Metabolomic analysis of uremic pruritus in patients on hemodialysis

Pruritus is a common debilitating symptom experienced by hemodialysis patients. Treatment is difficult because the cause of uremic pruritus is not known. This study addressed the hypothesis that pruritus is caused by solutes that accumulate in the plasma when the kidneys fail. We sought to identify solutes responsible for uremic pruritus using metabolomic analysis to compare the plasma of hemodialysis patients with severe pruritus versus mild/no pruritus. Pruritus severity in hemodialysis patients was assessed using a 100-mm visual analogue scale (VAS), with severe pruritus defined as >70 mm and mild/no pruritus defined as <10 mm. Twelve patients with severe pruritus (Itch) and 24 patients with mild/no pruritus (No Itch) were included. Pre-treatment plasma and plasma ultrafiltrate were analyzed using an established metabolomic platform (Metabolon, Inc.). To identify solutes associated with pruritus, we compared the average peak area of each solute in the Itch patients to that of the No Itch patients using the false discovery rate (q value) and principal component analysis. Dialysis vintage, Kt/Vurea, and serum levels of calcium, phosphorus, PTH, albumin, ferritin, and hemoglobin were similar in the Itch and No Itch patients. Metabolomic analysis identified 1,548 solutes of which 609 were classified as uremic. No difference in the plasma or plasma ultrafiltrate levels of any solute or group of solutes was found between the Itch and No Itch patients. Metabolomic analysis of hemodialysis patients did not reveal any solutes associated with pruritus. A limitation of metabolomic analysis is that the solute of interest may not be included in the metabolomic platform’s chemical library. A role for uremic solutes in pruritus remains to be established.

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Effects of Oral Base Therapy on Serum Ionized Calcium, Phosphorus and Parathyroid Hormone in Chronic Hemodialysis Patients

The International Journal of Artificial Organs ◽

10.1177/039139888901201208 ◽

1989 ◽

Vol 12 (12) ◽

pp. 778-781 ◽

Cited By ~ 2

Author(s):

R. J. Caruana ◽

R. S. Weinstein ◽

H. T. Campbell ◽

B. A. Chaudhary ◽

K. L. Smith ◽

...

Keyword(s):

Parathyroid Hormone ◽

Serum Levels ◽

Empiric Therapy ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Ionized Calcium ◽

Chemical Parameters ◽

Calcium Phosphorus ◽

Serum Ionized Calcium ◽

Pre Treatment

The purpose of this study was to evaluate the effects of oral base therapy on selected chemical parameters in chronic hemodialysis patients. Oral base supplements were administered to 20 acidotic chronic hemodialysis patients for one month. Serum bicarbonate levels rose from 18.6 ± 2.9 to 22.5 ± 4.0 mEq/L (p<0.0005) and pH rose from 7.35 ± 0.03 to 7.39 ± 0.04 (p<0.0005). Serum ionized calcium levels fell from 5.03 ± 0.37 to 4.83 ± 0.34 mg/dL (1.25 ± 0.09 to 1.21 ± 0.08 mmol/L) (p<0.01), while intact parathyroid hormone (PTH) levels rose from 547 ± 697 to 619 ± 776 pg/mL (p<0.05). Base therapy did not result in significant changes in serum levels of total calcium, phosphorus, alkaline phosphatase, urea nitrogen, creatinine, total protein, albumin or potassium. If empiric therapy with exogenous base is given to dialysis patients, ionized calcium levels should be closely monitored since changes in calcium supplement or vitamin D therapy may be required to maintain ionized calcium and parathyroid hormone values at the pre-treatment levels.

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Serum Sulphate Levels in Hemodialysis Patients

International Journal of Nephrology ◽

10.1155/2019/1063514 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Ibrahim Yildirim ◽

Ender Hur ◽

Kemal Magden ◽

Sevil İlikhan ◽

Hüseyin Engin ◽

...

Keyword(s):

Parathyroid Hormone ◽

Serum Levels ◽

Hemodialysis Patients ◽

Free Form ◽

Control Group ◽

Dialysis Patients ◽

Sulphur Compounds ◽

Adequate Knowledge ◽

Inorganic Sulphate ◽

Calcium Phosphorus

Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients. Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded. Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM, p<0.001) in HD patients. Serum sulphate level correlated with patient’s age, serum albumin, serum BUN and creatinine, and serum phosphorus level in HD patients. Serum sulphate levels were not associated with serum parathyroid hormone levels. Conclusion. Serum sulphate levels were approximately twofold higher in HD patients than in the normal control group. Inorganic sulphate does not seem to accumulate in long-term dialysis patients, and mild increased serum levels of sulphate has no poor clinical outcome in these patients.

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Elevated interleukin 31 serum levels in hemodialysis patients are associated with uremic pruritus

Cytokine ◽

10.1016/j.cyto.2020.155369 ◽

2020 ◽

pp. 155369

Author(s):

Ashraf O. Oweis ◽

Firas AL-Qarqaz ◽

Khaldon Bodoor ◽

Leen Heis ◽

Mahmoud A. Alfaqih ◽

...

Keyword(s):

Serum Levels ◽

Hemodialysis Patients ◽

Uremic Pruritus

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Resistance to Erythropoiesis-Stimulating Agents Is Associated with Arterial Microcalcification in Early Hemodialysis Patients

BioMed Research International ◽

10.1155/2014/731296 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Hye Sung Won ◽

Su Jin Choi ◽

Yu Seon Yun ◽

Ok-Ran Shin ◽

Yoon Ho Ko ◽

...

Keyword(s):

Multivariate Analyses ◽

Serum Levels ◽

Hemodialysis Patients ◽

Vascular Access Surgery ◽

Erythropoiesis Stimulating Agents ◽

Patients With Diabetes ◽

Calcium Phosphorus ◽

The Mean ◽

The Relationship ◽

Access Surgery

The aim of this study was to evaluate the relationship between arterial microcalcification (AMiC) and erythropoiesis-stimulating agents (ESA) hyporesponsiveness in hemodialysis patients. The presence of AMiC was confirmed by pathologic examination of von Kossa-stained arterial specimens acquired during vascular access surgery. We assessed the ESA hyporesponsiveness index (EHRI), defined as the weekly ESA dose per kilogram body weight divided by the hemoglobin level. AMiC was detected in 33 (40.2%) of 82 patients. Patients with diabetes had a higher incidence of AMiC than patients without diabetes. The serum levels of albumin and cholesterol were higher in patients without AMiC than in patients with AMiC. The serum levels of intact parathyroid hormone were lower in patients with AMiC than in patients without AMiC. The serum levels of phosphate and calcium-phosphorus product did not differ between the two groups. The mean EHRI value was higher in patients with AMiC than in patients without AMiC. In multivariate analyses, ESA hyporesponsiveness and diabetes showed a significant association with AMiC. In conclusion, ESA hyporesponsiveness may be a clinical relevant parameters related to AMiC in hemodialysis patients.

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P1532PARATHYROID HORMONE SERUM LEVELS AND MORTALITY AMONG HEMODIALYSIS PATIENTS IN THE GULF COOPERATION COUNCIL COUNTRIES: RESULTS FROM THE DOPPS (2012-2018)

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1532 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Issa Al Salmi ◽

Brian Bieber ◽

Mona AlRukhaimi ◽

Ali AlSahow ◽

Faissal Shaheen ◽

...

Keyword(s):

United Arab Emirates ◽

Cox Regression ◽

Serum Levels ◽

Gulf Cooperation Council ◽

Hemodialysis Patients ◽

Phosphate Binders ◽

Mortality Pattern ◽

Cell Counts ◽

Dialysis Vintage ◽

Dialysis Outcomes

Abstract Background and Aims The prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf cooperation council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). Here, we report the relationship of PTH with mortality in this largest GCC hemodialysis patient cohort studied to date. Method Data were from randomly-selected national samples of hemodialysis facilities in GCC DOPPS phases 5 and 6 (2012-2018). PTH descriptive findings and case-mix adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly-selected hemodialysis patients, respectively. Results Mean patient age was 55 years (median dialysis vintage = 2.1 years). Median PTH ranged from 259 pg/mL (UAE) to 437 pg/mL (Kuwait), with 22% having PTH <150 pg/mL, 24% (PTH 150-300), 34% (PTH 301-700), and 20% (PTH >700) pg/mL. Patients with PTH >700 pg/mL were younger, on dialysis longer, less likely to be diabetic, have urine>200 mL/day, prescribed 3.5 mEq/L dialysate calcium, had higher mean serum creatinine and phosphorus levels, lower white blood cell counts, and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A “U-shaped” PTH/mortality relationship was observed with >2-fold and 1.5 fold higher adjusted HR of death at PTH>700 pg/mL and <300 pg/mL, respectively, compared to PTH 301-450 pg/mL. Conclusion Secondary hyperparathyroidism is highly prevalent among GCC hemodialysis patients, with a strong U-shaped PTH/mortality relationship seen at PTH <300 and >450 pg/mL. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.

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Low serum vitamin B12 levels are associated with degenerative rotator cuff tear

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04231-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jae Hwa Kim ◽

Go-Tak Kim ◽

Siyeoung Yoon ◽

Hyun Il Lee ◽

Kyung Rae Ko ◽

...

Keyword(s):

Logistic Regression ◽

Rotator Cuff ◽

Univariate Analysis ◽

Serum Vitamin ◽

Serum Levels ◽

Control Group ◽

Mineral Density ◽

Calcium Phosphorus ◽

Healthy Control ◽

Low Serum

Abstract Background Vitamin B12 (Vit B12) deficiency results in elevated homocysteine levels and interference with collagen cross-linking, which may affect tendon integrity. The purpose of this study was to investigate whether serum Vit B12 levels were correlated with degenerative rotator cuff (RC) tear. Methods Eighty-seven consecutive patients with or without degenerative RC tear were enrolled as study participants. Possible risk factors (age, sex, medical history, bone mineral density, and serum chemistries including glucose, magnesium, calcium, phosphorus, zinc, homocysteine, Vitamin D, Vit B12, homocysteine, and folate) were assessed. Significant variables were selected based on the results of univariate analyses, and a logistic regression model (backward elimination) was constructed to predict the presence of degenerative RC tear. Results In the univariate analysis, the group of patients with degenerative RC tear had a mean concentration of 528.4 pg/mL Vit B12, which was significantly lower than the healthy control group (627.1 pg/mL). Logistic regression analysis using Vit B12 as an independent variable revealed that Vit B12 concentrations were significantly correlated with degenerative RC tear (p = 0.044). However, Vit B12 levels were not associated with tear size. Conclusion Low serum levels of Vit B12 were independently related to degenerative RC tear. Further investigations are warranted to determine if Vit B12 supplementation can decrease the risk of this condition.

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The Effect of Bilateral Nephrectomy on Renalase and Catecholamines in Hemodialysis Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126282 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6282

Author(s):

Magda Wiśniewska ◽

Natalia Serwin ◽

Violetta Dziedziejko ◽

Małgorzata Marchelek-Myśliwiec ◽

Barbara Dołęgowska ◽

...

Keyword(s):

Healthy Subjects ◽

Plasma Concentrations ◽

Serum Levels ◽

Hemodialysis Patients ◽

Pressure Regulation ◽

Serum Concentrations ◽

Monoamine Oxidase Activity ◽

Normal Kidney ◽

Bilateral Nephrectomy ◽

Arterial Blood

Background/Aims: Renalase is an enzyme with monoamine oxidase activity that metabolizes catecholamines; therefore, it has a significant influence on arterial blood pressure regulation and the development of cardiovascular diseases. Renalase is mainly produced in the kidneys. Nephrectomy and hemodialysis (HD) may alter the production and metabolism of renalase. The aim of this study was to examine the effect of bilateral nephrectomy on renalase levels in the serum and erythrocytes of hemodialysis patients. Methods: This study included 27 hemodialysis patients post-bilateral nephrectomy, 46 hemodialysis patients without nephrectomy but with chronic kidney disease and anuria and 30 healthy subjects with normal kidney function. Renalase levels in the serum and erythrocytes were measured using an ELISA kit. Results: Serum concentrations of renalase were significantly higher in post-bilateral nephrectomy patients when compared with those of control subjects (101.1 ± 65.5 vs. 19.6 ± 5.0; p < 0.01). Additionally, renalase concentrations, calculated per gram of hemoglobin, were significantly higher in patients after bilateral nephrectomy in comparison with those of healthy subjects (994.9 ± 345.5 vs. 697.6 ± 273.4, p = 0.015). There were no statistically significant differences in plasma concentrations of noradrenaline or adrenaline. In contrast, the concentration of dopamine was significantly lower in post-nephrectomy patients when compared with those of healthy subjects (116.8 ± 147.7 vs. 440.9 ± 343.2, p < 0.01). Conclusions: Increased serum levels of renalase in post-bilateral nephrectomy hemodialysis patients are likely related to production in extra-renal organs as a result of changes in the cardiovascular system and hypertension.

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The correlation between uremic pruritus and blood lead levels in prevalent hemodialysis patients and its relation to the severity of pruritus using visual analog score

The Egyptian Journal of Internal Medicine ◽

10.1186/s43162-021-00045-0 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Sahar Mahmoud Shawky ◽

Reeham Abdel Aziz Abdel Hamid ◽

Lina Essam Khedr

Keyword(s):

Blood Lead ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Visual Analog Score ◽

Blood Lead Levels ◽

Cross Sectional ◽

Uremic Pruritus ◽

Significant Difference ◽

Lead Levels ◽

Group 2

Abstract Background Pruritus is a common and often distressing symptom in patients with chronic kidney disease. Though the pathogenesis of uremic pruritus remains poorly understood, systemic inflammation has presented itself as one of the possible explanations. High blood lead levels (BLLs) have been noted to be associated with inflammation and poor nutritional status in hemodialysis patients. Our aim is to study the relation between blood lead levels and uremic pruritus. This is a cross-sectional study that enrolled 50 patients; all were on regular hemodialysis 3 times per week for at least 6 months. Patients were divided into 2 groups, group 1 (n =10) with no pruritus and group 2 (n=40) with varying degrees of pruritus. Group 2 was further divided according to intensity of pruritus by visual analog score (VAS) into mild (n=10), moderate (n=20), and severe pruritus (n=10). Results There was a significant difference in serum lead levels and ferritin levels between groups 1 and 2 (p value < 0.01 and < 0.05, respectively). There was a statistically significant difference in serum lead levels in the groups with varying intensity of pruritus, having higher serum lead levels in patients who exhibited severe pruritus (p value < 0.005) Moreover, a statistically significant relation between elevated blood lead levels and the duration of dialysis was observed in this study. Conclusion Uremic pruritus is a multi-factorial phenomenon, and our study showed that blood lead levels in hemodialysis patients might be associated with increased intensity of pruritus.

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Application of regularized regression to identify novel predictors of mortality in a cohort of hemodialysis patients

Scientific Reports ◽

10.1038/s41598-021-88655-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Stanislas Werfel ◽

Georg Lorenz ◽

Bernhard Haller ◽

Roman Günthner ◽

Julia Matschkal ◽

...

Keyword(s):

Statistical Learning ◽

Cox Regression ◽

Serum Levels ◽

Hemodialysis Patients ◽

Derivation Cohort ◽

Predictors Of Mortality ◽

Stage Renal Disease ◽

End Stage ◽

Study Participants ◽

Related Mortality

AbstractCohort studies often provide a large array of data on study participants. The techniques of statistical learning can allow an efficient way to analyze large datasets in order to uncover previously unknown, clinically relevant predictors of morbidity or mortality. We applied a combination of elastic net penalized Cox regression and stability selection with the aim of identifying novel predictors of mortality in a cohort of prevalent hemodialysis patients. In our analysis we included 475 patients from the “rISk strAtification in end-stage Renal disease” (ISAR) study, who we split into derivation and confirmation cohorts. A wide array of examinations was available for study participants, resulting in over a hundred potential predictors. In the selection approach many of the well established predictors were retrieved in the derivation cohort. Additionally, the serum levels of IL-12p70 and AST were selected as mortality predictors and confirmed in the withheld subgroup. High IL-12p70 levels were specifically prognostic of infection-related mortality. In summary, we demonstrate an approach how statistical learning can be applied to a cohort study to derive novel hypotheses in a data-driven way. Our results suggest a novel role of IL-12p70 in infection-related mortality, while AST is a promising additional biomarker in patients undergoing hemodialysis.

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