When CKD-MBD is not just CKD-MBD, a case of humoral hypercalcemia of malignancy in a dialysis patient

2020 ◽  
Vol 4 (3) ◽  
pp. 128-131
Author(s):  
Pulkit Gandhi ◽  
Roopali Goyal Gandhi ◽  
Ankur D Shah
Keyword(s):  
Kidney Disease ◽  
Dialysis Patient ◽  
Maintenance Hemodialysis ◽  
Humoral Hypercalcemia Of Malignancy ◽  
End Stage Kidney Disease ◽  
Hypercalcemia Of Malignancy ◽  
Humoral Hypercalcemia ◽  
Increased Risk ◽  
End Stage ◽  
The Relationship

Patients on maintenance hemodialysis have dysregulations of calcium and phosphorus homeostasis which results in a plethora of mineral and bone pathologies. Management is typically focused on maintenance eucalcemia and limiting hyperphosphatemia while avoiding extremes of intact parathyroid hormone. Hypercalcemia in this setting is often iatrogenic. We present a case of humoral hypercalcemia of malignancy initially thought to be iatrogenic due to mineral bone management and discuss the overlap of management of hypercalcemia and management of mineral bone disease in end stage kidney disease. We highlight the relationship between malignancy and end stage kidney disease and the increased risk of hypercalcemia associated with malignancy.

scholarly journals Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation

2021 ◽  
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Aristi Boulmpou ◽  
Christodoulos E Papadopoulos ◽  
Aikaterini Papagianni ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
End Stage Kidney Disease ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Functional Reserves ◽  
Increased Risk ◽  
End Stage

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

MO436PLASMA OXALATE VALUES IN PATIENTS WITH END-STAGE KIDNEY DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ella Metry ◽  
Sander Garrelfs ◽  
Michiel Oosterveld ◽  
Aegida Neradova ◽  
Joost Bijlsma ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Plasma Concentrations ◽  
Maintenance Hemodialysis ◽  
Healthy Individuals ◽  
End Stage Kidney Disease ◽  
Waste Products ◽  
Therapeutic Work ◽  
Reference Limit ◽  
End Stage ◽  
Work Up

Abstract Background and Aims Patients with end-stage kidney disease (ESKD) are known to have higher plasma concentrations of metabolic waste products than healthy individuals. Patients with Primary Hyperoxaluria (PH), a rare congenital cause of ESKD, suffer from hepatic overproduction of the metabolic end product oxalate. Plasma oxalate (POx) levels are determined in the diagnostic and therapeutic work-up for PH. Remarkably, correct interpretation of these values is hampered by the absence of knowledge concerning POx levels in patients with ESKD due to common causes. Method In this observational study, we obtained POx values in patients with ESKD due to another cause than PH, to establish reference values in this patient group. We collected blood samples from 120 adults with eGFR < 15 mL/min/1.73 m2 who required maintenance hemodialysis or peritoneal dialysis at the Amsterdam UMC. Results While there was a wide variation in POx levels in patients with ESKD, the median was 50 umol/L and lowest values were twice the upper reference limit that applies to healthy individuals (6.7 umol/L). Conclusion This study shows that POx levels of 50 umol/L are not necessarily suggestive for PH which contradicts the current literature. This study could lead to a paradigm shift in the diagnostic and therapeutic work-up for patients with ESKD.

scholarly journals The Serum Concentration of Anti-Aging Proteins, Sirtuin1 and αKlotho in Patients with End-Stage Kidney Disease on Maintenance Hemodialysis

2020 ◽  
Vol Volume 15 ◽  
pp. 387-393 ◽  
Author(s):  
Edyta Zbroch ◽  
Angelika Bielach - Bazyluk ◽  
Jolanta Malyszko ◽  
Ewa Koc-Zorawska ◽  
Alicja Rydzewska-Rosolowska ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Serum Concentration ◽  
Maintenance Hemodialysis ◽  
End Stage Kidney Disease ◽  
End Stage

Types of erythropoiesis-stimulating agents and risk of end-stage kidney disease and death in patients with non-dialysis chronic kidney disease

2020 ◽  
Author(s):  
Roberto Minutolo ◽  
Carlo Garofalo ◽  
Paolo Chiodini ◽  
Filippo Aucella ◽  
Lucia Del Vecchio ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Endpoint ◽  
End Stage Kidney Disease ◽  
Short Acting ◽  
Erythropoiesis Stimulating Agents ◽  
Increased Risk ◽  
Significant Difference ◽  
Long Acting ◽  
End Stage

Abstract Background Despite the widespread use of erythropoiesis-stimulating agents (ESAs) to treat anaemia, the risk of adverse outcomes associated with the use of different types of ESAs in non-dialysis chronic kidney disease (CKD) is poorly investigated. Methods From a pooled cohort of four observational studies, we selected CKD patients receiving short-acting (epoetin α/β; n = 299) or long-acting ESAs (darbepoetin and methoxy polyethylene glycol-epoetin β; n = 403). The primary composite endpoint was end-stage kidney disease (ESKD; dialysis or transplantation) or all-cause death. Multivariable Cox models were used to estimate the relative risk of the primary endpoint between short- and long-acting ESA users. Results During follow-up [median 3.6 years (interquartile range 2.1–6.3)], the primary endpoint was registered in 401 patients [166 (72%) in the short-acting ESA group and 235 (58%) in the long-acting ESA group]. In the highest tertile of short-acting ESA dose, the adjusted risk of primary endpoint was 2-fold higher {hazard ratio [HR] 2.07 [95% confidence interval (CI) 1.37–3.12]} than in the lowest tertile, whereas it did not change across tertiles of dose for long-acting ESA patients. Furthermore, the comparison of ESA type in each tertile of ESA dose disclosed a significant difference only in the highest tertile, where the risk of the primary endpoint was significantly higher in patients receiving short-acting ESAs [HR 1.56 (95% CI 1.09–2.24); P = 0.016]. Results were confirmed when ESA dose was analysed as continuous variable with a significant difference in the primary endpoint between short- and long-acting ESAs for doses >105 IU/kg/week. Conclusions Among non-dialysis CKD patients, the use of a short-acting ESA may be associated with an increased risk of ESKD or death versus long-acting ESAs when higher ESA doses are prescribed.

Heparin Leakage by Advective-Diffusive Transport in Central Venous Catheters

2013 ◽  
Author(s):  
Patrick M. McGah ◽  
Michael Barbour ◽  
Alberto Aliseda ◽  
Kenneth W. Gow
Keyword(s):  
Blood Flow ◽  
Kidney Disease ◽  
Central Venous Catheters ◽  
Artificial Kidney ◽  
Diffusive Transport ◽  
End Stage Kidney Disease ◽  
Central Venous ◽  
Increased Risk ◽  
End Stage

Central venous catheters (CVCs) are used as a way to provide adequate access of blood flow for hemodialysis, a common treatment for end-stage kidney disease. During hemodialysis, the catheter must circulate up to 300 mL/min [1] of blood flow to the extracorporeal artificial kidney. Catheters contain two lumens: the inflow lumen provides flow to the artificial kidney, and the outflow lumen returns it to the patient’s circulation. Although catheters are used in the treatment of patients of all ages, this study is motivated by the use of central venous catheters for pediatric applications; the catheter types and calibers available for children are much more limited than for adults, thereby placing children in a further disadvantage and potentially subjecting them to increased risk of complications.

scholarly journals Cerebral blood flow regulation in end-stage kidney disease

2020 ◽  
Vol 319 (5) ◽  
pp. F782-F791
Author(s):  
Justin D. Sprick ◽  
Joe R. Nocera ◽  
Ihab Hajjar ◽  
W. Charles O’Neill ◽  
James Bailey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Kidney Disease ◽  
Cerebral Oxygenation ◽  
Cerebrovascular Reactivity ◽  
Regulatory Mechanisms ◽  
End Stage Kidney Disease ◽  
Increased Risk ◽  
End Stage

Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) experience an increased risk of cerebrovascular disease and cognitive dysfunction. Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD and how the maintenance of cerebral oxygenation may be compromised during HD. Patients with ESKD exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or “stunning.” Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remains relatively unexplored. In particular, cerebral autoregulation can oppose reductions in CBF driven by reductions in systemic blood pressure, while cerebrovascular reactivity to CO2 may attenuate intradialytic reductions in CBF through promoting cerebral vasodilation. However, whether these mechanisms are effective in ESKD and during HD remain relatively unexplored. Important areas for future work include investigating potential alterations in cerebrovascular regulation in CKD and ESKD and how key regulatory mechanisms are engaged and integrated during HD to modulate intradialytic declines in CBF.

scholarly journals ASSESSMENT OF NUTRITIONAL STATUS IN END STAGE KIDNEY DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS.

2020 ◽  
pp. 1-3
Author(s):  
P. C Sandhya ◽  
Himanshu Sharma ◽  
M. Gupta
Keyword(s):  
Kidney Disease ◽  
Nutritional Status ◽  
Dietary Protein ◽  
Calorie Intake ◽  
Maintenance Hemodialysis ◽  
Study Cohort ◽  
End Stage Kidney Disease ◽  
Nutritional Counselling ◽  
End Stage ◽  
The Impact

ABSTRACT Background: Malnutrition is a common problem in patients with end-stage-kidney-disease (ESKD) and is a strong risk factor for morbidity and mortality. ESKDis a maladaptive metabolic state and patients need to increase their dietary protein and calorie intake especially when on maintenance dialysis. In a developing country like India, the economic and knowledge barrier affects the diet of the patient. In this study we assessed the prevalence of malnutrition and the impact of dietary counselling on improvement in nutritional status of the patient. Method: This study enrolled patients undergoing maintenance hemodialysis in our centre between June 2017 and June 2019. The prevalence of malnutrition was assessed by Subjective Global Assessment (SGA). Dietary history was recorded with a 24-hour dietary recall method. The patient was then periodically counselled regarding adequate dietary protein and calorie requirement and was re-assessed for the prevalence of malnutrition at the end of 6 months. Results: The mean age of study cohort was 38.76±10.85 years and 64 % were male.Hypertension (38.89%) and Diabetes (11.11%) were the most common co-morbid illnesses.The prevalence of PEW was 92% at baseline and 86% at the end of 6 months of follow up. There was a significant increase in BMI from 19.97 to 20.38 (p=0.022). Most of the study patients were from very low socioeconomic status (78% Class V modified Prasad's scale). Conclusions: There is a very high prevalence of protein-energy malnutrition among ESKD patients on maintenance haemodialysis. Nutritional counselling resulted in statistically significant improvement in the prevalence of malnutrition. Hence,nutritional counselling must be given regularly to patients with kidney disease.

scholarly journals Serum Erythroferrone Levels Associate with Mortality and Cardiovascular Events in Hemodialysis and in CKD Patients: A Two Cohorts Study

2019 ◽  
Vol 8 (4) ◽  
pp. 523 ◽  
Author(s):  
Spoto ◽  
Kakkar ◽  
Lo ◽  
Devalaraja ◽  
Pizzini ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Iron Absorption ◽  
Linear Increase ◽  
Enzyme Linked Immunosorbent Assay ◽  
End Stage Kidney Disease ◽  
End Point ◽  
Traditional Risk Factors ◽  
End Stage ◽  
Stage 1 ◽  
The Relationship

Erythroferrone (ERFE) is a hepcidin inhibitor whose synthesis is stimulated by erythropoietin, which increases iron absorption and mobilization. We studied the association between serum ERFE and mortality and non-fatal cardiovascular (CV) events in a cohort of 1123 hemodialysis patients and in a cohort of 745 stage 1–5 chronic kidney disease (CKD) patients. Erythroferrone was measured by a validated enzyme-linked immunosorbent assay (ELISA). In the hemodialysis cohort, serum ERFE associated directly with erythropoiesis stimulating agents (ESA) dose (p < 0.001) and inversely with serum iron and ferritin (p < 0.001). Erythroferrone associated with the combined outcome in an analysis adjusting for traditional risk factors, factors peculiar to end-stage kidney disease, serum ferritin, inflammation, and nutritional status (HR, hazard ratio, (5 ng/mL increase: 1.04, 95% confidence interval, CI: 1.01–1.08, p = 0.005). Furthermore, treatment with ESA modified the relationship between ERFE and the combined end-point in adjusted analyses (p for the effect modification = 0.018). Similarly, in CKD patients there was a linear increase in the risk for the same outcome in adjusted analyses (HR (2 ng/mL increase): 1.04, 95% CI: 1.0–1.07, p = 0.015). Serum ERFE is associated with mortality and CV events in CKD and in HD patients, and treatment by ESA amplifies the risk for this combined end-point in HD patients.

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