MO788ERYPTOSIS AND PARATHORMONE IN PATIENTS WITH END STAGE RENAL DISEASE TREATED BY HEMODIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Aya Hefny ◽  
Fatima El-Tahir ◽  
Abeer Fikry ◽  
Ali M Shendi
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Annexin V ◽  
Dialysis Session ◽  
Multilinear Regression ◽  
Multilinear Regression Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Hemodialysis ◽  
Pth Level

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.

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

Blood ◽  
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.

scholarly journals Parathyroid Hormone Status in Patients with End Stage Renal Disease on Maintenance Haemodialysis

2014 ◽  
Vol 4 (1) ◽  
pp. 13-17
Author(s):  
SM Sajjad ◽  
YA Zaman ◽  
MA Rahim ◽  
A Mahmuda ◽  
WMM Haque ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Calcium Phosphate ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Haemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Pth Level

Objective: To evaluate parathyroid hormone (PTH) status among end stage renal disease (ESRD) patients on maintenance haemodialysis (MHD). Methodology: This descriptive cross-sectional study was done in the Department of Nephrology, BIRDEM General Hospital, Dhaka, from April to September 2011. Results: A total of 50 patients were included in this study with a 3:2 male predominance. Mean age was 54.6 (range 34-76) years. Mean duration of ESRD was 3.73 years. All the patients were diabetic and other common co-morbidities were hypertension (76%), dyslipidaemia (56%), ischaemic heart disease (48%) and stroke (12%). They were receiving calcium (72%), vitamin D (40%), both calcium and vitamin D (38%) supplementation and 20% were not on any medication for treatment of chronic kidney disease mineral bone disorder (CKD-MBD). Mean pre-dialysis values of urea and creatinine were 30.28 mg/dl and 8.67 mg/dl respectively. Mean (± SD) serum level of calcium, phosphate and PTH were 8.32 (±1.26) mg/dl, 4.42 (±1.54) mg/dl and 125.45±117.71 pg/ml respectively. In 76% of the study subjects, PTH level was above normal. Significant difference (P=<0.05) in PTH levels was observed among patients with and without any medication for prevention of CKD-MBD but the levels were within the acceptable range. Serum calcium level in the study subjects had significant positive relationship with serum PTH level. It was also observed that PTH level had significant negative relationship with phosphate level. Conclusion: PTH level was higher in ESRD patients on MHD specially those who were not on any medication than those who took calcium, vitamin D or both but it was still within the acceptable reference range. In such patients, serum calcium, phosphate and PTH levels should be monitored periodically. DOI: http://dx.doi.org/10.3329/birdem.v4i1.18547 Birdem Med J 2014; 4(1): 13-17

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

2016 ◽  
Vol 60 (4) ◽  
pp. 2564-2566 ◽  
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.)

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

2019 ◽  
Vol 47 (Suppl. 2) ◽  
pp. 45-49 ◽  
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.

scholarly journals Progression of coronary artery calcification in conventional hemodialysis, nocturnal hemodialysis, and kidney transplantation

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244639
Author(s):  
Thijs T. Jansz ◽  
Akin Özyilmaz ◽  
Franka E. van Reekum ◽  
Franciscus T. J. Boereboom ◽  
Pim A. de Jong ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Coronary Artery ◽  
Renal Disease ◽  
Kidney Transplant ◽  
Vascular Calcification ◽  
End Stage Renal Disease ◽  
Nocturnal Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Hemodialysis

Introduction Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) and is strongly associated with vascular calcification. An important driver of vascular calcification is high phosphate levels, but these become lower when patients initiate nocturnal hemodialysis or receive a kidney transplant. However, it is unknown whether nocturnal hemodialysis or kidney transplantation mitigate vascular calcification. Therefore, we compared progression of coronary artery calcification (CAC) between patients treated with conventional hemodialysis, nocturnal hemodialysis, and kidney transplant recipients. Methods We measured CAC annually up to 3 years in 114 patients with ESRD that were transplantation candidates: 32 that continued conventional hemodialysis, 34 that initiated nocturnal hemodialysis (≥4x 8 hours/week), and 48 that received a kidney transplant. We compared CAC progression between groups as the difference in square root transformed volume scores per year (ΔCAC SQRV) using linear mixed models. Reference category was conventional hemodialysis. Results The mean age of the study population was 53 ±13 years, 75 (66%) were male, and median dialysis duration was 28 (IQR 12–56) months. Median CAC score at enrollment was 171 (IQR 10–647), which did not differ significantly between treatment groups (P = 0.83). Compared to conventional hemodialysis, CAC progression was non-significantly different in nocturnal hemodialysis -0.10 (95% CI -0.77 to 0.57) and kidney transplantation -0.33 (95% CI -0.96 to 0.29) in adjusted models. Conclusions Nocturnal hemodialysis and kidney transplantation are not associated with significantly less CAC progression compared to conventional hemodialysis during up to 3 years follow-up. Further studies are needed to confirm these findings, to determine which type of calcification is measured with CAC in end-stage renal disease, and whether that reflects cardiovascular risk.

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

2017 ◽  
Vol 10 ◽  
pp. 117863291771302 ◽  
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.

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

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.

β2-Microglobulin Elimination in End-Stage Renal Disease Patients on Renal Replacement Therapy

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 520-522
Author(s):  
Vladisav Stefanovic' ◽  
Svetislav Kostic' ◽  
Vidojko Djordjevic' ◽  
Marina Mitic' ◽  
Momcilo Bogicevic'
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Fluid ◽  
Efficient Removal ◽  
Β2 Microglobulin ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Hemodialysis ◽  
Esrd Patients

β2-microglobulin (β2M) is a small molecular mass protein associated with dialysis amyloidosis. We have studied β2M elimination in end-stage renal disease (EsRD) patients treated by peritoneal dialysis. In 12 patients on continuous ambulatory peritoneal dialysis (CAPD) and 7 patients on intermittent peritoneal dialysis (IPD) 30.4±4.2 mg/day and 21.3± 1.8 mg/12 hour of β2M, respectively, were removed by dialysis fluid. Approximately the same amount of β2M was removed by each of four 2-L exchanges in CAPD; however, the most efficient removal of β2M was in the first IPD exchange. Serum β2M levels in these patients were 25.7 ±4.4 and 31.4±5.2 mg/L, respectively. In 24 patients on hemodialysis using cuprophan membrane the serum level of β2M was 55.1±4.1 mg/L. After a 3-month dialysis on polyacrylonitrile (PAN) membrane, the serum β2M level decreased to 45.0±2.3 mg/L. A substantial amount of β2M was removed by urine, 14.6.:1:2.3 mg/L, and saliva, 2.3±0.4 mg/L. This study has shown markedly increased β2M levels in patients on conventional hemodialysis treatment, predisposing to β2M-related amyloidosis. A significant amount of β2M was removed during both CAPD and IPD treatment.

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