Increased Levels of Anaphylatoxin (C5a) and Bradykinin in End-Stage Renal Disease Patients on Maintenance Hemodialysis. Potential Relevance to Heparin Mediated Hemodynamic Responses

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4079-4079
Author(s):  
Cafer Adiguzel ◽  
Vinod Bansal ◽  
Josephine Cunanan ◽  
Evangelos Litinas ◽  
Debra Hoppensteadt ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Sandwich Elisa ◽  
Maintenance Hemodialysis ◽  
Control Group ◽  
Contact Activation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Besides the upregulation of inflammatory mediators, end stage renal disease (ESRD) patients maintained on hemodialysis are subjected to periodic exposure to heparin and contact activation due to procedural settings. Recently the presence of a heparin contaminant, namely hypersulfated chondroitin sulfate was linked with the adverse reactions and deaths observed in these patients (Kishmoto, et al. N J Med 2008). To validate this report we measured both the C5a anaphlatoxin and bradykinin levels in ESRD patients prior to and after maintenance hemodialysis. The control group comprised of 40 normal healthy individuals were included to establish the normal level of these mediators. A sandwich ELISA method utilizing a monoclonal antibody which is specific for human C5a and bradykinin were used in these studies. Both the C5a and bradykinin were elevated in pre-dialysis samples from ESRD patients (C5a: 3.2±0.6 ng/ml vs 14.2± 4.6 ng/ml, bradykinin: 6.4±1.8 ng/ml vs 9.3±2.4 ng/ml). Moreover, dialysis itself produced an increase in both the C5a and bradykinin levels. Moreover, the postdialysis samples were further increased, suggesting that dialysis and heparinization itself result in the up-regulation of these mediators. Supplementation of heparin to the plasma also resulted in the generation of both C5a and bradykinin. The plasma samples included in these studies represents patients who were not treateded with the contaminant heparin. Additional studies on in-vitro generation of these markers with contaminated heparin and the isolated contaminant showed that both of these triggered the generation of C5a and bradyknin. These results suggest that both C5a and bradykinin are up-regulated in ESRD patients and this level can be further augmented by dialysis and heparinization. Therefore, additional factors may have contributed to the complex adverse reaction profiles and deaths in patients administrated with contaminated heparin.

scholarly journals Clinical Manifestations of Cardiac Disease in Patients with End Stage Renal Disease Under Maintenance Hemodialysis in a Tertiary Level Hospital of Nepal

2016 ◽  
Vol 15 (1) ◽  
pp. 61-65
Author(s):  
Kumar Roka ◽  
Pratibha Bista Roka
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Low Voltage ◽  
Clinical Manifestations ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Introduction: End stage renal disease presents with multiple clinical and systemic manifestations. The aim of the present study was to identify the early cardiac and other morbidities in end stage renal disease (ESRD) patients who were under maintenance hemodialysis.Methods: This was an observational, prospective study conducted in fifty established ESRD patients of 20 to 74 years under maintenance hemodialysis in Nephrology unit of Shree Birendra Hospital. Clinical examination, laboratory parameters, electrocardiogram and echocardiography findings were used to identify the morbidities. Results: Among all patients enrolled in the study 88.7% had anemia, 64.2 % systolic murmurs, 62.26 % pedal edema, 73.6 % fatiguability, 71.7 % angina, 24.4 % palpitations and 13.2 % had breathlessness on exertion.  62.26% of the patients had hypertension and 13.20 % had diabetes. In the electrocardiogram, prolonged QTc was observed in 10.4%, followed by T wave inversion in 9.4 % and finally low voltage complex comprised 7.6 %. The echocardiogram showed left ventricular diastolic dysfunction in 58.5 %, left ventricular hypertrophy (overall type) 49 % and valvular lesion like mitral regurgitation and tricuspid regurgitation 83 % and 58.5 % respectively. Conclusion: Cardiac co-morbidities are common in patients diagnosed with ESRD on maintenance hemodialysis.

scholarly journals Redox Balance Correlates with Nutritional Status among Patients with End-Stage Renal Disease Treated with Maintenance Hemodialysis

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Małgorzata Maraj ◽  
Beata Kuśnierz-Cabala ◽  
Paulina Dumnicka ◽  
Katarzyna Gawlik ◽  
Dorota Pawlica-Gosiewska ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Renal Disease ◽  
Antioxidant Capacity ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Sod Activity ◽  
Antioxidant Power ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Over 50% of end-stage renal disease (ESRD) patients die of cardiovascular disease. ESRD patients treated with maintenance hemodialysis are repeatedly exposed to oxidative stress. The aim of the study was to find the relationship between lifestyle factors, nutritional status, calcium-phosphate metabolism, and selected redox parameters such as glutathione peroxidase (GPx), glutathione reductase (GR), superoxide dismutase (SOD), uric acid (UA), and total antioxidant capacity expressed as ferric reducing antioxidant power (FRAP). The study included 97 ESRD hemodialysis patients and 42 controls with no renal disease. Patients were asked to complete a questionnaire which gathered information on their physical activity, hours of sleep, smoking, and frequency of fruit and vegetable intake; the blood samples were then drawn before the midweek dialysis session. The ESRD patients had lower levels of GR, GPx, and SOD activity, a lower level of FRAP, and a higher UA concentration than the control group. The FRAP value decreased with age (ρ=−0.32, p=0.001); smokers had a significantly lower SOD activity in comparison to nonsmokers (p=0.03). In the ESRD patients, FRAP and UA correlated with both albumin (ρ=0.26, p=0.011; ρ=0.41, p=0.006, respectively) and prealbumin (ρ=0.34, p≤0.001; ρ=0.28, p=0.006, respectively), whereas UA, GR, GPx, and SOD correlated with calcium, UA, GR, and GPx with phosphate level. Based on the findings, there are weak associations between nutritional status and selected redox parameters in hemodialyzed patients. Further studies are needed to establish if diet modifications and adequate nutritional status can positively impact the antioxidant capacity in this group of patients.

scholarly journals Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

2020 ◽  
Author(s):  
Shaohui Ma ◽  
Ming Zhang ◽  
Yang Liu ◽  
Dun Ding ◽  
Peng Li ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Renal Disease ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Neuropsychological Tests ◽  
Maintenance Hemodialysis ◽  
Rich Club ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background End-stage renal disease (ESRD) patients are at substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there did not provide an uncontested result whether cognition was improved or worsened during dialysis. Methods To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), ESRD patients before dialysis initiation (bESRD) and those undergoing maintenance hemodialysis (mESRD). All ESRD patients performed a serious of blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K + and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in mESRD and bESRD groups. Results Neuropsychological analysis showed mESRD exhibited greater cognitive function than bESRD, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the bESRD and mESRD than the HCs. Besides, lower normalized clustering coefficient was in bESRD relative to the HCs and mESRD. For the GLMs analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in bESRD. Conclusions Our study revealed that dialysis had a limited effect on cognitive improvement. Cystatin C may be a risk feature of cognitive decline of bESRD.

scholarly journals Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

2020 ◽  
Author(s):  
Shaohui Ma ◽  
Ming Zhang ◽  
Yang Liu ◽  
Dun Ding ◽  
Peng Li ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Renal Disease ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Neuropsychological Tests ◽  
Maintenance Hemodialysis ◽  
Rich Club ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background: End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there isn’t an uncontested result whether cognition was improved or worsened during dialysis.Methods: To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), predialysis ESRD patients (predialysis group), and maintenance hemodialysis ESRD patients (HD group). All ESRD patients performed six blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K+, and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in the HD group and predialysis group.Results: Neuropsychological analysis showed the HD group exhibited better cognitive function than the predialysis group, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the predialysis group and HD group than the HCs. Besides, a lower normalized clustering coefficient was found in the predialysis group relative to the HCs and HD group. For the GLM analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in the predialysis group.Conclusions: Our study revealed that dialysis had a limited effect on cognitive improvement.

scholarly journals Prevalence of Renal Osteodystrophy and its Related Factors among Patients with End-Stage Renal Disease Undergoing Hemodialysis: Single Center Experience from Kermanshah, Iran

2021 ◽  
Author(s):  
Abolhassan Seyedzadeh ◽  
Mohamad Reza Tohidi ◽  
Sima Golmohamadi ◽  
Hamid Reza Omrani ◽  
Mohammad Saleh Seyedzadeh ◽  
...  
Keyword(s):  
Renal Disease ◽  
Bone Turnover ◽  
Renal Osteodystrophy ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Related Factors ◽  
Laboratory Variables ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Objectives: The current study aimed to determine the prevalence of Renal Osteodystrophy (ROD) and its related factors in a group consisting of End-Stage Renal Disease (ESRD) patients undergoing maintenance hemodialysis. Methods: One hundred twenty –eight ESRD patients (52 men & 76 women) with a mean age of 59.3 years old undergoing maintenance hemodialysis at Imam Reza Referral Hospital, were included in this cross-sectional study. Thereafter, serum parathyroid hormone (PTH) levels were measured, and the range of 150 to 300 pg/mL was determined as the desirable range for the values. Values lower or higher than this range were used to determine ROD. Furthermore, this study investigated the association of ROD with clinical and laboratory variables (age at the onset of renal failure, hemodialysis sessions per week, clinical symptoms associated with renal osteodystrophy, and serum calcium and phosphate levels). Results: ROD was diagnosed in 93 patients (72.7%) out of 128 patients studied. Of them, 53 (41.4%) patients had PTH levels above 300 pg/mL (high bone turnover, HTO group) and 40 patients (31.3%) had PTH levels below 150 pg/mL (low bone turnover, LTO group). No statistically significant difference was detected in terms of ROD-related clinical findings (P=0.11), age at the time of ESRD diagnosis (P=0.2), and number of hemodialysis sessions per week (P=0.2). Hyperphosphatemia (52 patients, 57.1%) was more prevalent in ROD group compared with 11 patients (31.4%) included in the group without ROD (P=0.004). Conclusion: The prevalence rate of ROD in this study was found to be significant, and it was largely consistent with the rate reported in the research previously performed in some Asian countries. Hyperphosphatemia were laboratory variables closely related to ROD.

scholarly journals Associations of Common Variants in HFE and TMPRSS6 Genes with Hepcidin-25 and Iron Status Parameters in Patients with End-Stage Renal Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Violeta Dopsaj ◽  
Aleksandra Topić ◽  
Miljan Savković ◽  
Neda Milinković ◽  
Ivana Novaković ◽  
...  
Keyword(s):  
Renal Disease ◽  
Diagnostic Accuracy ◽  
End Stage Renal Disease ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Deficiency Anemia ◽  
Control Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background. Influence of TMPRSS6 A736V and HFE (C282Y and H63D) polymorphisms on serum hepcidin-25 levels and iron status parameters in end-stage renal disease (ESRD) patients stratified according to gender has not been previously investigated. In addition, we aimed to evaluate the diagnostic accuracy of the parameters to separate iron-deficiency anemia (IDA) from anemia of chronic disease. Materials and Methods. Iron status parameters and genetic analysis were performed in 126 ESRD patients and in 31 IDA patients as the control group. Results. ESRD patients had significantly higher ferritin and hepcidin-25 (<0.001) relative to IDA patients. Cut-off values with the best diagnostic accuracy were found for hepcidin ≥9.32 ng/mL, ferritin ≥48.2 μg/L, transferrin saturation ≥16.8%, and MCV ≥81 fL. Interaction between gender and HFE haplotypes for the hepcidin-25 and ferritin levels in ESRD patients (p=0.005, partial eta squared=0.09; p=0.027, partial eta squared=0.06, respectively) was found. Serum transferrin was influenced by the combined effect of gender and TMPRSS6 A736V polymorphism in ESRD patients (p=0.002, partial eta squared=0.07). Conclusion. Our findings could contribute to the further investigation of mechanisms involved in the pathophysiology and important gender-related involvement of the TMPRSS6 and HFE polymorphisms on anemia in ESRD patients.

Impaired resistance artery function in patients with end-stage renal disease

2011 ◽  
Vol 120 (12) ◽  
pp. 525-536 ◽  
Author(s):  
Natallia Luksha ◽  
Leanid Luksha ◽  
Juan Jesús Carrero ◽  
Folke Hammarqvist ◽  
Peter Stenvinkel ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Nitrosative Stress ◽  
Control Group ◽  
Strong Impact ◽  
Arterial Distensibility ◽  
Functional Features ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

We investigated an effect of uraemia on structural and functional features of human resistance vasculature. Arteries (≈ 200 μm) isolated from subcutaneous fat biopsies obtained from 35 ESRD (end-stage renal disease) patients starting peritoneal dialysis and 30 matched controls were studied using isolated small artery bioassays. Flow-mediated dilatation was attenuated in ESRD patients compared with controls. NO (nitric oxide) contribution to flow was lacking in ESRD patients, but present in the controls. ADMA (asymmetrical dimethyl L-arginine) levels were higher in the ESRD group compared with the control group. Dilatation in response to acetylcholine was reduced in ESRD patients compared with controls, but response to NO donor was similar. Expression of nitrotyrosine and heat shock proteins 70 and 27, but not 90, was increased in arteries from ESRD patients compared with controls. Arterial remodelling was absent in ESRD patients. There was no difference between the groups in myogenic tone, vascular reactivity or sensitivity to several vasoconstrictors. Arterial distensibility, reflecting passive properties of the vascular wall, was reduced in ESRD patients compared with controls. Exclusion of ESRD patients with diabetes and/or cardiovascular disease from analyses had no influence on the main findings. Thus we propose that uraemia has a strong impact on endothelial function and passive properties of the arterial wall of human peripheral resistance vasculature. The reduced contribution of NO to flow stimulus via enhanced nitrosative stress and higher plasma concentrations of ADMA may suggest potential mechanisms behind endothelial dysfunction in the resistance peripheral circulation in ESRD.

scholarly journals Factors Affecting Carpal Tunnel Syndrome in End Stage Renal Disease with Maintenance Hemodialysis: A Systematic Review

2021 ◽  
pp. 05-12
Author(s):  
Dary Gunawan ◽  
Theodore Dharma Tedjamartono
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Renal Disease ◽  
Carpal Tunnel ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Number Of Patients ◽  
Tunnel Syndrome ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Introduction: The number of patients with End Stage Renal Disease (ESRD) is increasing every year, as well as those who have to undergo hemodialysis. Most hemodialysis must be undertaken in a long time. Long term hemodialysis is known to be associated with the incidence of Carpal Tunnel Syndrome (CTS). Method: This study aimed to systematically review factors contributing in the mentioned problem. Literature research was done using three search engines, consist of Google Scholar, Pubmed and ProQuest. Journals used are limited to the last 5 years or those deemed to be relevant. The studies obtained were further read and and appraised critically. Result and Discussion: From a total of 423 journals, 4 articles were selected based on inclusion and exclusion criteria. The prevalence of CTS was found to be higher in ESRD patients undergoing maintenance hemodialysis (MHD). Age, Gender, MHD Duration, β2-Microglobulin are factors that have long been known to play a role. Several other factors such as serum prealbumin, serum albumin, Blood Lead Levels, hepatitis infection, wrist injury, predialytic urea serum and BMI have been implicated in the incidence of CTS in ESRD patients undergoing MHD in some literatures. Conclusion: The factors mentioned earlier were found to have different roles and it is interesting for further reviewed. However, unfortunately there is still very little research that discuss these matters and more research needs to be done related to the factors above.

scholarly journals Serum Sclerostin But Not DKK-1 Correlated with Central Arterial Stiffness in End Stage Renal Disease Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 1230 ◽  
Author(s):  
Chun-Feng Wu ◽  
Jia-Sian Hou ◽  
Chih-Hsien Wang ◽  
Yu-Li Lin ◽  
Yu-Hsien Lai ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Arterial Stiffness ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Serum Levels ◽  
Control Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Sclerostin and dickkopf-1 (DKK1) played a role in the development of cardiovascular diseases and arterial stiffness in chronic kidney disease (CKD) patients but with controversial results of patients in end-stage renal disease (ESRD) including hemodialysis (HD) and peritoneal dialysis (PD). This study aimed to examine the association between the mode of dialysis or the values of sclerostin or DKK1 and carotid-femoral pulse wave velocity (cfPWV) in ESRD patients. There were 122 HD and 72 PD patients enrolled in this study. By a validated tonometry system, cfPWV was measured and then segregated patients into values of >10 m/s as the high central arterial stiffness (AS) group and values ≤ 10 m/s as the control group. Serum levels of sclerostin and DKK1 were measured using a commercial enzyme-linked immunosorbent assay kit. Possible risk factors for the development of AS were analyzed by logistic regression analysis. There were 21 (29.2%) of PD and 53 (43.4%) of HD in the high AS group. Compared to patients in the control group, those in the high AS group were older, had more comorbidities, had higher systolic blood pressure, and had higher serum levels of fasting glucose, C-reactive protein, and sclerostin. Levels of sclerostin (adjusted OR 1.012, 95% CI. 1.006–1.017, p = 0.0001) was found to be an independent predictor of high AS in ESRD patients by multivariate logistic regression analysis. Furthermore, receiver operating characteristic curve analysis showed the optimal cut-off values of sclerostin for predicting AS was 208.64 pmol/L (Area under the curve 0.673, 95% CI: 0.603–0.739, p < 0.001). This study showed that serum levels of sclerostin, but not DKK1 or mode of dialysis, to be a predictor for high central AS in ESRD patients.

scholarly journals Dyslipidemia among Patients with End Stage Renal Disease on Maintenance Hemodialysis

2018 ◽  
pp. 123-128
Author(s):  
Mohammed Ghazi Abdulhadi ◽  
Mohammed Omer Mohammed ◽  
Fenk Bakir Maarouf
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
High Plasma ◽  
Atherogenic Index ◽  
Maintenance Hemodialysis ◽  
Control Group ◽  
Low Hdl ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Dyslipidemia has been suggested to be one of the factors that contribute to the high incidence of cardiovascular disease in hemodialysis patients. Previous studies suggest that end-stage renal disease may contribute to dyslipidemia. The aim of the study: to assess the prevalence of dyslipidemia in patients on maintenance hemodialysis. Patients and Methods: A case-control study was conducted from February 2015 until August 2015 in Ibn-Sena teaching hospital on 100 participants (52 males and 48 females), 50 were patients with end-stage renal disease on regular hemodialysis and 50 were age and gender-matched apparently healthy subjects as the control. Questioner used to collect data, a thorough examination was done including height and weight and BMI. A blood sample from all participants in fasting state was sent for the renal function test, complete blood picture, serum albumin, electrolytes, TG, total cholesterol, LDL and HDL measured by the enzymatic method, plasma atherogenic index calculated as [log (TG/HDL)].   Results: Age of the participants ranged between 18 - 70 years and the mean age was (44.45 ± 13.6) years. In HD group, the mean cholesterol  was  (3.29 + 0.73) mmol/l, serum TG (2.38 ± 0.56) mmol/l, LDL (1.91 ± 0.66) mmol/l, HDL (0.88 ± 0.2) mmol/l, atherogenic index (0.434 ± 0.16), while in control group, the mean cholesterol  was (4.17 ± 0.69) mmol/l, serum TG (1.6 ± 0.43) mmol/l, LDL (2.69 ± 0.63 ) mmol/l, HDL (1.066 ± 0.13) mmol/l, atherogenic index (0.177 ± 0.12).  The lipid abnormalities in hemodialysis group were high plasma atherogenic index in 84%, hypertriglyceridemia 50%, hypercholesterolemia 8% and high LDL  6% and low HDL in 48%, while in control group, high plasma atherogenic index in 34%, hypertriglyceridemia in 26%, hypercholesterolemia 14% high LDL 7% and low HDL in 16%. Conclusions: patients with end-stage renal disease on hemodialysis have significant dyslipidemia compared to control group characterized by hypertriglyceridemia, low HDL and high atherogenic index of plasma.

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