrit S, Gavrieli R, Zitman-Gal T, Cohen-Hagai K. Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes. Semin Dial 2023; 36:399-406. [PMID: 37424019 DOI: 10.1111/sdi.13168] [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] [Received: 07/29/2022] [Revised: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Patients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections. OBJECTIVE The objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status. METHODS This prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12-Myristate-13-Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24-month follow-up period were obtained from electronic medical records. RESULTS Phagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI-PMA percentiles. Patients in the lowest (25th) MFI-PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all-cause mortality was 8.85. In multivariate analysis, the MFI-PMA percentile and ischemic heart disease were the strongest predictors of all-cause mortality (p = 0.02 and p = 0.005, respectively). CONCLUSIONS Low MFI-PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.
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Affiliation(s)
- Hadar Mudrik-Zohar
- Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Alon
- Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Nacasch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Aviad Sternschuss
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Meidad Greenberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Ronit Gavrieli
- Laboratory for Leukocyte Functions, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
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11
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Bnaya A, Nacasch N, Einbinder Y, Shavit L, Erez D, Shashar M, Grupper A, Benchetrit S, Wand O, Cohen-Hagai K. Dialysis modality, humoral response to vaccine, and SARS-CoV-2 infection risk: Comparative prospective evaluation. Semin Dial 2023; 36:382-389. [PMID: 37042666 DOI: 10.1111/sdi.13155] [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] [Received: 07/05/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND COVID-19 vaccinations have a central role in decreasing severe SARS-CoV-2 disease complications. This study investigated the long-term humoral immune response to BNT162b2 vaccine among hemodialysis (HD) versus peritoneal dialysis (PD) patients, and their relative risk for COVID-19 infection. METHODS This prospective, observational study included maintenance HD and PD patients who had received at least two BNT162b2 vaccine doses. Levels of antibodies targeting SARS-CoV-2 spike protein were measured 6 and 12 months after the first vaccine dose, and 2-3 weeks after the third and fourth vaccine doses. Patients were divided according to dialysis modality (HD or PD). Humoral response was evaluated at different time points among different vaccine regimens (two vs. three vs. four doses of vaccine). An adjusted multivariate model was used to assess cumulative risk for SARS-CoV-2 infection. RESULTS Eighty-seven HD and 36 PD patients were included. Among them, 106 (86%) received at least three vaccine doses. Both HD and PD patients demonstrated marked increases in humoral response 2-3 weeks after the third dose (mean anti-S antibody increased from 452 ± 501 AU/mL to 19,556 ± 14,949 AU/mL, p < 0.001). By 6 months after the third dose, antibody titers had declined significantly (mean anti-S antibody 9841 ± 10,493 AU/mL, p < 0.001). HD patients had higher risk for SARS-CoV-2 infection than PD patients (OR 4.4 [95% CI 1.4-13.6], p = 0.006). In multivariate analysis, the most important predictor for SARS-CoV-2 infection was dialysis modality. CONCLUSION This study found a high antibody response rate after the third and fourth doses of BNT162b2 vaccine among dialysis patients. Hemodialysis as dialysis modality is an important predictor of COVID-19 infection, despite similar humoral responses to vaccine in peritoneal dialysis.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Pulmonary Division, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wand O, Cohen-Hagai K. Outcomes of Hospitalized COVID-19 Patients: SARS-CoV-2 Variants and Vaccination Status Are Important Confounders of Results. J Am Coll Cardiol 2023; 82:e55. [PMID: 37558378 DOI: 10.1016/j.jacc.2023.03.431] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 08/11/2023]
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13
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Cohen-Hagai K, Benchetrit S, Wand O, Grupper A, Shashar M, Solo O, Pereg D, Zitman-Gal T, Haskiah F, Erez D. The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome. Medicina (Kaunas) 2023; 59:1312. [PMID: 37512123 PMCID: PMC10385584 DOI: 10.3390/medicina59071312] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Background and objectives: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. Materials and Methods: This retrospective cohort study includes HD patients hospitalized due to acute coronary syndrome (ACS) in the period 2015-2020 with lipid profile data during ACS. A control group with preserved kidney function was matched. Risk factors for 30-day and 1-year mortality were assessed. Results: Among 349 patients included in the analysis, 246 were HD-dependent ("HD group"). HD group patients had higher prevalence of diabetes, hypertension, and heart disease than the control group. At ACS hospitalization, lipid profile and chronic statin treatment were comparable between groups. Odds ratios for 30-day mortality in HD vs. control group was 5.2 (95% CI 1.8-15; p = 0.002) and for 1-year, 3.4 (95% CI 1.9-6.1; p <0.001). LDL and LDL < 70 did not change 30-day and 1-year mortality rates in the HD group (p = 0.995, 0.823, respectively). However, survival after ACS in HD patients correlated positively with nutritional parameters such as serum albumin (r = 0.368, p < 0.001) and total cholesterol (r = 0.185, p < 0.001), and inversely with the inflammatory markers C-reactive protein (CRP; r = -0.348, p < 0.001) and neutrophils-to-lymphocytes ratio (NLR; r = -0.181, p = 0.019). Multivariate analysis demonstrated that heart failure was the only significant predictor of 1-year mortality (OR 2.8, p = 0.002). LDL < 70 mg/dL at ACS hospitalization did not predict 1-year mortality in the HD group. Conclusions: Despite comparable lipid profiles and statin treatment before and after ACS hospitalization, mortality rates were significantly higher among HD group. While malnutrition-inflammation markers were associated with survival of dialysis patients after ACS, LDL cholesterol was not. Thus, our study results emphasize that better nutritional status and less inflammation are associated with improved survival among HD patients.
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Affiliation(s)
- Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ori Wand
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Ayelet Grupper
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya 4244916, Israel
| | - Olga Solo
- Department of Anesthesiology, Pain and Intensive Care, Meir Medical Center, Kfar Saba 4428164, Israel
| | - David Pereg
- Department of Cardiology, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Feras Haskiah
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Daniel Erez
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba 4428164, Israel
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14
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Bnaya A, Abu-Amer N, Beckerman P, Volkov A, Cohen-Hagai K, Greenberg M, Ben-Chetrit S, Ben Tikva Kagan K, Goldman S, Navarro HA, Sneineh MA, Rozen-Zvi B, Borovitz Y, Tobar A, Yanay NB, Biton R, Angel-Korman A, Rappoport V, Leiba A, Bathish Y, Farber E, Kaidar-Ronat M, Schreiber L, Shashar M, Kazarski R, Chernin G, Itzkowitz E, Atrash J, Iaina NL, Efrati S, Nizri E, Lurie Y, Ben Itzhak O, Assady S, Kenig-Kozlovsky Y, Shavit L. Acute Kidney Injury and Hair-Straightening Products: A Case Series. Am J Kidney Dis 2023; 82:43-52.e1. [PMID: 36610611 DOI: 10.1053/j.ajkd.2022.11.016] [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: 07/07/2022] [Accepted: 11/27/2022] [Indexed: 01/06/2023]
Abstract
RATIONALE & OBJECTIVE Keratin-based hair-straightening treatment is a popular hair-styling method. The majority of keratin-based hair-straightening products in Israel contain glycolic acid derivatives, which are considered safe when used topically. Systemic absorption of these products is possible, and anecdotal reports have described kidney toxicity associated with their use. We report a series of cases of severe acute kidney injury (AKI) following use of hair-straightening treatment in Israel during the past several years. STUDY DESIGN Case series. SETTING & PARTICIPANTS We retrospectively identified 26 patients from 14 medical centers in Israel who experienced severe AKI and reported prior treatment with hair-straightening products in 2019-2022. FINDINGS The 26 patients described had a median age of 28.5 (range, 14-58) years and experienced severe AKI following a hair-straightening procedure. The most common symptoms at presentation were nausea, vomiting, and abdominal pain. Scalp rash was noted in 10 (38%) patients. Two patients experienced a recurrent episode of AKI following a repeat hair-straightening treatment. Seven patients underwent kidney biopsies, which demonstrated intratubular calcium oxalate deposition in 6 and microcalcification in tubular cells in 1. In all biopsies, signs of acute tubular injury were present, and an interstitial infiltrate was noted in 4 cases. Three patients required temporary dialysis. LIMITATIONS Retrospective uncontrolled study, small number of kidney biopsies. CONCLUSIONS This series describes cases of AKI with prior exposure to hair-straightening treatments. Acute oxalate nephropathy was the dominant finding on kidney biopsies, which may be related to absorption of glycolic acid derivatives and their metabolism to oxalate. This case series suggests a potential underrecognized cause of AKI in the young healthy population. Further studies are needed to confirm this association and to assess the extent of this phenomenon as well as its pathogenesis.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem.
| | - Nabil Abu-Amer
- Institute of Nephrology and Hypertension, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Pazit Beckerman
- Institute of Nephrology and Hypertension, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Alexander Volkov
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Keren Cohen-Hagai
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba
| | - Meidad Greenberg
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba
| | - Sydney Ben-Chetrit
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba
| | - Kim Ben Tikva Kagan
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Shira Goldman
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Hadar Agmon Navarro
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Marwan Abu Sneineh
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Benaya Rozen-Zvi
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Yael Borovitz
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Nephrology institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ana Tobar
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Pathology, Rabin Medical Center, Petah Tikva
| | | | - Ray Biton
- Nephrology and Hypertension Institute, Samson Assuta Ashdod University Hospital, Ashdod
| | - Avital Angel-Korman
- Nephrology and Hypertension Institute, Samson Assuta Ashdod University Hospital, Ashdod; Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba
| | - Vladimir Rappoport
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba
| | - Adi Leiba
- Nephrology and Hypertension Institute, Samson Assuta Ashdod University Hospital, Ashdod; Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba
| | | | - Evgeni Farber
- Nephrology Unit, Baruch Padeh Medical Center, Tiberias
| | - Maital Kaidar-Ronat
- Edith Wolfson Medical Center Ringgold Standard Institution, Edith Wolfson Medical Center, Holon
| | - Letizia Schreiber
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem; Department of Pathology, Edith Wolfson Medical Center, Holon
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya
| | | | - Gil Chernin
- Nephrology Institute, Kaplan Medical Center, Rehovot
| | - Eyal Itzkowitz
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem
| | - Jawad Atrash
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem
| | - Nomy Levin Iaina
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba; Department of Nephrology and Hypertension, Barzilai Medical Center, Ashkelon
| | - Shai Efrati
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology, Shamir (Assaf Harofeh) Medical Center, Zerifin
| | - Elad Nizri
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology, Shamir (Assaf Harofeh) Medical Center, Zerifin
| | - Yael Lurie
- Clinical Pharmacology and Toxicology Section, Israel Poison Information Center, Nephrology and Hypertension, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ofer Ben Itzhak
- Department of Pathology, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Suheir Assady
- Department of Nephrology and Hypertension, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yael Kenig-Kozlovsky
- Clinical Pharmacology and Toxicology Section, Israel Poison Information Center, Nephrology and Hypertension, Rambam Medical Center; Department of Nephrology and Hypertension, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem
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Scott N, Ben-David A, Davidov Y, Cohen-Hagai K, Yemini R, Ghinea R, Mor E, Hod T. The Clinical Manifestation of Immunosuppressive Therapy as a Tool to Improve Immune Monitoring in Renal Transplant Recipients. Kidney Blood Press Res 2023; 48:445-459. [PMID: 37231964 PMCID: PMC10357385 DOI: 10.1159/000530855] [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: 02/07/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Metrics for posttransplant immune monitoring to prevent over or under immunosuppression in renal transplant recipients (RTRs) are lacking. METHODS We surveyed 132 RTRs, 38 in the first year posttransplant and 94 >1-year posttransplant, to study the clinical expression of immunosuppressive therapy. A questionnaire administered to these RTRs was divided into physical (Q physical) and mental (Q mental) symptoms. RESULTS In multivariable models for the association between the calculated Q physical and Q mental scores and different clinical and biochemical variables in the 38 RTRs who filled out the questionnaire 130 times during the first year posttransplant, it was found that mycophenolic acid (MPA) and prednisone use increased the mean Q physical score by 0.59 (95% CI: 0.21-0.98, p = 0.002) and 0.53 (95% CI: 0.26-0.81, p = 0.00), respectively, while MPA use increased the mean Q mental score by 0.72 (95% CI: 0.31-1.12, p = 0.001). Among the 94 RTRs who each completed the questionnaire only once, the odds for the mean Q mental score to be above the median value were more than 3 times higher for RTRs treated versus non-treated with MPA (OR 3.38, 95% CI: 1.1-10.3, p = 0.03). MPA-treated RTRs had higher mean scores for questions related to sleep disorders (1.83 ± 1.06 vs. 1.32 ± 0.67 for not treated, p = 0.037), to difficulty falling asleep (1.72 ± 1.11 vs. 1.16 ± 0.5, p = 0.02), and to depression and anxiety. CONCLUSION We concluded that prednisone and MPA use are associated with an increased Q physical and Q mental scores in RTRs. Routine monitoring of physical and mental status of RTRs should be implemented to improve the diagnosis of overimmunosuppression. Dose reduction or discontinuation of MPA should be considered in RTRs who report sleep disorders, depression, and anxiety.
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Affiliation(s)
- Noa Scott
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aharon Ben-David
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel
- Nephrology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Yana Davidov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Liver Disease Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Renana Yemini
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Ronen Ghinea
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Eytan Mor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Tammy Hod
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel
- Nephrology Department, Sheba Medical Center, Tel Hashomer, Israel
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Cohen-Hagai K, Kashua H, Benchetrit S, Zitman-Gal T. Hemodialysis Serum Stimulates the TXNIP-eNOS-STAT3 Inflammatory Pathway In Vitro. Antioxidants (Basel) 2023; 12:antiox12051109. [PMID: 37237975 DOI: 10.3390/antiox12051109] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Endothelial dysfunction, vascular inflammation and accelerated atherosclerosis have been investigated extensively in patients with chronic kidney disease (CKD). These conditions, as well as protein-energy malnutrition and oxidative stress, impair kidney function and contribute to increased morbidity and mortality among patients with end-stage kidney disease undergoing hemodialysis (HD). TXNIP, a key regulator of oxidative stress, has been linked to inflammation and suppresses eNOS activity. STAT3 activation adds to endothelial cell dysfunction, macrophage polarization, immunity and inflammation. Therefore, it is critically involved in atherosclerosis. This study evaluated the effect of sera from HD patients on the TXNIP-eNOS-STAT3 pathway using an in vitro model of human umbilical vein endothelial cells (HUVECs). METHODS Thirty HD patients with end-stage kidney disease and ten healthy volunteers were recruited. Serum samples were taken at dialysis initiation. HUVECs were treated with HD or healthy serum (10% v/v) for 24 h. Then, cells were collected for mRNA and protein analysis. RESULTS TXNIP mRNA and protein expression were significantly increased in HUVECs treated with HD serum compared to healthy controls (fold changes: 2.41 ± 1.84 vs. 1.41 ± 0.5 and 2.04 ± 1.16 vs. 0.92 ± 0.29, respectively), as were IL-8 mRNA (fold changes: 2.22 ± 1.09 vs. 0.98 ± 0.64) and STAT3 protein expression (fold changes: 1.31 ± 0.75 vs. 0.57 ± 0.43). The expression of eNOS mRNA and protein (fold changes: 0.64 ± 0.11 vs. 0.95 ± 0.24; 0.56 ± 0.28 vs. 4.35 ± 1.77, respectively) and that of SOCS3 and SIRT1 proteins were decreased. Patients' nutritional status, reflected by their malnutrition-inflammation scores, did not affect these inflammatory markers. CONCLUSIONS This study showed that sera from HD patients stimulated a novel inflammatory pathway, regardless of their nutritional status.
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Affiliation(s)
- Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hadil Kashua
- Department of Pediatric, Meir Medical Center, Kfar Saba 44281, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Hod T, Oberman B, Scott N, Levy L, Shlomai G, Beckerman P, Cohen-Hagai K, Mor E, Grossman E, Zimlichman E, Shashar M. Predictors and Adverse Outcomes of Acute Kidney Injury in Hospitalized Renal Transplant Recipients. Transpl Int 2023; 36:11141. [PMID: 36968791 PMCID: PMC10033630 DOI: 10.3389/ti.2023.11141] [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] [Received: 12/18/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
Data about in-hospital AKI in RTRs is lacking. We conducted a retrospective study of 292 RTRs, with 807 hospital admissions, to reveal predictors and outcomes of AKI during admission. In-hospital AKI developed in 149 patients (51%). AKI in a previous admission was associated with a more than twofold increased risk of AKI in subsequent admissions (OR 2.13, p < 0.001). Other major significant predictors for in-hospital AKI included an infection as the major admission diagnosis (OR 2.93, p = 0.015), a medical history of hypertension (OR 1.91, p = 0.027), minimum systolic blood pressure (OR 0.98, p = 0.002), maximum tacrolimus trough level (OR 1.08, p = 0.005), hemoglobin level (OR 0.9, p = 0.016) and albumin level (OR 0.51, p = 0.025) during admission. Compared to admissions with no AKI, admissions with AKI were associated with longer length of stay (median time of 3.83 vs. 7.01 days, p < 0.001). In-hospital AKI was associated with higher rates of mortality during admission, almost doubled odds for rehospitalization within 90 days from discharge and increased the risk of overall mortality in multivariable mixed effect models. In-hospital AKI is common and is associated with poor short- and long-term outcomes. Strategies to prevent AKI during admission in RTRs should be implemented to reduce re-admission rates and improve patient survival.
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Affiliation(s)
- Tammy Hod
- Renal Transplant Center, Sheba Medical Center, Ramat Gan, Israel
- Nephrology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Tammy Hod,
| | - Bernice Oberman
- Bio-Statistical and Bio-Mathematical Unit, The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Noa Scott
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Liran Levy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Gadi Shlomai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D and Hypertension Unit, The Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Pazit Beckerman
- Nephrology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Eytan Mor
- Renal Transplant Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Eyal Zimlichman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
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18
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Wand O, Gabbai D, Epstein Shochet G, Prokupetz A, Kats T, Ben-Ari O, Cohen-Hagai K, Gordon B. Negative impact of high-performance flights on aviators with mitral valve prolapse. J Cardiol 2023; 81:323-328. [PMID: 36372322 DOI: 10.1016/j.jjcc.2022.11.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND While it appears not to affect healthy aviators' hearts, there are scarce data regarding the impact of high-performance flights on aviators with mitral valve prolapse (MVP). METHODS A retrospective, comparative cohort study of military aviators with MVP. Subjects were categorized to either high-performance (jet fighter) or low-performance (transport and helicopter) aviators. The primary outcomes were the rates of mitral interventions and of adverse cardiovascular events since being an aircrew candidate and up to the end of flying career. Additional outcomes were echocardiographic measurements and the cumulative proportion of mitral valve interventions over time. RESULTS Of 33 male aviators with MVP, 18 were high-performance aviators. On average, follow-up started at age 18.5 years and lasted 27.8 ± 10.1 years. Baseline characteristics were similar between the study groups. Aviators of high-performance aircraft had increased rates of mitral valve surgery (33 % vs. 0, p = 0.021), MVP-related complications (39 % vs. 6.7 %, p = 0.046), and a higher incidence of mitral valve repair over time (p = 0.02). High-performance flight was associated with increased intraventricular septum thickness (IVS, 9.7 mm vs 8.9 mm, p = 0.015) and IVS index (p = 0.026) at the last echocardiographic assessment. High-performance aviators tended to develop worsening severity of mitral regurgitation. CONCLUSIONS High-performance flight may be associated with an increased risk for valvular deterioration and need for mitral surgery in aviators with MVP.
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Affiliation(s)
- Ori Wand
- Israeli Defense Force Medical Corps, Tel Hashomer, Israel; Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Daniel Gabbai
- Israeli Defense Force Medical Corps, Tel Hashomer, Israel
| | | | - Alex Prokupetz
- Israeli Defense Force Medical Corps, Tel Hashomer, Israel
| | - Tatiana Kats
- Israeli Defense Force Medical Corps, Tel Hashomer, Israel
| | - Oded Ben-Ari
- Israeli Defense Force Medical Corps, Tel Hashomer, Israel
| | - Keren Cohen-Hagai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, Israel
| | - Barak Gordon
- Israeli Defense Force Medical Corps, Tel Hashomer, Israel; The Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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19
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Wand O, Breslavsky A, Bar-Shai A, Levy C, Maayan S, Rimler A, Zwahra M, Cohen-Hagai K, Harish A, Zacks N, Bilenko N. One-year dynamics of antibody titers after three doses of SARS-CoV-2 BNT162b2 vaccine. Vaccine 2023; 41:871-874. [PMID: 36566162 PMCID: PMC9767891 DOI: 10.1016/j.vaccine.2022.12.042] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND A third dose of the BNT162b2 SARS-CoV-2 vaccine leads to a significant increase in antibody levels, however, concerns regarding the long-term persistence of this response exist. We assessed the humoral response for one year following vaccination. METHODS A prospective study among immunocompetent healthcare workers (HCW) who received three doses of BNT162b2. anti-spike antibody titers were measured at six predefined timepoints, from before the second vaccine dose, and up to one year afterwards, which is 4-6 months after the third dose. HCW with a history of SARS-CoV-2 infection were excluded. RESULTS Seventy-six HCW had all the six serological measurements. Antibody titers significantly increased shortly following the third vaccine dose, and while declining, remained higher from all previous measurements for up to six months. CONCLUSIONS A third dose of BNT162b2 leads to a profound humoral response, which remains significantly higher than previous measurements, even after 6 months.
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Affiliation(s)
- Ori Wand
- Division of Pulmonary Medicine, Barzilai Medical Center, Ashkelon, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Corresponding author at: Division of Pulmonary Medicine, Barzilai Medical Center, Hahistadrut St. 2, Ashkelon, Israel
| | - Anna Breslavsky
- Division of Pulmonary Medicine, Barzilai Medical Center, Ashkelon, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv, Israel,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chezy Levy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Administration Department, Barzilai Medical Center, Ashkelon, Israel
| | - Shlomo Maayan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Department of Infectious Diseases, Barzilai Medical Center, Ashkelon, Israel
| | - Avi Rimler
- Department of Medical Laboratories, Barzilai Medical Center, Ashkelon, Israel
| | - Moatasem Zwahra
- Department of Medical Laboratories, Barzilai Medical Center, Ashkelon, Israel
| | | | - Alma Harish
- Division of Pulmonary Medicine, Barzilai Medical Center, Ashkelon, Israel
| | - Nadav Zacks
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Natalya Bilenko
- School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Medical Office of Southern District, Ministry of Health, Ashkelon, Israel
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20
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Wand O, Einbinder Y, Nacasch N, Halperin T, Erez D, Grupper A, Benchetrit S, Lishner M, Bar-Shai A, Shashar M, Cohen-Hagai K. Kinetics of the humoral response 1-year following vaccination with BNT162b2 SARS-CoV-2 vaccine among maintenance hemodialysis patients. J Nephrol 2023; 36:213-216. [PMID: 35809158 PMCID: PMC9893191 DOI: 10.1007/s40620-022-01377-y] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/03/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Ori Wand
- Pulmonary Division, Barzilai Medical Center, Hahistadrut St 2, 4428164, Ashkelon, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Yael Einbinder
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Naomi Nacasch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Tamar Halperin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laboratory for HIV Diagnosis, The HIV Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center Tel Aviv, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Michael Lishner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Meir Medical Center, Kfar Saba, Israel
| | - Amir Bar-Shai
- Pulmonary Division, Barzilai Medical Center, Hahistadrut St 2, 4428164, Ashkelon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
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21
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Grupper A, Rabinowich A, Ben Shabat I, Tzadok R, Schwartz D, Schwartz IF, Goykhman Y, Kliuk Ben-Bassat O, Baruch R, Shashar M, Cohen-Hagai K, Katchman H. Nonalcoholic Fatty Liver Disease before Kidney Transplantation Correlates with New Onset Diabetes and Poor Metabolic Outcomes. Am J Nephrol 2022; 53:636-645. [PMID: 36075195 PMCID: PMC9808776 DOI: 10.1159/000526118] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of morbidity and mortality after kidney transplantation. Metabolic syndrome is common in renal transplant recipients and is associated with increased CVD risk in those patients. Nonalcoholic fatty liver disease (NAFLD) is considered to be the hepatic manifestation of a multi-system disorder, including CVD and metabolic syndrome. The data about prevalence of NAFLD before kidney transplantation and its consequences following transplantation are scarce. METHODS A retrospective study of metabolic parameters and sonographic evidence of NAFLD, and an analysis of its metabolic outcomes, was performed in 341 consecutive kidney transplant recipients. RESULTS One-hundred twenty-four (36.4%) kidney recipients had NAFLD before transplantation. The risk of NAFLD before kidney transplantation was independently and significantly related to diabetes (OR = 1.8), male gender (OR = 1.4), older age (every year of age increased the risk by 4%), higher BMI (every increase of 1 kg/m2 increased the risk by 15%), and higher triglycerides level. Mean levels of liver enzymes were similar in patients with and without NAFLD. Recipients with NAFLD before transplantation had a higher prevalence of new onset diabetes, even after adjustment to covariables. In addition, they had a higher increase in liver enzymes, triglycerides, and FIB-4 score, as an indication of liver fibrosis, after transplantation. Furthermore, NAFLD pre-transplantation was independently associated with cardiovascular mortality (HR = 4.4) following kidney transplantation. CONCLUSIONS Sonographic evidence of NAFLD before kidney transplantation is associated with significant metabolic outcomes including de novo diabetes and cardiovascular mortality following transplantation and should be included as part of the assessment of kidney transplant candidate.
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Affiliation(s)
- Ayelet Grupper
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,*Ayelet Grupper,
| | - Aviad Rabinowich
- Department of Radiology, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Ben Shabat
- Internal Medicine Department “H”, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roie Tzadok
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Doron Schwartz
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit F. Schwartz
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaacov Goykhman
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Kliuk Ben-Bassat
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Baruch
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helena Katchman
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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22
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Greenberg M, Bnaya A, Cohen-Hagai K. Not always "straight ahead" - A surprising cause of acute kidney injury. Eur J Intern Med 2022; 106:124-125. [PMID: 35985950 DOI: 10.1016/j.ejim.2022.08.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Meidad Greenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Levy D, Gur E, Topaz G, Naser R, Kitay-Cohen Y, Benchetrit S, Sarel E, Cohen-Hagai K, Wand O. Mortality prediction using a modified R 2CHA 2DS 2-VASc score among hospitalized COVID-19 patients. Intern Emerg Med 2022; 17:1711-1717. [PMID: 35751741 PMCID: PMC9244353 DOI: 10.1007/s11739-022-02993-z] [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: 02/14/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022]
Abstract
The CHA2DS2-VASc score incorporates several comorbidities which have prognostic implications in COVID-19. We assessed whether a modified score (M-R2CHA2DS2-VASc), which includes pre-admission kidney function and male sex, could be used to classify mortality risk among people hospitalized with COVID-19. This retrospective study included adults admitted for COVID-19 between March and December 2020. Pre-admission glomerular filtration rate (GFR) was calculated based on serum creatinine and used for scoring M-R2CHA2DS2-VASc. Participants were categorized according to the M-R2CHA2DS2-VASc categories as 0-1 (low), 2-3 (intermediate), or ≥ 4 (high), and according to initial COVID-19 severity score. The primary outcome was 30-day mortality rates. Secondary outcomes were mortality rates over time, and rates of mechanical ventilation, hemodynamic support, and renal replacement therapy. Eight hundred hospitalizations met the study criteria. Participants were 55% males, average age was 65.2 ± 17 years. There were similar proportions of subjects across the M-R2CHA2DS2-VASc categories. 30-day mortality was higher in those in higher M-R2CHA2DS2-VASc category and with severe or critical COVID-19 at admission. Subjects in the low, intermediate, and high M-R2CHA2DS2-VASc categories had 30-day mortality rates of 4.7%, 17% and 31%, respectively (p < 0.001). Higher category was also associated with increased need for mechanical ventilation and renal replacement therapy. All-cause 90-day mortality remained significantly associated with M-R2CHA2DS2-VASc. The M-R2CHA2DS2-VASc score is associated with 30-day mortality rates among patients hospitalized with COVID-19, and adds predictive value when combined with initial COVID-19 severity.
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Affiliation(s)
- David Levy
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Efrat Gur
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Guy Topaz
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rawand Naser
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Yona Kitay-Cohen
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Erez Sarel
- Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Ori Wand
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Institute of Pulmonary Medicine, Barzilai Medical Center, 2 Hahistadrut St, 7830604, Ashkelon, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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24
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Rozenberg I, Benchetrit S, Raigorodetsky M, Fajer S, Shnaker A, Nacasch N, Einbinder Y, Zitman-Gal T, Cohen-Hagai K. Clinical Outcomes of Vascular Accesses in Hemodialysis Patients. Isr Med Assoc J 2022; 24:514-519. [PMID: 35972011] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Reliable vascular access is a fundamental tool for providing effective hemodialysis. Vascular access dysfunction is associated with increased morbidity and mortality among hemodialysis patients. Current vascular access guidelines strongly recommend creating an arteriovenous fistula (AVF) as the first option; however, a substantial proportion of new AVFs may not be usable. OBJECTIVES To assess possible predictors of primary and secondary failure of vascular access. METHODS This retrospective cohort study included all vascular access sites created at Meir Medical Center from 2006 through 2012. Vascular access site, primary and secondary failure rates, and relevant demographic and clinical data were recorded during 60 months of follow-up. RESULTS A total of 612 vascular accesses were created and followed for a median of 32 ± 29.4 months. Of these, 490 (80%) were suitable for initiating hemodialysis. Vascular access site was the most important predictor of primary failure but did not predict secondary failure. Co-morbidities such as diabetes mellitus and congestive heart failure, as well as the use of antiplatelet agents did not predict primary or secondary failure. Preoperative vascular mapping using Doppler ultrasonography was performed in 36.4% of cases and was not associated with lower rates of primary or secondary failure. CONCLUSIONS Vascular access site is an important predictor of primary failure. We did not find a benefit of pre-operative vessel mapping or chronic antiplatelet therapy in terms of decreasing primary and secondary failure rates. Physicians should carefully consider the characteristics of the patient and blood vessels before creating vascular access in patients requiring chronic hemodialysis.
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Affiliation(s)
| | - Sydney Benchetrit
- Departments of Nephrology and Hypertension
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Simone Fajer
- Vascular Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Ali Shnaker
- Vascular Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Naomi Nacasch
- Departments of Nephrology and Hypertension
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Einbinder
- Departments of Nephrology and Hypertension
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Zitman-Gal
- Departments of Nephrology and Hypertension
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Departments of Nephrology and Hypertension
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Einbinder Y, Perl J, Nacasch N, Bnaya A, Shavit L, Erez D, Shashar M, Halperin T, Grupper A, Benchetrit S, Wand O, Cohen-Hagai K. Humoral Response and SARS-CoV-2 Infection Risk following the Third and Fourth Doses of the BNT162b2 Vaccine in Dialysis Patients. Am J Nephrol 2022; 53:586-590. [PMID: 35850101 PMCID: PMC9501772 DOI: 10.1159/000525309] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/12/2022] [Indexed: 11/19/2022]
Abstract
The optimal SARS-CoV-2 vaccination schedule in dialysis patients and the potential need for a fourth vaccine dose are debatable. We prospectively assessed the humoral responses to three and four doses of BNT162b2 among dialysis patients. The study included 106 dialysis patients; 60 (56.6%) and 46 (43.4%) received 3 and 4 vaccine doses, respectively. Anti-spike (anti-S) antibody titers significantly increased after the third vaccine dose, followed by a decline, yet still remained higher than all previous measurements. The fourth vaccine dose led to another profound rise in anti-S titers. The absolute increase following the fourth dose correlated with response to the third dose. Infection risk however was similar between patients vaccinated with three or four doses.
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Affiliation(s)
- Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Tamar Halperin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laboratory for HIV Diagnosis, The HIV Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center Tel Aviv, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pulmonary Division, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sarel E, Nacasch N, Rozenberg I, Ayzenfeld RH, Benchetrit S, Feldman J, Cohen-Hagai K. The efficacy of rehabilitation for elderly chronic kidney disease patients: a retrospective, single-center study. Aging Clin Exp Res 2022; 34:1399-1406. [PMID: 35239146 DOI: 10.1007/s40520-021-02055-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: 06/27/2021] [Accepted: 12/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND As the geriatric population is growing rapidly, so is the prevalence of chronic kidney disease (CKD). Suitable rehabilitation programs are needed to decrease disability and improve functionality to maintain independence in activities of daily life. AIMS To assess the impact of CKD on the efficacy of rehabilitation in the geriatric population. METHODS Retrospective single-center cohort study, demographic and clinical data of 190 elderly, non-dialysis dependent CKD patients, who underwent rehabilitation, during 2016-2020 were analyzed. RESULTS Early CKD patients had longer duration of rehabilitation as compared with advanced CKD (32.6 ± 19.5 vs. 25.1 ± 17.6 days, p = 0.011) and tended to be more independent at discharge (37.2% vs. 27.9%, respectively; p < 0.001). Duration of rehabilitation, Mini-Mental State Examination (MMSE), Functional Independence Measurement (FIM) admission and estimated GFR were important predictors of FIM at discharge. Age was negatively correlated with admission FIM, eGFR, MMSE, and discharge FIM. The odds ratio for mortality among patients with advanced as compared to early CKD was 2.197 (CI 95% 1.159-4.166, p = 0.015). DISCUSSION Existing rehabilitation programs raise questions of suitability for the consistently aging population, play an indispensable part in the goal of achieving functional independence in the elderly and should promote further investigation of the efficacy of rehabilitation for CKD patients. CONCLUSIONS Advanced CKD was associated with lower FIM at admission and discharge, shorter duration of rehabilitation and more dependence at discharge, as compared to patients with early CKD. Implementing a multidisciplinary team, focused on the specific needs of geriatric CKD patients, with clear, objective parameters and goals may lead to better rehabilitative outcomes, with decreased public and private costs of ongoing care.
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Affiliation(s)
- Erez Sarel
- Department of Anesthesiology, Pain and Intensive Care, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Heffez Ayzenfeld
- Department of Geriatric Medicine and Rehabilitation, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Feldman
- Department of Geriatric Medicine and Rehabilitation, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wand O, Nacasch N, Fadeela A, Shashar M, Grupper A, Benchetrit S, Erez D, Shitrit P, Cohen-Hagai K. Humoral response and breakthrough infections with SARS-CoV-2 B.1.617.2 variant in vaccinated maintenance hemodialysis patients. J Nephrol 2022; 35:1479-1487. [PMID: 35175577 PMCID: PMC8852959 DOI: 10.1007/s40620-022-01245-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Breakthrough COVID-19 may occur in vaccinated people, and may result from declining vaccine effectiveness or highly transmittable SARS-CoV-2 variants, such as the B.167.2 (delta) variant. We investigated risk factors and outcomes for infection with the delta variant among vaccinated hemodialysis patients. METHODS Patients on maintenance hemodialysis who received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine were analysed according to having developed COVID-19 (study group) or not (control group), in a retrospective, observational, comparative study. We compared risk-factors for developing breakthrough COVID-19 and assessed clinical outcomes, including 30-day mortality rates. RESULTS Twenty-four cases of breakthrough SARS-CoV-2 infection were compared to 91 controls without infection. Breakthrough infection was associated with chronic immunosuppressive treatment, hematological malignancies, and low antibody levels against SARS-CoV-2 spike protein. All COVID-19 cases occurred at least 5 months after vaccination, and most were caused by the B.1.617.2 variant (at least 23/24 cases). COVID-19 was categorized as severe or critical disease in 11/24 patients (46%), and 54% required hospitalization and COVID-19-directed treatment. The source of infection was nosocomial in 6/24 cases (25%), and healthcare-related in 3/24 (12.5%). Mortality rate was 21%. Overall mortality was significantly higher in patients who developed COVID-19 than in controls (odds ratio for all-cause mortality 7.6, 95% CI 1.4-41, p = 0.002). CONCLUSIONS Breakthrough COVID-19 with the B.1.617.2 variant can occur in vaccinated hemodialysis patients and is associated with immunosuppression and weaker humoral response to vaccination. Infections may be nosocomial and result in significant morbidity and mortality.
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Affiliation(s)
- Ori Wand
- Department of Pulmonology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Nacasch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Ayman Fadeela
- Corona and Respiratory Viruses Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center Tel Aviv, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Pnina Shitrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infection Control Unit, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.
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Einbinder Y, Hornik-Lurie T, Cohen-Hagai K, Goldman S, Tanasiychuk T, Nacasch N, Erez D, Magen S, Zitman-Gal T, Wiener-Well Y, Frajewicki V, Benchetrit S, Shavit L, Bnaya A. Correction to: Comparison of long-term antibody response to mRNA SARS-CoV-2 vaccine among peritoneal dialysis and hemodialysis patients. Nephrol Dial Transplant 2022; 37:1780. [PMID: 35639832 DOI: 10.1093/ndt/gfac141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Goldman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Rabin Medical Center, Pathach Tikva, Israel
| | - Tatiana Tanasiychuk
- Department of Nephrology and Hypertension, Carmel Medical Center, Haifa, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonit Wiener-Well
- Hebrew University of Jerusalem, Jerusalem, Israel.,Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Victor Frajewicki
- Department of Nephrology and Hypertension, Carmel Medical Center, Haifa, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Shavit
- Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Alon Bnaya
- Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
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Druckmann I, Yashar H, Schwartz D, Schwartz IF, Goykhman Y, Kliuk Ben-Bassat O, Baruch R, Tzadok R, Shashar M, Cohen-Hagai K, Grupper A. Presence of Sarcopenia before Kidney Transplantation Is Associated with Poor Outcomes. Am J Nephrol 2022; 53:427-434. [PMID: 35584614 PMCID: PMC9393828 DOI: 10.1159/000524774] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022]
Abstract
Introduction Kidney transplantation is the treatment of choice for patients with renal failure. It is crucial to select which patients may benefit from renal transplantation and which are at high risk for post-transplant complications. Sarcopenia is associated with poor outcome in various conditions, including in chronic kidney disease patients. The gold standard for measuring sarcopenia is computed tomography (CT) imaging to estimate muscle mass and quality since it is objective, reproducible, and reflects the overall health condition. The data regarding those measurements among kidney transplant recipients are limited, therefore we aimed to describe it in patients before kidney transplantation, assess the parameters associated with sarcopenia, and evaluate the clinical significance of those markers on outcomes following transplantation. Methods We retrospectively analyzed 183 kidney transplant recipients who had a CT scan 90 days prior to transplant. Sarcopenia was assessed by measuring the cross-sectional area (CSA) and mean muscle density of the psoas muscle at the third and fourth lumbar vertebrae levels and paravertebral muscles at the 12th thoracic vertebra level. Results There was a strong linear correlation between muscle size measured as CSA of the psoas muscle at the L3 and L4 vertebral body level and the CSA of the paravertebral muscles at the D12 vertebra level, and a moderate correlation to muscle density at those levels. Age was independently associated with risk of sarcopenia, defined as psoas CSA in the lowest tertile, with every year of age increasing the risk by 5%. CSA at the L3 level had a significant independent association with post kidney transplantation mortality, with an adjusted hazard ratio of 0.86 per cm2. There was a significantly longer hospitalization period postoperation in kidney recipients in the lower tertile of psoas CSA and density. Conclusions Sarcopenia as measured by psoas CSA is associated with poor short- and long-term outcomes following kidney transplantation and should be included as part of the assessment of kidney transplantation candidates.
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Affiliation(s)
- Ido Druckmann
- Radiology Department, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Yashar
- Radiology Department, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Schwartz
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Idit F. Schwartz
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yaacov Goykhman
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Kliuk Ben-Bassat
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roni Baruch
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roie Tzadok
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ayelet Grupper
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- *Ayelet Grupper,
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30
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Erez D, Dorvish Z, Zahavi T, Cohen-Hagai K, Korzets Z. Membranous Lupus Nephritis and Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Overlap Syndrome: A Case Report. Isr Med Assoc J 2022; 24:268-270. [PMID: 35415989] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Daniel Erez
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zamir Dorvish
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Zahavi
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ze'ev Korzets
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Gur E, Levy D, Topaz G, Naser R, Wand O, Kitay-Cohen Y, Benchetrit S, Sarel E, Cohen-Hagai K. Disease severity and renal outcomes of patients with chronic kidney disease infected with COVID-19. Clin Exp Nephrol 2022; 26:445-452. [PMID: 35230569 PMCID: PMC8886555 DOI: 10.1007/s10157-022-02180-6] [Citation(s) in RCA: 3] [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: 11/28/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While there is evidence of the presence of the coronavirus in the kidneys and resultant acute kidney injury (AKI), information on the effect of chronic kidney disease (CKD) on COVID-19 outcomes and its pathogenesis is currently lacking. METHODS This retrospective, observational study evaluated the outcomes of all consecutive patients hospitalized during COVID-19 outbreaks in Meir Medical Center. Serum creatinine level was assessed before hospitalization ("baseline serum creatinine") and at admission, as well as minimum and maximum serum creatinine levels during hospitalization. RESULTS Among 658 patients, 152 had eGFR < 60 ml/min (termed the CKD group), 506 patients served as controls. Patients in the CKD group were older, with higher prevalence of hypertension, diabetes mellitus and atherosclerosis. Disease severity and clinical presentation of CKD group were comparable to that of control group. Odds ratio for AKI was 5.8 (95%CI 3.8-8.7; p < 0.001) in CKD group vs. control group and 3.4 (95%CI 1.1-10.8) for renal replacement therapy (p < 0.026). Among the CKD group, 32.2% died after COVID-19 infection versus 14.8% of the controls (p < 0.001). Mortality increased as CKD stage increased (14.8% in controls, 29.6% in CKD stage 3, and 39.3% in CKD stages 4 and 5, p < 0.001). CONCLUSION Despite comparable disease severity at presentation, patients with CKD had significantly more AKI events and required more renal replacement therapy during hospitalization than control patients did. Mortality increased as CKD stage increased.
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Affiliation(s)
- Efrat Gur
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel
| | - David Levy
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel
| | - Guy Topaz
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rawand Naser
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel
| | - Ori Wand
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pulmonology, Meir Medical Center, Kefar Sava, Israel
| | - Yona Kitay-Cohen
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kefar Sava, Israel
| | - Erez Sarel
- Department of Anesthesiology, Meir Medical Center, Kefar Sava, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Nephrology and Hypertension, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kefar Sava, Israel.
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Shashar M, Nacasch N, Grupper A, Benchetrit S, Halperin T, Erez D, Rozenberg I, Shitrit P, Sela Y, Wand O, Cohen-Hagai K. Humoral Response to Pfizer BNT162b2 Vaccine Booster in Maintenance Hemodialysis Patients. Am J Nephrol 2022; 53:207-214. [PMID: 35172312 DOI: 10.1159/000521676] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/01/2021] [Accepted: 12/12/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Coronavirus disease is associated with increased morbidity and mortality in maintenance hemodialysis (MHD) patients. Recent breakthrough infection in vaccinated people has led some authorities to recommend a booster dose for patients fully vaccinated 5-8 months ago. We aimed to assess the humoral response of MHD patients following a booster dose with the BNT162b2 vaccine. METHODS The study included 102 MHD patients vaccinated with 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine. A third dose (booster) was recommended to all MHD patients in our center and was given to those who opted to receive it, resulting in a booster group and a control group that did not receive the booster. Previous exposure was excluded by testing for the presence of the anti-nucleocapsid antibody (SARS-CoV-2) or positive PCR. We assessed the humoral response before and after the booster dose. RESULTS Of 66 patients in the booster group, 65 patients (98.5%) developed a positive antibody response, from 472.7 ± 749.5 to 16,336.8 ± 15,397.3, as compared to a sustained decrease in the control group (695.7 ± 642.7 to 383.6 ± 298.6), p < 0.0001. No significant adverse effects were reported. Prior antibody titers were positively correlated to IgG levels following the booster dose. There was a significant association between malnutrition-inflammation markers and the humoral response. CONCLUSIONS Almost all MHD patients developed a substantial humoral response following the booster dose, which was significantly higher than levels reported for MHD patients following administration of 2 doses alone. Further studies and observations are needed to determine the exact timing and dosing schedule.
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Affiliation(s)
- Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Grupper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Halperin
- Laboratory for HIV Diagnosis, The HIV Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Shitrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infection Control Unit, Meir Medical Center, Kfar Saba, Israel
| | - Yaron Sela
- Interdisciplinary Center (IDC), Reichman University, Herzliya, Israel
| | - Ori Wand
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pulmonology, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Silber M, Dekel N, Heuzler I, Gershnabel SF, Biron-Shental T, Shechter-Maor G, Amiel A, Weisz A, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. Inflammasome activation in preeclampsia and intrauterine growth restriction. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1251] [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: 11/01/2022]
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34
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Nacasch N, Erez D, Lishner M, Benchetrit S, Rozenberg I, Sarel E, Shitrit P, Wand O, Cohen-Hagai K. Long-term Antibody Response to the BNT162b2 Vaccine Among Maintenance Hemodialysis Patients. Am J Kidney Dis 2022; 79:137-139. [PMID: 34571066 PMCID: PMC8463099 DOI: 10.1053/j.ajkd.2021.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/18/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Erez
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Lishner
- Department of Hematology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Sarel
- Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - Pnina Shitrit
- Infection Control Unit, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Wand
- Department of Pulmonology, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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35
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Einbinder Y, Hornik-Lurie T, Cohen-Hagai K, Goldman S, Tanasiychuk T, Nacasch N, Erez D, Magen S, Zitman-Gal T, Wiener-Well Y, Frajewicki V, Benchetrit S, Shavit L, Bnaya A. Comparison of long-term antibody response to mRNA SARS-CoV-2 vaccine among peritoneal dialysis and hemodialysis patients. Nephrol Dial Transplant 2021; 37:602-604. [PMID: 34788861 PMCID: PMC8767896 DOI: 10.1093/ndt/gfab321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Goldman
- Department of Nephrology and Hypertension, Rabin Medical Center, Pathach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Tanasiychuk
- Department of Nephrology and Hypertension, Carmel Medical Center, Haifa, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonit Wiener-Well
- Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Jerusalem, Israel
| | - Victor Frajewicki
- Department of Nephrology and Hypertension, Carmel Medical Center, Haifa, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Shavit
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alon Bnaya
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.,Hebrew University of Jerusalem, Jerusalem, Israel
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Farladansky-Gershnabel S, Heusler I, Biron-Shental T, Shechter-Maor G, Amiel A, Kidron D, Weisz A, Einbinder Y, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. Elevated expression of galectin-3, thioredoxin and thioredoxin interacting protein in preeclampsia. Pregnancy Hypertens 2021; 26:95-101. [PMID: 34700108 DOI: 10.1016/j.preghy.2021.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/09/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Preeclampsia (PE) is a pregnancy-related syndrome characterized by the onset of hypertension and proteinuria that can lead to end-organ dysfunction. Galectin-3 (Gal-3) is involved in cell growth, differentiation, inflammation and fibrosis. Thioredoxin (TXN) acts as antioxidant enzyme in several cellular processes, regulating inflammation and inhibiting apoptosis. TXNIP is an endogenous inhibitor of TXN. We evaluated changes in the inflammatory response of Gal-3, TXN, and TXNIP at the level of maternal blood, placenta, and umbilical cord blood of women with PE. STUDY DESIGN Ten women with PE and 20 with normal pregnancy (NP) were recruited during admission for delivery. Blood samples were obtained from parturients and umbilical cords, and placental tissue for analysis. RESULTS Gal-3 and TXNIP mRNA expression were higher in maternal plasma in PE group compared to NP and were lower in cord blood plasma and placentas in the PE group. In the PE group, TXN/TXNIP mRNA ratio was higher in cord blood plasma (2.07) compared to maternal plasma (1.09). TXN/TXNIP placental protein ratio was similar between PE (0.89) and NP (0.79). ELISA demonstrated that Gal-3 levels in maternal serum were significantly higher in the PE vs. the NP group. CONCLUSIONS Pro-inflammatory changes were expressed by high Gal-3 and TXNIP mRNA in maternal blood of PE women, but not in their placental and cord blood samples. These findings may imply that the placenta has a role in protecting the fetus from the damages of inflammatory response, which is more common in PE than in NP.
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Affiliation(s)
- Sivan Farladansky-Gershnabel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ishai Heusler
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter-Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aliza Amiel
- School of Nursing, Academic College of Tel Aviv-Jaffo, Tel Aviv-Jaffo, Israel
| | - Debora Kidron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pathology Department, Meir Medical Center, Kfar Saba, Israel
| | - Avivit Weisz
- Pathology Department, Meir Medical Center, Kfar Saba, Israel
| | - Yael Einbinder
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.
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Einbinder Y, Siboni A, Zaidenstein S, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. Presence of galectin-3 in peritoneal dialysate. Does it have a role in the peritoneal membrane inflammatory process? Nephrology (Carlton) 2021; 27:104-108. [PMID: 34611952 DOI: 10.1111/nep.13981] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
Peritoneal dialysis (PD) causes structural and functional changes in the peritoneal membrane, which are attributed to local inflammatory process. This study assessed the presence of galectin-3 (Gal-3), a known inflammatory modulator, in dialysate effluent and correlated its levels with markers of inflammatory process. Gal-3 levels in serum and dialysate effluent were measured in prevalent PD patients on morning visits (n = 27) or during peritoneal equilibration tests (PET, n = 16), it association with clinical and laboratory parameters, including dialysate/plasma creatinine (D/P creatinine) and interleukin-6 (IL-6) levels was analysed. Gal-3 levels in dialysate effluent correlated with D/P creatinine (0.663, p = 0.005) and dialysate effluent IL-6 levels (0.674, p = 0.002), but not with serum Gal-3 levels or dialysis vintage. Patients who were high transporters had higher Gal-3 levels in dialysate effluent, as compared to lower transporters. In multivariate regression analysis, dialysate IL-6 level was the strongest predictor of dialysate Gal-3 levels. This study found Gal-3 in dialysate effluent correlated with D/P creatinine and dialysate IL-6 levels. These findings may imply that Gal-3 has a role in the intraperitoneal inflammatory process. However, this needs to be investigated further.
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Affiliation(s)
- Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Siboni
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Shirley Zaidenstein
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Erez D, Fanadka F, Benchetrit S, Cohen-Hagai K. The Combined Prognostic Significance of Alkaline Phosphatase and Intracranial Arterial Calcifications in Hemodialysis Patients. Am J Nephrol 2021; 52:763-770. [PMID: 34569494 DOI: 10.1159/000518399] [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: 05/01/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prevalence of intracranial arterial calcification (ICAC) in maintenance hemodialysis (MHD) patients is about 90%, and its severity is correlated with age, hemodialysis vintage, and mineral bone disease. Elevated concentrations of calcium and phosphorus are not sufficient for medial calcification because of inhibition by pyrophosphate. Alkaline phosphatase (ALP) promotes calcification by hydrolyzing extracellular pyrophosphate. Epigenetic mechanisms involving ALP inhibition by apabetalone were investigated as a potential target for preventing vascular calcifications (VCs). This study assessed the combined impact of VCs and elevated serum ALP on mortality among chronic HD patients. METHODS VCs represented by ICAC were measured simultaneously with mineral bone disease parameters including serum ALP of MHD patients who underwent noncontrast brain computed tomography from 2015 to 2018 in our institution. RESULTS This retrospective study included 150 MHD patients (mean age 71.3 ± 12.1 years, 60.1% male). Of the total cohort, 12 (7.8%) had no brain calcifications and 69 (45.1%) had multiple intracranial calcifications. Considering the patients with normal ALP and no calcification as the reference group yielded adjusted odds ratios for all-cause mortality of 4.6 (95% CI: 1.7-12.7) among patients with brain calcifications and normal ALP (p = 0.003) and odds ratios for all-cause mortality of 6.1 (95% CI: 2.1-17.7) among patients with brain calcifications and elevated ALP (p= 0.001). CONCLUSION We found an independent association between ICAC and the risk of death among MHD patients. The combined effect of ICAC and elevated ALP was associated with a higher odds ratio for all-cause mortality in MHD patients and may contribute to the risk stratification of these patients.
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Affiliation(s)
- Daniel Erez
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel
| | - Feda Fanadka
- Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wand O, Mor O, Zuckerman N, Fadeela A, Benchetrit S, Nacasch N, Cohen-Hagai K. Outcomes From Infections With Variant Strains of SARS-CoV-2 Among Patients Receiving Maintenance Hemodialysis. Am J Kidney Dis 2021; 78:617-619. [PMID: 34273437 PMCID: PMC8279937 DOI: 10.1053/j.ajkd.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/27/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Ori Wand
- Department of Pulmonology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Mor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Israeli Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Neta Zuckerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Israeli Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Ayman Fadeela
- Corona and Respiratory Viruses Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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40
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Heusler I, Biron-Shental T, Farladansky-Gershnabel S, Pasternak Y, Kidron D, Vulih-Shuitsman I, Einbinder Y, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. Enhanced expression of Galectin-3 in gestational diabetes. Nutr Metab Cardiovasc Dis 2021; 31:1791-1797. [PMID: 34023181 DOI: 10.1016/j.numecd.2021.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Gestational diabetes mellitus (GDM), hyperglycemia diagnosed during pregnancy, is one of the most common medical complications of pregnancy, treated primarily by diet and pharmacotherapy, if indicated. It is well-established that GDM increases the risk of adverse pregnancy outcomes and long-term complications in mothers and infants. Galectin-3 (Gal-3) is important in processes of cell growth, differentiation, inflammation, and fibrosis. We evaluated Gal-3 expression in pregnancies complicated by GDM as a parameter that might explain how GDM influences early onset of future complications. METHODS AND RESULTS Forty-four women with GDM and 40 with normal pregnancy (NP) were recruited during delivery admission. Blood samples were obtained from parturients and umbilical cords blood, as well as placental tissue for analysis. Gal-3 mRNA expression was increased in maternal blood samples and placental tissue of women with GDM compared to NP. In GDM, Gal-3 mRNA was decreased in cord blood compared to maternal blood and placental tissue. Gal-3 GDM placental protein expression was increased compared to NP. Immunostaining revealed that Gal-3 is upregulated in GDM placental extravillous trophoblast. ELISA of Gal-3 maternal serum levels between GDM and NP were similar. CONCLUSION Gal-3 is strongly expressed at molecular levels (mRNA and protein expression) in GDM maternal blood and placental tissue, and decreased in cord blood. These findings highlight the role of the placenta in protecting the fetus from potential Gal-3 damage. Gal-3 expression at mRNA and protein levels might be influenced by diabetes, even if blood glucose is balanced by medication or diet.
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Affiliation(s)
- Ishai Heusler
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Farladansky-Gershnabel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Pasternak
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debora Kidron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pathology Department, Meir Medical Center, Kfar Saba, Israel
| | | | - Yael Einbinder
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.
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41
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Einbinder Y, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. MO710GALECTIN-3, IS IT A NEW PLAYER IN PERITONEAL INFLAMMATION AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS? Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab101.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Peritoneal dialysis (PD) is a common used method for renal replacement therapy. Prolonged PD treatment causes structural and functional changes in the peritoneal membrane which are attributed to local inflammatory process in the peritoneal cavity. Galectin-3 (Gal-3) is a galactoside-binding lectin with pro-inflammatory and pro-fibrotic effects. The aim of this study was to assess correlation between Gal-3 serum and dialysate effluent levels with peritoneal membrane transport characteristics.
Method
Gal-3 levels in serum and dialysate effluent were measured simultaneously in prevalent PD patients in morning visit or during peritoneal equilibration test (PET). Gal-3 levels were correlated with clinical and laboratory parameters. Interlukin (IL) -6 levels were measured in dialysate effluent. Gal-3 mRNA and protein expression were evaluated after exposure of primary endothelial cell culture to several dialysate solutions.
Results
37 PD patients were included in the study; mean age was 65.7±13.1 years, mean dialysis vintage was 17.5±13 months. Gal-3 levels in dialysate effluent correlated with peritoneal equilibration test (PET) results (0.663, p=0.005) and effluent IL-6 levels (0.674, p=0.002) but not with serum Gal-3 levels or dialysis vintage. Patients with high PET results had higher effluent Gal-3 levels as compared average low PET results. In multivariate regression analysis effluent IL-6 level was the most dominant predictor of effluent Gal-3 levels. Gal-3 mRNA and protein expression in primary endothelial cell culture were not affected by stimulation with dialysate solutions.
Conclusion
Our study demonstrated presence of Gal-3 within the dialysate effluent in PD patients. Gal-3 levels correlated with peritoneal membrane transport characteristics and effluent IL-6 levels suggesting a role in the inflammatory process within the peritoneal cavity.
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Affiliation(s)
- Yael Einbinder
- Meir Medical Center, Kefar Sava, Israel
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Keren Cohen-Hagai
- Meir Medical Center, Kefar Sava, Israel
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Sydney Benchetrit
- Meir Medical Center, Kefar Sava, Israel
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Tali Zitman-Gal
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
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42
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Cohen-Hagai K, Fanadka F, Grumberg T, Topaz G, Nacasch N, Greenberg M, Zitman-Gal T, Benchetrit S. Diastolic blood pressure is associated with brain atrophy in hemodialysis patients: A single center case-control study. Ther Apher Dial 2021; 26:94-102. [PMID: 33763913 DOI: 10.1111/1744-9987.13647] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
Brain atrophy (BA) is often found in neuroimaging of hemodialysis patients, representing parenchymal cerebral damage. Likely contributing factors to BA are age, chronic hypertension, diabetes mellitus and other cardiovascular risk factors of atherosclerosis that are also common among hemodialysis patients. BA may also occur due to focal ischemia and hypoperfusion during hemodialysis. However, data on optimal blood pressure (BP) in these patients are limited. The goal of this study was to determine whether the prevalence and severity of BA would be higher among hemodialysis patients with lower BP. A blinded neuroradiologist graded BA of all hemodialysis patients who underwent brain non-contrast computerized tomography (CT) from 2015 to 2017 in our institution. Age- and sex-matched patients with normal kidney function who underwent brain CT during the same period and technique served as the control group. A total of 280 patients were included in this retrospective study, with average BP of 140/70 mmHg among hemodialysis patients and 142/75 mmHg in the control group. BA was more common in dialysis patients and its severity increased with age and traditional cardiovascular risk factors. We observed a significant negative correlation between diastolic BP (DBP) at dialysis initiation and BA. Average DBP decreased with increasing severity of BA. These findings were observed in both hemodialysis and non-CKD patients. BA was associated with lower DBP, which may induce cerebral hypoperfusion and ischemia. This finding should discourage over-treatment of hypertension among hemodialysis patients.
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Affiliation(s)
- Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Feda Fanadka
- Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Tania Grumberg
- Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - Guy Topaz
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Meidad Greenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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43
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Farladansky-Gershnabel S, Heusler I, Biron-Shental T, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. 374 Thioredoxin, thioredoxin interacting protein and galectin-3 in preeclampsia. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.397] [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: 11/28/2022]
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44
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Heusler I, Biron-Shental T, Farladansky-Gershnabel S, Pasternak Y, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. 384 Galectin-3 expression among women with gestational diabetes type 2. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.407] [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: 10/22/2022]
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45
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Einbinder Y, Shnaider A, Ghanayem K, Basok A, Rogachev B, Lior Y, Haviv YS, Cohen-Hagai K, Nacasch N, Rozenberg I, Benchetrit S, Zitman-Gal T, Douvdevani A. Elevated Circulating Cell-Free DNA in Hemodialysis-Treated Patients Is Associated with Increased Mortality. Am J Nephrol 2020; 51:852-860. [PMID: 33105130 DOI: 10.1159/000510771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/02/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Predicting the mortality risk of patients un-dergoing hemodialysis (HD) is challenging. Cell-free DNA (cfDNA) is released into circulation from dying cells, and its elevation is predictive of unfavorable outcome. In a pilot study, we found post-HD cfDNA level to be a predictor of all-cause mortality. Thus, the aim of this study was to confirm the prognostic power of cfDNA in a larger prospective cohort study conducted at 2 medical centers. METHODS CfDNA levels were measured by a rapid fluorometric assay on sera obtained before and after 1 HD session. One hundred fifty-three patients were followed up to 46 months for mortality during which time 47 patients died. We compared the predictive value of cfDNA to age, comorbidities, and standard blood tests. RESULTS Examining standard blood tests, only post-HD cfDNA levels were elevated in the non-survivor group compared to survivors (959 vs. 803 ng/mL, p = 0.04). Pre- and post-HD cfDNA levels correlated with age and diabetes. Patients with elevated cfDNA (>850 ng/mL) showed lower survival than those with normal levels. A Cox proportional hazard regression model demonstrated a significant hazard ratio of 1.92 for post-HD cfDNA levels. Logistic regression models showed that post-HD cfDNA was a significant predictor of mortality at 1-3 years with odd ratios of 4.61, 4.36, and 6.22, respectively. CONCLUSIONS Post-HD cfDNA level was superior to standard blood tests and could serve as a biomarker to assist in decision-making for HD-treated patients.
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Affiliation(s)
- Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alla Shnaider
- Department of Nephrology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Khaled Ghanayem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Basok
- Department of Nephrology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Rogachev
- Department of Nephrology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Lior
- Department of Clinical Biochemistry and Pharmacology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yosef Shmuel Haviv
- Department of Nephrology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Douvdevani
- Department of Nephrology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel,
- Department of Clinical Biochemistry and Pharmacology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel,
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46
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Topaz G, Ben-Zvi E, Pereg D, Kitay-Cohen Y, Benchetrit S, Zitman-Gal T, Lotan S, Cohen-Hagai K. Prediction of acute-coronary-syndrome using newly-defined R 2-CHA 2DS 2-VASc score among patients with chest pain. J Cardiol 2020; 77:370-374. [PMID: 32988692 DOI: 10.1016/j.jjcc.2020.08.013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/26/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chest-pain patients with no evidence of acute coronary syndrome might still be at risk for adverse outcomes. Adding renal function to the classic scoring of CHADS and CHA2DS2 VASC may improve risk stratification of chest-pain patients discharged from internal medicine wards after acute coronary syndrome (ACS) rule-out. METHODS We accessed medical records of patients admitted to internal medicine wards during 2010-2016 and discharged following ACS rule-out. A R2CHA2DS2-VASc score model that included higher scores as kidney function deteriorated was calculated and compared to CHADS and CHA2DS2 VASC scores. The primary endpoint was the composite of 30-day ACS and mortality. One-year ACS and 1-year mortality were the secondary endpoints. The study included 12,449 patients, stratified into three risk groups according to their R2CHA2DS2-VASc score. RESULTS Participants were stratified into 3 groups according to R2CHA2DS2-VASc score. R2CHA2DS2-VASc score predicted better the composite outcome of ACS and 30-day and 1-year mortality after discharge (OR: 4, 95%, CI 2.3-7, p < 0.01 and OR: 13.3, 95% CI 7.8-22.7, p < 0.01, respectively). Receiver operating characteristic curve analysis showed better risk stratification of the R2CHA2DS2-VASc compared with both CHADS and CHA2DS2 VASC score. CONCLUSIONS The R2CHA2DS2-VASc score is a better predictor of short- and long-term cardiovascular morbidity and mortality after hospital discharge.
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Affiliation(s)
- Guy Topaz
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Elad Ben-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Pereg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Yona Kitay-Cohen
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology, Meir Medical Center, Kfar Saba, Israel
| | - Shilo Lotan
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology, Meir Medical Center, Kfar Saba, Israel.
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Tanasiychuk T, Kushnir D, Vardi Y, Cohen-Hagai K, Zitman-Gal T, Frajewicki V, Benchetrit S, Einbinder Y. A simple novel device can provide independence for peritoneal dialysis patients. Perit Dial Int 2020; 41:344-346. [PMID: 32964803 DOI: 10.1177/0896860820958956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tatiana Tanasiychuk
- Department of Nephrology and Hypertension, 549236Carmel Medical Center, Haifa, Israel
| | - Daniel Kushnir
- Department of Nephrology and Hypertension, 549236Carmel Medical Center, Haifa, Israel
| | - Yafa Vardi
- Department of Nephrology and Hypertension, 549236Carmel Medical Center, Haifa, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Victor Frajewicki
- Department of Nephrology and Hypertension, 549236Carmel Medical Center, Haifa, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
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48
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Cohen-Hagai K, Nacasch N, Sternschuss A, Ohana M, Wolach B, Benchetrit S, Gavrieli R, Zitman-Gal T. Malnutrition and inflammation in hemodialysis patients: Comparative evaluation of neutrophil reactive oxygen formation. Nutrition 2020; 78:110793. [PMID: 32454385 DOI: 10.1016/j.nut.2020.110793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Impaired phagocytic function has been established in uremic patients. Chemotaxis, particle ingestion, and free radical and metabolic activity were all found to be disturbed in dialysis patients. Malnutrition is common among hemodialysis (HD) patients, with an estimated prevalence of 40% to 70%. Malnutrition-Inflammation Score (MIS) appears to be a useful tool for risk stratification of chronic HD patients. We assessed the correlation between MIS and phagocyte function in HD patients. METHODS Forty-four chronic HD patients were enrolled from the dialysis unit. The patients were divided into two groups according to the MIS: 1 to 12 (normal-mild) and 13 to 30 (severely malnourished). Hydrogen peroxide release by polymorphonuclear leukocytes was evaluated using the dihydrorhodamine 123 method. Phagocytic activity of neutrophils was evaluated after stimulation with Escherichia coli bacteria and phorbol 12-myristate 13-acetate (PMA) (positive control). RESULTS Neutrophil oxidative activity in all HD patients versus healthy controls was significantly lower in median fluorescence intensity (MdFI)-E. coli and MdFI-PMA. We found significant correlations among MdFI-PMA and calculated MIS and other nutritional parameters in chronic HD patients. CONCLUSIONS Impaired phagocytic function was identified in chronic HD patients. The severity of the impairment was associated with nutrition and inflammation parameters, as well as Malnutrition-Inflammation Score.
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Affiliation(s)
- Keren Cohen-Hagai
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Naomi Nacasch
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Sternschuss
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Meital Ohana
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Baruch Wolach
- Laboratory for Leukocyte Functions, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Gavrieli
- Laboratory for Leukocyte Functions, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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49
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Pasternak Y, Ohana M, Biron-Shental T, Cohen-Hagai K, Benchetrit S, Zitman-Gal T. Thioredoxin, thioredoxin interacting protein and transducer and activator of transcription 3 in gestational diabetes. Mol Biol Rep 2019; 47:1199-1206. [PMID: 31848914 DOI: 10.1007/s11033-019-05221-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
To evaluate changes in the inflammatory response of thioredoxin (TXN), thioredoxin interacting protein (TXNIP), transducer and activator of transcription 3, NFƙB-p50 and STAT3 at the level of maternal serum, placenta, and umbilical cord blood of women with gestational diabetes mellitus type 2 (GDMA2) compared to normal pregnancies (NP). Thirty pregnant women (20 with GDMA2 and 10 NP) were recruited during admission for delivery. Blood samples were obtained from the parturients and umbilical cords, as well as placental tissue for mRNA and protein extraction. TXNIP mRNA expression was significantly increased in maternal serum of women with GDMA2 compared to NP women. TXNIP mRNA was significantly decreased in GDMA2 placentas and cord blood compared to NP. TXN/TXNIP mRNA ratio showed significantly high absolute values in placental and cord blood (2.39 and 1.66) respectively, compared to maternal ratio (1.084) (P < 0.001). TXN/TXNIP placenta protein ratio showed similar values between GDMA2 and NP (0.98 and 0.86; P = 0.7). STAT3 and its target protein SOCS3, as well as NFƙB-p50 mRNA expression were significantly increased in placentas of GDMA2. NFƙB-p50 mRNA expression was significantly decreased in cord blood compared to both maternal and placental mRNA expression. Pro-inflammatory changes are expressed by low mRNA TXN/TXNIP ratio in maternal blood of GDMA2 patients, but not in placental and umbilical cord blood samples. This, as well as the feedback role of SOCS3 in STAT3 pathway and NFƙB-p50 expression, may indicate that the placenta has a role in protecting the fetus from damage due to inflammatory response, which is common in diabetes.
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Affiliation(s)
- Yael Pasternak
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Ohana
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Tali Zitman-Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Nephrology Laboratory, Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.
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50
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Cohen-Hagai K, Nacasch N, Rozenberg I, Korzets Z, Einbinder Y, Zitman-Gal T, Benchetrit S. Clinical outcomes of stroke in hemodialysis patients: a retrospective single-center study. Int Urol Nephrol 2019; 51:1435-1441. [PMID: 31264088 DOI: 10.1007/s11255-019-02218-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The incidence of stroke in patients undergoing hemodialysis (HD) is eight-to-ten times greater than that of the general population. However, data on the outcome of stroke in these patients are limited. METHODS In this retrospective observational cohort study, electronic medical records of all patients undergoing HD from 1.1.2014 to 31.12.2017 at Meir Medical Center, Israel, were reviewed. Stroke was defined as a focal neurological deficit of cerebrovascular origin, and confirmed as ischemic or hemorrhagic by computed tomography. Age- and sex-matched HD patients who did not experience a stroke (HD-NS) and hospitalized stroke patients with normal kidney function (NRF-S) served as the two control groups. Baseline demographic, clinical, and laboratory data were collected. Thrombolytic therapy, duration of hospital stay, and mortality were recorded. Functional status at discharge was assessed by the Modified Rankin Scale. RESULTS In the cohort study group (HD-S), 52 strokes occurred during 248.3 patient years, an incidence rate of 8.13%, and a stroke rate of 0.19% patients/month. Most strokes in HD patients were ischemic, and only four patients were administered tissue plasminogen activator. HD-S had longer hospitalization than did NRF-S (10.6 ± 9.9 vs. 5.96 ± 5.3 days, p = 0.004) and lower functional status at discharge (Rankin score 3.75 ± 1.57 vs. 2.29 ± 1.89, p < 0.001). HD-S patients had a higher mortality than both HD-NS and NRF-S patients. CONCLUSIONS Stroke outcome in these patients is dismal with prolonged hospital stay, poor functional status at discharge, very limited response to rehabilitation, and increased mortality.
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Affiliation(s)
- Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.
| | - Naomi Nacasch
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Rozenberg
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ze'ev Korzets
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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