P1417ALTERED CATHEPSIN-K LEVELS REFLECT SEVERITY OF MINERAL BONE DISEASE AND INFLAMMATION IN CHRONIC HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Giuseppe Coppolino ◽  
Marta Greco ◽  
Giuseppe Leonardi ◽  
Michele Provenzano ◽  
Omar Tripolino ◽  
...  
Keyword(s):  
Bone Disease ◽  
Calcium Concentration ◽  
Cathepsin K ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Future Research ◽  
Dialysis Session ◽  
Dialysis Patients ◽  
Dialysis Vintage ◽  
Dialysate Calcium

Abstract Background and Aims Mineral bone disease (MBD) and chronic inflammation are key triggers of the exceeding cardiovascular risk that characterizes dialysis patients. Cathepsin-K (Cts-K) is a lysosomal cysteine protease involved in bone remodeling and resorption, whose expression is promoted particularly by inflammation and whose involvement in bone and cardiovascular disorders has previously been demonstrated. We set out to undertake an exploratory, observational study to assess the possible clinical significance of Cts-K in dialysis patients. Method Eighty-five chronic HD patients (mean age 67±12, median dialysis vintage 3.2 yrs) with stable dry weight were studied. Cts-K was measured in peripheral blood samples before a mid-week dialysis session together with standard biochemical parameters. Twenty-six healthy subjects, matched with HD patients for age and gender, served as controls. Results Cts-K was statistically higher in HD patients than in controls (median 340, IQR 170-835 vs. 190 IQR 20-120 pg/mL, p<0.0001). At univariate analyses, Cts-K levels were significantly associated with ALP (r=0.50, p<0.001), CRP (r=0.46, p<0.001), PTH (r=0.24,p=0.02), presence of diabetes (r=0.28,p<0.001),peripheral vasculopathy (r=0.20, p=0.05) and dialysate calcium concentration (r=-0.28,p<0.001). In a multivariate model including all univariate predictors (R2=61%, p<0.001) only ALP (β=0.70,p<0.001), CRP (β=0.49,p<0.001) and dialysate calcium concentration (β -0.40,p=0.04) remained significantly associated with Cts-K levels. Interestingly, Cts-K levels were significantly higher among individuals who were under active calcimimetic therapy (n=28; p<0.001) but significantly lower among those who previously underwent parathyroidectomy (n=8; p<0.001) (Figure 1). Conclusion Cathepsin-K is a biomarker at the crossroads of bone and inflammatory disorders in chronic hemodialysis patients. Future research is needed to clarify the exact pathophysiological role of this protein and to test its potential usefulness as a marker for managing MBD therapy and complications.

scholarly journals Prescription characteristics of phosphate binders in a high pill burden for hemodialysis patients

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Nobuo Nagano ◽  
Kyoko Ito ◽  
Takashi Ono ◽  
Yuichi Ariyoshi ◽  
Soichiro Masima ◽  
...  
Keyword(s):  
Significant Negative Correlation ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Phosphate Binders ◽  
Pill Burden ◽  
Dialysis Patients ◽  
Oral Drugs ◽  
Dialysis Vintage ◽  
The Mean ◽  
The Relationship

Abstract Background Dialysis patients have to take many oral drugs, causing a high pill burden. Phosphate binders (PBs) account for a large proportion of daily pill burden; however, the relationship between patient background and prescription status of PBs is not clear. Methods We clarified the characteristics of PBs in the total daily pill burden by analyzing the drugs prescribed for 533 chronic hemodialysis patients in our facility. Results An average of nine different types of oral drugs was prescribed for each patient. The mean and median values of total pill burden were 15.1 and 14.1 pills/day/patient, respectively. The total pill burden showed a significant negative correlation with age and a significant positive correlation with dialysis vintage. In addition, the total pill burden was significantly higher in males than in females. However, there was no difference in the pill burden between patients with and without diabetes mellitus (DM). PBs were prescribed to 409 patients (76.7%), and the mean pill burden derived from PBs was 6.44 pills/day/patient. This was by far the highest of all 35 different drug categories and accounted for 32.84% of all pills. Multiple regression analysis demonstrated that independent predictors of total pill burden were age, dialysis vintage, DM, and serum phosphorus (P) levels, and all these variables, except DM, were also independent predictors of pill burden from PBs. These variables were also selected when considering the use of calcimimetics. Conclusions A high pill burden is more likely to occur in younger patients with longer dialysis vintage, DM, higher serum P levels, and prescription of calcimimetics. In addition, PB was the single largest contributor to the total pill burden that positively and linearly linked to serum P levels. Therefore, P management is a high-priority issue in the mitigation of high pill burdens in dialysis patients.

MO722PHOSPHATE-BINDER THERAPY WITH SUCROFERRIC OXYHYDROXIDE REDUCES ENDOGENOUS CALCIPROTEIN PARTICLE FORMATION AND CRYSTALLIZATION IN A POST-HOC ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL IN DIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ursula Thiem ◽  
Tim D Hewitson ◽  
Nigel D Toussaint ◽  
Maria C Haller ◽  
Andreas Pasch ◽  
...  
Keyword(s):  
Phosphate Binder ◽  
Particle Formation ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Serum Phosphate ◽  
High Dose ◽  
Dialysis Patients ◽  
Randomized Controlled ◽  
Dialysis Vintage ◽  
Post Hoc

Abstract Background and Aims Calcification propensity of serum can be measured with the so-called T50-test, which integrates the complex biological interplay of promoters and inhibitors of calciprotein particle formation in blood into a single readout. Calcification propensity is associated with the risk for cardiovascular events and death in dialysis patients. As we have recently demonstrated in a randomized, controlled, cross-over study in 39 chronic hemodialysis patients with hyperphosphatemia, lowering serum phosphate with high-dose phosphate-binder therapy with 2000 mg/d of sucroferric oxyhydroxide (SO) over two weeks reduces calcification propensity as determined by the T50-test compared to a two-week wash-out phase. Based on these results, we hypothesized that SO would influence endogenous calciprotein particle (CPP) formation and crystallization, i.e. conversion from primary to secondary CPP. Method To test this hypothesis, we conducted post-hoc analyses of the previously reported RCT (74% men, mean age 63±27 years, median dialysis vintage 24, IQR 16-36 months). Native serum CPP levels were measured by a fluorescent probe-based flow cytometric assay. Moreover, hydrodynamic radii (Rh) of secondary CPP formed after enrichment with exogenous calcium and phosphate was assessed by three-dimensional cross-correlation dynamic light scattering. Results Phosphate-binder therapy with SO lead to a reduction in serum phosphate levels from 2.28±0.5 mmol/l to 1.63±0.43 mmol/l (p<0.0001), accompanied by a significant reduction of endogenous calciprotein particle load and crystallization. Median (IQR) number of primary CPP decreased from 9.2x105 (7.7x105 - 12x105) particles/ml to 3.8 x105 (2.7x105 - 4.4x105) particles/ml (p<0.0001) and secondary CPP decreased from 5.4x104 (3.6x104 - 7.5x104) particles/ml to 3.2x104 (2.4x104 - 4.2x104) particles/ml (p<0.01, both by Wilcoxon matched-pairs test). Upon SO therapy we also observed a significant reduction of secondary calciprotein particle size as determined by Rh compared to phosphate-binder wash-out (214±55 nm vs. 231±52 nm, p<0.01 by paired t-test). Conclusion In chronic hemodialysis patients, lowering serum phosphate with SO is associated with a reduction in the load of primary and secondary CPP and a smaller size of secondary CPP.

scholarly journals Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

2020 ◽  
Vol 10 (1) ◽  
pp. 4
Author(s):  
Romain Vial ◽  
Marion Gully ◽  
Mickael Bobot ◽  
Violaine Scarfoglière ◽  
Philippe Brunet ◽  
...  
Keyword(s):  
Predictive Value ◽  
Eosinophil Count ◽  
Characteristic Curve ◽  
Final Analysis ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Screening Methods ◽  
Dialysis Session ◽  
Diagnostic Study ◽  
Rt Pcr

Background: Daily management to shield chronic dialysis patients from SARS-CoV-2 contamination makes patient care cumbersome. There are no screening methods to date and a molecular biology platform is essential to perform RT-PCR for SARS-CoV-2; however, accessibility remains poor. Our goal was to assess whether the tools routinely used to monitor our hemodialysis patients could represent reliable and quickly accessible diagnostic indicators to improve the management of our hemodialysis patients in this pandemic environment. Methods: In this prospective observational diagnostic study, we recruited patients from La Conception hospital. Patients were eligible for inclusion if suspected of SARS-CoV-2 infection when arriving at our center for a dialysis session between March 12th and April 24th 2020. They were included if both RT-PCR result for SARS-CoV-2 and cell blood count on the day that infection was suspected were available. We calculated the area under the curve (AUC) of the receiver operating characteristic curve. Results: 37 patients were included in the final analysis, of which 16 (43.2%) were COVID-19 positive. For the day of suspected COVID-19, total leukocytes were significantly lower in the COVID-19 positive group (4.1 vs. 7.4 G/L, p = 0.0072) and were characterized by lower neutrophils (2.7 vs. 5.1 G/L, p = 0.021) and eosinophils (0.01 vs. 0.15 G/L, p = 0.0003). Eosinophil count below 0.045 G/L identified SARS-CoV-2 infection with AUC of 0.9 [95% CI 0.81—1] (p < 0.0001), sensitivity of 82%, specificity of 86%, a positive predictive value of 82%, a negative predictive value of 86% and a likelihood ratio of 6.04. Conclusions: Eosinophil count enables rapid routine screening of symptomatic chronic hemodialysis patients suspected of being COVID-19 within a range of low or high probability.

Higher Serum Bisphenol A Levels in Diabetic Hemodialysis Patients

2016 ◽  
Vol 42 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Faruk Turgut ◽  
Sana Sungur ◽  
Ramazan Okur ◽  
Mustafa Yaprak ◽  
Muge Ozsan ◽  
...  
Keyword(s):  
Bisphenol A ◽  
High Performance ◽  
Patient Characteristics ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Dialysis Session ◽  
Laboratory Parameters ◽  
Hemodialysis Session ◽  
Before And After ◽  
Patients With Diabetes

Background: Bisphenol A (BPA) has been implicated as an ‘endocrine disruptor'. We aimed at exploring the association between serum BPA levels and patient characteristics, particularly the presence of diabetes mellitus, and laboratory parameters in hemodialysis patients. Methods: This study included 47 chronic hemodialysis patients. Patient characteristics were recorded. Blood was drawn before and after hemodialysis session. Serum BPA levels were measured by the high-performance-liquid-chromatography and laboratory parameters were measured by using standard methods. Results: In hemodialysis patients, postdialysis serum BPA levels were significantly higher than predialysis after a single hemodialysis session (5.57 ± 1.2 vs. 4.06 ± 0.73, p < 0.0001). Predialysis serum BPA levels were significantly higher in patients with diabetes than non-diabetics (4.4 ± 0.6 vs. 3.9 ± 0.7, p = 0.025). No association was found between serum BPA levels and patient characteristics, and particularly laboratory parameters. Conclusion: Serum BPA levels were rising significantly after a single dialysis session. Diabetic hemodialysis patients had higher predialysis serum BPA levels.

MO752EVALUATION AND ANALYSIS OF CHRONIC PAIN IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sanae Ezzaki ◽  
Imane Failal ◽  
Rania Elafifi ◽  
Salma siham Elkhayat ◽  
Ghizlane Medkouri ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Advanced Age ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
High Prevalence ◽  
Significant Intensity

Abstract Background and Aims Despite progress these recent years in support the hemodialysis, chronic pain remains a problem concern that ultimately affect the quality of life and psycho-emotional state, even among dialysis patients already psychologically fragile. However, it is often overlooked and its characteristics in chronic hemodialysis (HDC) are poorly understood. The purpose of this study was to evaluate the prevalence, features, impact and treatment of pain in our population of chronic hemodialysis patients and to determine the factors associated with it. Method cross-sectional study conducted in January 2020 including 71 chronic hemodialysis patients from the nephrology department of the CHU ibn rochd CASABLANCA. They were subjected to a questionnaire on socio-demographic characteristics, the characteristics of the pain, its impact on daily life, the various treatments performed. The pain is chronic if it persists for more than 3 months. The intensity was assessed using a visual analog scale. Results Of the 71 patients, 64.4% report chronic pain, the average age of our patients was 46.5 years, ranging from 16 to 93 years, with a sex ratio M/F 1.1, seniority hemodialysis was 17.3 years. The pain is continuous, frequent, intermittent and rare in respectively 55.5%, 27.5%, 13.7%, 3.44% of cases, it is a weak, moderate, severe, very severe in respectively: 13.7%, 58.6%, 17.24%, 10.3%, causing musculoskeletal was predominant in 75.8% of cases, the most common sites are: shoulders (47,23%), knees (34.5%), the head (41.2%) and the back (19.65%). It resounded on the patient's daily activity in 55.17%, and sleep in 41.3%, the treatment was essentially based analgesics in 58.6% of cases, these analgesics were level 1 in 47.1% cases and level 2 in 52.9% of cases. This is taken daily in 28.5% of patients, common in 42.8% and 28.5% rare among of them, the disappearance of pain was achieved in 65.51% of cases. In perdialyse, the intensity of the pain does not change in 79.4% of patients. Pain was favored by advanced age and age dialysis (advanced age (p = 0.043) and age dialysis (p = 0.01).) Conclusion Chronic pain is a major problem in hemodialysis by its high prevalence, its significant intensity and its impact on life daily patient. However its management remains inadequate. Regular assessment of pain using a well-codified questionnaire is necessary to improve the care of dialysis patients.

Arteriosclerosis in Dialysis Patients

1996 ◽  
Vol 19 (11) ◽  
pp. 638-644 ◽  
Author(s):  
J. Bommer ◽  
E. Strohbeck ◽  
J. Goerich ◽  
M. Bahner ◽  
I. Zuna
Keyword(s):  
Calcium Phosphate ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Time Interval ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
Vldl Cholesterol

Arteriosclerosis is a constant problem in long-term hemodialysis patients. Computer tomography of the abdominal aorta allows a well-defined and reproducible evaluation of aortosclerosis. In the cross-sectional study, aortosclerosis was significantly accelerated in 84 chronic hemodialysis patients and was comparable to the results found in 20-year older control patients without renal disease. The increase of aortosclerosis correlated significantly with age of the patient, smoking, and duration of dialysis therapy. Furthermore, increased VLDL cholesterol and decreased HDL cholesterol seem to enhance aortosclerosis in our dialysis patients. In the longitudinal study (two CT scans with a time interval of 87 ± 62.7 months) in 36 dialysis patients, progressed aortosclerosis correlated significantly with the long duration of hypertriglyceridemia, VLDL cholesterol, uric acid, and calcium phosphate products. Progression of aortosclerosis was reduced in parathyroidectomized patients. The study suggests that premature aortosclerosis is found in dialysis patients. In addition to the common risk factor of aortosclerosis, disturbed calcium phosphate and parathyroid hormone metabolism seem to enhance aortosclerosis in patients under maintenance hemodialysis.

scholarly journals MON-111 Effect of the dialysate calcium concentration and of the mineral bone disease therapies on mortality in the REIN registry

2019 ◽  
Vol 4 (7) ◽  
pp. S349-S350
Author(s):  
L. Mercadal ◽  
L. Oriane ◽  
C. Cécile ◽  
M. marie ◽  
B. philippe ◽  
...  
Keyword(s):  
Bone Disease ◽  
Calcium Concentration ◽  
Dialysate Calcium ◽  
Rein Registry

scholarly journals MP566SERUM CHROMIUM LEVEL IN CHRONIC PERITONEAL DIALYSIS PATIENTS IS HIGHER THAN IN CHRONIC HEMODIALYSIS PATIENTS

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii638-iii638
Author(s):  
Leonid Feldman ◽  
Ilia Beberashvili ◽  
Ramzia Abu Hamad ◽  
Iris Yakov-Hai ◽  
Elena Abramov ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Chromium Level

Annual Iron Loss Associated with Hemodialysis

2016 ◽  
Vol 43 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Tatsuo Tsukamoto ◽  
Takayuki Matsubara ◽  
Yuka Akashi ◽  
Morihiro Kondo ◽  
Motoko Yanagita
Keyword(s):  
Whole Blood ◽  
Iron Content ◽  
Iron Supplementation ◽  
Iron Status ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Total Iron ◽  
Iron Loss ◽  
Dialysis Session ◽  
Residual Blood

Background: In order to keep up the optimal iron status in chronic hemodialysis patients, it is important to know how much iron is lost due to hemodialysis. Residual blood associated with the hemodialysis procedure together with blood sampling inevitably causes the loss of iron in chronic hemodialysis patients. Recent advances in hemodialysis techniques might have reduced this complication. In this cross-sectional study, we directly measured total iron loss by hemodialysis. Methods: Two hundred thirty-nine patients who received chronic hemodialysis at Otowa Memorial Hospital were enrolled; 65.7% of patients were men, and mean age was 67 ± 6.4 years (mean ± SD) and 43.2% were diabetic. Residual blood in blood tubing set and dialyzer after rinse back with saline was collected and homogenized. The iron content including free, protein-bound and heme iron was measured using an atomic absorption spectrometry. Results: The mean iron content in residual blood was 1,247.3 ± 796.2 µg (mean ± SD) and the median was 1,002 µg (95% CI 377.6-3,461.6 µg), indicating 160.8 mg (95% CI 58.9-540.0 mg) iron loss annually when hemodialysis was performed 156 times a year. Fifty milliliter whole blood for monthly blood test and another 2 ml of whole blood lost by paracentesis at every dialysis session contains 228.6 and 118.9 mg iron at 11 g/dl hemoglobin, respectively. Therefore, an annual total iron loss due to hemodialysis comes to 508.3 mg (95% CI 406.4-887.5 mg). Conclusions: Five hundred milligram of annual iron supplementation might be sufficient to maintain iron status in hemodialysis patients, which is less than the dose recommended as 1,000-2,000 mg a year. Further study will be required to verify this iron supplementation dosage with recent hemodialysis procedure.

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