Immediate Abnormal Intrinsic Brain Activity Patterns in Patients with End-stage Renal Disease During a Single Dialysis Session

Abstract Background and Aims Eryptosis (Red cell apoptosis) has been recognized as one of the mechanisms that mediate anaemia in patients with chronic kidney disease whether pre or on dialysis. Phosphorus (Ph) and parathormone (PTH) can be considered as uremic toxins which are associated with renal anaemia, and both were suggested to be associated with shortened red blood cell (RBC) life span. We aimed to assess the relation between each of PTH and phosphorus levels and eryptosis in a cohort of patients with end stage renal disease (ESRD) treated by haemodialysis. Method We studied a cohort of 85 patients with ESRD on conventional hemodialysis for at least 3 months. Blood was drawn prior to the mid-week dialysis session. Patients are dialysed on Fresenius 4008s machines. The percent of Annexin V-binding RBCs was assessed by flow cytometry in fresh blood samples and was used to indicate the percent of Eryptotic RBCs. Data were represented as median (interquartile range). Results The study included 85 patients on prevalent hemodialysis for a median of 8 (3-12) years, 52.9% females. Hypertension was the most common cause of ESRD (49.4%). The median hemoglobin was 10.9 (9.3 - 13) gm/dl and most patients received erythropoietin therapy (83/85) at a median dose of 8000 (4000 – 8000 units/weak). The median percent of Annexin V- binding RBCs was 2.3 (1.4 – 4.7%). On multilinear regression analysis, only PTH was independently associated with the percent of Annexin V- binding RBCs (standardized β= 0.630; 95.0% CI: 0.001 – 0.003; p<0.001). Patients were then stratified according to the PTH level into: low PTH (< 150 ng/dl; 25/85, 29.4%), target PTH (150 – 600 ng/dl; 33/85, 38.8%) and high PTH (> 600 ng/dl; 27/85, 31.8%) groups. The 3 groups differed significantly in the percent of Annexin V- binding RBCs (1.2 (0.7-1.7); 2.5 (1.8-3.6) and 4.8 (3.2-5.6) % respectively; p<0.001) (Figure). The percent of Annexin V- binding RBCs was similar in patients with high (>5.5) and target (<5.5 mg/dl) Ph levels (p=0.318). It was higher in patients with above-target CaXPh product (>55) than those with target CaXPh product (<55 mg2/dl2) (5 (2-5.4) % vs 2.3 (4.1 – 1.2) %), yet this was not statistically significant (p=0.068). Conclusion Patients with ESRD treated by hemodialysis express high rates of eryptosis. Parathormone excess in those patients may result in further eryptosis enhancement, and this represents a potential pathogenic mechanism linking hyperparathyroidism with the anemia of CKD. Larger interventional studies are thus warranted to further explore the association between parathormone and eryptosis.

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Increased Levels Of Tissue Factor, Adhesion Molecules, Nitric Oxide and Adiponectin In End Stage Renal Disease. A Complex Interplay

Blood ◽

10.1182/blood.v122.21.4742.4742 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4742-4742

Author(s):

Jawed Fareed ◽

Kristiyana Kaneva ◽

Debra Hoppensteadt ◽

Vinod Bansal

Keyword(s):

Nitric Oxide ◽

Renal Disease ◽

Tissue Factor ◽

Adhesion Molecules ◽

End Stage Renal Disease ◽

Esrd Patient ◽

Dialysis Session ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Introduction End stage renal disease (ESRD) represents the fifth (final) stage of chronic kidney disease characterized by an established kidney failure (GFR <15 mL/min/1.73 m2). To further understand the pathophysiology of ESRD, this study was designed to measure the circulating levels of tissue factor (TF), adhesion molecules, such as p-selectin (P-Sel), soluble ICAM (s-ICAM), nitric oxide and adiponectin (AD). Methods This study included 119 ESRD patients undergoing maintenance hemodialysis in conjunction with an ongoing IRB approved protocol on the profiling of inflammatory markers in this syndrome. Citrated blood plasma samples were collected from these patients prior to the routine dialysis session. Nitric oxide levels (NO) were measured using a commercial kit from R&D systems (Minneapolis, Minnesota) and ELISA based methods for TF, P-Sel, s-ICAM and adiponectin were also purchased from R&D systems. Chromogenic and thrombin substrate method were used to measure the anti-Xa activity thrombin generation. Results Tissue factor levels were found to be increased in the ESRD group (20.4±6.1pg/ml) vs the control (11.9±2.8pg/ml). The nitric oxide level was markedly higher in the ESRD group (32±17uM) vs the controls (7±3uM). The p-selectin levels were also elevated in the ESRD group (46±20ng/ml) vs the control (31±3ng/ml). The soluble ICAM levels were higher in the ESRD group (250±112ng/ml) vs the control (180±19ng/ml). Interestingly, the adiponectin levels were also increased in the ESRD group (19.2±9.3ug/ml) vs the control (11.2±4.1ug/ml). The pre-dialysis samples of the ESRD patients exhibited detectable levels of heparin. Summary/Conclusions These studies suggest that TF, NO, p-selectin and s-ICAM levels are increased in the ESRD patient. It is of interest to note that despite that a significant number of ESRD patients were diabetic; the AD levels were increased in this group. These results suggest that while ESRD represents a pro-inflammatory/hypercoagulable state, the repeated administration of heparin and other drugs may contribute to the regulation of the hemostatic process and inflammatory balance. Disclosures: No relevant conflicts of interest to declare.

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Removal of Dolutegravir by Hemodialysis in HIV-Infected Patients with End-Stage Renal Disease

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03131-15 ◽

2016 ◽

Vol 60 (4) ◽

pp. 2564-2566 ◽

Cited By ~ 7

Author(s):

José Moltó ◽

Fredzzia Graterol ◽

Cristina Miranda ◽

Saye Khoo ◽

Ioana Bancu ◽

...

Keyword(s):

Renal Disease ◽

Protein Binding ◽

End Stage Renal Disease ◽

Inhibitory Concentration ◽

Plasma Concentrations ◽

Extraction Ratio ◽

Dialysis Session ◽

Registration Number ◽

Stage Renal Disease ◽

End Stage

ABSTRACTData on dolutegravir removal by hemodialysis are lacking. To study this, we measured dolutegravir plasma concentrations in samples of blood entering and leaving the dialyzer and of the resulting dialysate from 5 HIV-infected patients with end-stage renal disease. The median dolutegravir hemodialysis extraction ratio was 7%. The dolutegravir concentrations after the dialysis session remained far above the protein-binding-adjusted inhibitory concentration. Our results show minimal dolutegravir removal by hemodialysis, with no specific dolutegravir dosage adjustments required in this setting. (This study is registered at ClinicalTrials.gov under registration number NCT02487706.)

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Prevalence and Severity of Itching in Patients with End-Stage Renal Disease: Treatment with Nalfurafine Hydrochloride

Blood Purification ◽

10.1159/000496637 ◽

2019 ◽

Vol 47 (Suppl. 2) ◽

pp. 45-49 ◽

Cited By ~ 2

Author(s):

Hidetomo Nakamoto ◽

Takehito Kobayashi ◽

Toru Noguchi ◽

Takeru Kusano ◽

Keigo Ashitani ◽

...

Keyword(s):

Conservative Treatment ◽

Renal Disease ◽

End Stage Renal Disease ◽

Dialysis Session ◽

Disease Treatment ◽

Uremic Pruritus ◽

Oral Medications ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

Background/Aims: In this study, we investigated the severity and frequency of uremic pruritus and itch-associated insomnia in patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD). Methods: This questionnaire-based study included outpatients with ESRD or CKD who were attending Tokorozawa Renal Clinic in Saitama Prefecture or Musashi Ranzan Hospital and were stable on treatment. The questionnaire was completed by patients on hemodialysis (HD) before a dialysis session and by patients on peritoneal dialysis (PD) or conservative treatment at the time of an outpatient hospital visit. Results: Itching was reported by 61.6% of patients on HD, 61.5% on PD, and 43.2% on conservative CKD management. There was no statistically significant difference in the severity or frequency of itch according to whether patients were on HD for ESRD, PD for ESRD, or receiving conservative treatment for CKD. However, insomnia was significantly more common in the PD group than in the HD and conservative CKD groups. Conclusion: Better skin management is needed for itch in patients with ESRD or CKD. Moisturizing and lifestyle factors are important. Topical or oral medications may also be used. Nalfurafine, a κ receptor agonist, is now available in Japan for the treatment of uremic pruritus in these patients.

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Preoperative Evaluation in Patients With End-Stage Renal Disease and Chronic Kidney Disease

Health Services Insights ◽

10.1177/1178632917713020 ◽

2017 ◽

Vol 10 ◽

pp. 117863291771302 ◽

Cited By ~ 2

Author(s):

Rabih Nasr ◽

Sridhar Chilimuri

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Preoperative Evaluation ◽

Dialysis Session ◽

Dialysis Access ◽

Dialysis Patients ◽

Stage Renal Disease ◽

End Stage

Optimal preoperative management of dialysis patients remains challenging. Patients with end-stage renal disease (ESRD) have higher mortality in the perioperative setting compared with non-ESRD patients. However, it is well established that dialysis should be done on the day before surgery. Additional dialysis session prior to surgery does not improve outcomes. All dialysis patients should undergo blood work to check electrolytes and especially serum potassium prior to any surgery. Some medications, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics, should be stopped prior to surgery to minimize hemodynamic changes during surgery. The dialysis access should be carefully examined for any signs of infection. The arteriovenous fistula or graft should be evaluated for patency. Glycemic control in diabetic ESRD and chronic kidney disease patients is very important, and clinicians should be aware of the risk of bleeding and the appropriate analgesics that can be used in dialysis patients in the perioperative setting. In conclusion, preoperative evaluation in patients with ESRD should be a multidisciplinary approach.

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Prevalence of Right Ventricular Dysfunction & Pulmonary Hypertension and their Relationship to the Number of Hemodialysis Sessions in Patients of End-Stage Renal Disease (ESRD)

Proceedings of Shaikh Zayed Medical Complex Lahore - October to December ◽

10.47489/pszmc-811-35-3-64-68 ◽

2021 ◽

Vol 35 (3) ◽

pp. 64-68

Author(s):

Rakesh Bahadur Adhikari

Keyword(s):

Pulmonary Hypertension ◽

Renal Disease ◽

Right Ventricular ◽

End Stage Renal Disease ◽

Chronic Hemodialysis ◽

Dialysis Session ◽

Systolic Pulmonary Artery Pressure ◽

Cross Sectional ◽

Stage Renal Disease ◽

End Stage

Introduction: Chronic hemodialysis (HD) ends up with right ventricular (RV) dysfunction and increased pulmonary hypertension (PHTN). Left to right shunt in dialysis patients due to arterio-venous fistula (AVF) causes chronic volume overload, independent of rise in body water leading to worsening RV overload and RV dysfunction (RVD). Aims & Objectives: To determine the prevalence of RV dysfunction & pulmonary hypertension and its relationship to the number of dialysis sessions in patients of ESRD. Place and duration of study: Department of Cardiology & Nephrology, Sheikh Zayed Hospital, Lahore for one year from March 2016 - March 2017. Material & Methods: This cross-sectional analytical hospital based study enrolled 145 Patients of End-Stage Renal Disease (ESRD) on regular 4-hours HD sessions at two or more times per week for at least 3 months. Echocardiography (Echo) with 2-D, M (Motion) Mode & Doppler studies were done. RV dysfunction by TAPSE value less than 15mm & PHTN by Systolic pulmonary artery pressure >35 mm Hg or tricuspid regurgitation velocity (VTR) ?2m/s at rest were noted. Data was analyzed on SPSS version 20. Results: RV dysfunction was seen in 40.7% (59) of patients and the frequency rose across the 4 dialysis session groups (13.8%, 37.3%, 51.7% & 100%, p<0.001). PHTN was observed in 44.1% of the patients and the prevalence progressively increased across the groups (17.2%, 45.1%, 53.3% & 80.01%, p<0.003). There was significant association between RVD and PHTN (p=0.011). Conclusion: We observed positive correlation between RV dysfunction and PHTN with total number of hemodialysis sessions. Early detection of sub-clinical RV dysfunction may improve mortality and morbidity by optimizing treatment options.

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Abstract 560: Association of Female Gender with Arterial Stiffness in Patients With End-Stage Renal Disease

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.35.suppl_1.560 ◽

2015 ◽

Vol 35 (suppl_1) ◽

Author(s):

Isabella Guajardo ◽

Mills Claire ◽

Peter Ganz ◽

Carmen A Peralta ◽

Ruth Dubin

Keyword(s):

Peritoneal Dialysis ◽

Arterial Stiffness ◽

Renal Disease ◽

End Stage Renal Disease ◽

Female Gender ◽

Dialysis Session ◽

Clinical Factors ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage

Objectives: Cardiovascular mortality remains disproportionately high in patients with end-stage renal disease (ESRD), and arterial stiffness is a strong risk factor for death in these patients. Recent studies have shown that women are at increased risk for death in this population. We explored whether arterial stiffness differed by gender in a diverse cohort of patients on hemo- or peritoneal dialysis. Methods: Stable patients on hemo- or peritoneal dialysis (N=86) underwent arterial stiffness testing by radial tonometry (SphygmoCor, AtCor Medical). Patients were studied on Tuesday or Wednesday mornings (for patients on hemodialysis, the day after the first dialysis session of the week). Central aortic augmentation index (AIx) was calculated at a standardized heart rate of 75 bpm using a generalized transfer function.[[Unable to Display Character:  ]] Results: The mean±SD age was 54±12 years, 30% were women, 36% were African American, and 38% had diabetes. The median(IQR) years on dialysis was 4(1.8, 7), 80% were on hemodialysis, and 20% were on peritoneal dialysis. Overall, mean±SD Aix was 24±11%; mean±SD Aix was 29±9% for women vs. 21±9% for men (p<0.001). Clinical factors associated with both higher Aix (worse arterial stiffness) and female gender (p≤0.2) included older age, diabetes, lower albumin, lower hemoglobin and higher Kt/V. After adjustment for these covariates, female gender remained a significant correlate of worse arterial stiffness (β=8%;95%CI [-14, -1.7];p=0.01). Further adjustment for peripheral systolic blood pressure, height and weight (parameters used to calculate Aix) did not attenuate this effect (β=9%;95%CI [-15, -3.1];p=0.004). Conclusions: In this ESRD cohort, female gender was associated with higher Aix (worse arterial stiffness) after adjustment for clinical factors. Further studies are needed to explore whether residual confounding explains this association or if hormonal and metabolic factors could lead to worsened arterial stiffness in women with ESRD.

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