Plasma Total Homocysteine Levels among Patients Undergoing Nocturnal versus Standard Hemodialysis

ABSTRACT. Mild hyperhomocysteinemia, a putative risk factor for arteriosclerotic outcomes, is seen in >85% of hemodialysis patients. Therapeutic strategies, including pharmacologic-dose B vitamin supplementation and “high-flux” or “super-flux” hemodialysis, have consistently failed to normalize total homocysteine (tHcy) levels in these patients. Predialysis plasma tHcy levels in 23 patients who were undergoing nocturnal hemodialysis (NHD) six or seven nights/wk were compared with those in 31 patients from the same Canadian dialysis unit who were undergoing chronic standard hemodialysis (SHD) (all <65 yr of age, undergoing thrice-weekly treatments). The SHD patients were similar to typical North American chronic hemodialysis patients with respect to B vitamin status and albumin, creatinine, and tHcy levels. Geometric mean tHcy levels for the NHD patients were significantly lower (12.7 versus 20.0 μM, P < 0.0001), as was the prevalence of mild-to-moderate hyperhomocysteinemia (>12 μM; NHD, 57%; SHD, 94%; P = 0.002). Analysis of covariance adjusted for plasma folate, vitamin B12, and pyridoxal 5′-phosphate levels, age, and gender confirmed that NHD was independently associated with 6.0 μM lower geometric mean tHcy levels (P = 0.001). It is concluded that tHcy levels are significantly lower among NHD patients, compared with SHD patients. Clinical trials will be necessary to confirm that NHD is effective in reducing tHcy levels among patients with dialysis-dependent end-stage renal disease.

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Lowering of Homocysteine Concentrations in Elderly Men and Women

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.69.3.187 ◽

1999 ◽

Vol 69 (3) ◽

pp. 187-193 ◽

Cited By ~ 9

Author(s):

Brönstrup ◽

Hages ◽

Pietrzik

Keyword(s):

Low Dose ◽

Geometric Mean ◽

B Vitamins ◽

Vitamin Supplementation ◽

Entire Treatment Period ◽

Men And Women ◽

Elderly Individuals ◽

Total Homocysteine ◽

B Vitamin ◽

Plasma Total Homocysteine

B-vitamin supplementation has previously been shown to lower the concentration of plasma total homocysteine, a risk factor for cardiovascular disease. Little is known about the homocysteine-lowering effects of low-dose B-vitamins in elderly individuals, who are prone to higher homocysteine levels due to advanced age and a greater frequency of impaired vitamin status. We aimed to identify if and to what extent B-vitamins lower total homocysteine and its subfractions in elderly individuals. Men and women (>= 60 years) received either B-vitamins (400 mug folic acid +1.65 mg pyridoxine +3 mug cyanocobalamin) or a placebo daily for 4 weeks. Subjects in the vitamin group showed a significant decrease in plasma total homocysteine during the first 2 weeks; thereafter, total homocysteine only slightly decreased further resulting in a geometric mean reduction of –16.3% (95% CI: –11.3% to –21.0%) over the entire treatment period. Free homocysteine decreased as well. However, the observed higher ratio of free/total homocysteine after 4 weeks of supplementation suggest a more pronounced reduction in protein-bound homocysteine. Low-dose B-vitamin supplementation is effective in lowering homocysteine in elderly individuals. Further studies are needed to be able to depict the effect of B-vitamin supplementation on different homocysteine subfractions in plasma.

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Extended erythrocyte and reticulocyte parameters in the diagnosis of iron deficiency in hemodialysis patients

Chinese Journal of Medical Research ◽

10.37515/cjmr.091x.3405 ◽

2020 ◽

Vol 3 (4) ◽

pp. 109-113

Author(s):

Mohammed Nazim Bennaoum ◽

◽

Affaf Adda ◽

Mohamed Chekkal ◽

Fatima Seghier ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Status ◽

High Sensitivity ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Red Cells ◽

Corpuscular Hemoglobin ◽

Cellular Concentration ◽

Stage Renal Disease ◽

End Stage

Objective: Iron deficiency (ID) is a frequent complication in end stage renal insufficiency. These patients have to be diagnosed and treated to reduce the prevalence of anemia. Functional iron deficiency (FID) is a situation that can disrupt biochemical iron tests and mask an eventual association with ID. In this study, we tried to prove the ability of extended parameters of red cells and reticulocytes to diagnose ID without being influenced by FID. Design and methods: 164 chronic hemodialysis patients (CHP) in end stage renal disease were enrolled. Research parameters of red cells and reticulocytes determined on ADVIA 2120i were studied in the diagnosis of ID associated or not with chronic inflammation. Results: Parameters such as corpuscular hemoglobin of mature red cells (CHm), corpuscular hemoglobin of reticulocytes (CHr), cellular concentration of hemoglobin in mature red cells (CHCMm), cellular concentration of hemoglobin in reticulocytes (CHCMr) and percentage of microcytic and hypochromic red cells (HYMI) showed a high sensitivity to diagnose ID. However, the distinction of combined iron deficiency (CID) from other entities was not possible with all parameters. In chronic inflammatory states, the decrease of CHm, CHCMm and CHCMr with the rise of percentage hypochromic mature red cells (HYPOm) and reticulocytes (HYPOr) is in favor of CID. So, determination of inflammatory state is needed to complete research parameters of blood count in CHP. Conclusion: Extended erythrocyte and reticulocyte parameters can be useful to check iron status in CHP.

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Phase IIa Study of the Immunogenicity and Safety of the Novel Staphylococcus aureus Vaccine V710 in Adults with End-Stage Renal Disease Receiving Hemodialysis

Clinical and Vaccine Immunology ◽

10.1128/cvi.00034-12 ◽

2012 ◽

Vol 19 (9) ◽

pp. 1509-1516 ◽

Cited By ~ 21

Author(s):

Moustafa Moustafa ◽

George R. Aronoff ◽

Chandra Chandran ◽

Jonathan S. Hartzel ◽

Steven S. Smugar ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Renal Disease ◽

End Stage Renal Disease ◽

Geometric Mean ◽

Surface Protein ◽

Chronic Hemodialysis ◽

Content Type ◽

Primary Hypothesis ◽

Stage Renal Disease ◽

End Stage

ABSTRACTBacteremia is the second leading cause of death in patients with end-stage renal disease who are on hemodialysis. A vaccine eliciting long-term immune responses againstStaphylococcus aureusin patients on chronic hemodialysis may reduce the incidence of bacteremia and its complications in these patients. V710 is a vaccine containing iron surface determinant B (IsdB), a highly conservedS. aureussurface protein, which has been shown to be immunogenic in healthy subjects. In this blinded phase II immunogenicity study, 206 chronic hemodialysis patients between the ages of 18 and 80 years old were randomized to receive 60 μg V710 (with or without adjuvant), 90 μg V710 (with adjuvant), or a placebo in various combinations on days 1, 28, and 180. All 201 vaccinated patients were to be followed through day 360. The primary hypothesis was that at least 1 of the 3 groups receiving 2 V710 doses on days 1 and 28 would have a ≥2.5 geometric mean fold rise (GMFR) in anti-IsdB IgG titers over the baseline 28 days after the second vaccination (day 56). At day 56, all three groups receiving 2 doses of V710 achieved a ≥2.5 GMFR in anti-IsdB antibodies compared to the baseline (Pvalues of <0.001 for all 3 groups), satisfying the primary immunogenicity hypothesis. None of the 33 reported serious adverse experiences were considered vaccine related by the investigators. V710 induced sustained antibody responses for at least 1 year postvaccination in patients on chronic hemodialysis.

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Serum Erythropoietin Concentrations and Iron Status in Patients on Chronic Hemodialysis

Clinical Chemistry ◽

10.1093/clinchem/38.2.199 ◽

1992 ◽

Vol 38 (2) ◽

pp. 199-203 ◽

Cited By ~ 5

Author(s):

Chuichi Seguchi ◽

Teruo Shima ◽

Moriharu Misaki ◽

Yoshihiro Takarada ◽

Toni Okazaki

Keyword(s):

Negative Correlation ◽

Binding Capacity ◽

Iron Status ◽

Geometric Mean ◽

Normal Subjects ◽

Significant Negative Correlation ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Serum Concentrations ◽

Serum Erythropoietin

Abstract We studied the relationship between serum erythropoietin (EPO) concentration and iron status in 67 patients undergoing chronic hemodialysis. Serum concentrations of EPO were measured by RIA with recombinant human EPO. The geometric mean of the serum EPO concentration was 10.9 int. units/L (mean +/- SD range = 7.8 - 15.3 int. units/L) in hemodialysis patients, considerably lower than that in normal subjects (12.9 int. units/L). We found no significant correlation between concentrations of serum EPO and hemoglobin in hemodialysis patients, but found a significant negative correlation between serum concentrations of EPO and iron in hemodialysis patients. Moreover, we also found a significant positive correlation between the EPO concentration and the unsaturated iron-binding capacity (UIBC) in serum, and a significant negative correlation between the serum concentrations of EPO and ferritin in hemodialysis patients. Several patients who had relatively high EPO concentrations for hemodialysis patients also had low iron concentrations, high UIBC values, and low ferritin concentrations. These findings suggest that iron was utilized even at these EPO concentrations, which were very low for the degree of anemia observed in the hemodialysis patients.

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The Fate of Patients Who Started Hemodialysis during Childhood or Adolescence: Results of an Interregional Moroccan Survey

International Scholarly Research Notices ◽

10.1155/2014/389729 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

F. Z. Souilmi ◽

T. Sqalli Houssaini ◽

G. EL Bardai ◽

N. Kabbali ◽

M. Arrayhani ◽

...

Keyword(s):

End Stage Renal Disease ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Pediatric Age ◽

Sectional Study ◽

Cross Sectional ◽

Low Weight ◽

Stage Renal Disease ◽

End Stage

Hemodialysis is the most used renal replacement therapy for children in Morocco. The objective of this study was to determine the prevalence of patients who started hemodialysis in childhood and study their characteristics and specificities of their care. For this we conducted a multicentric descriptive cross-sectional study of all chronic hemodialysis patients who started dialysis in pediatric age, in hemodialysis centers in four of the sixteen regions of Morocco. We collected 2066 patients undergoing dialysis in 39 hemodialysis centers; from these, only 72 patients (3.48%) started hemodialysis in childhood. The average age of patients was 20.64 ± 6.5 years with a sex ratio of 1.9. Duration of dialysis was 78.2 ± 56 months. The cause of end stage renal disease was urological abnormalities in 18% of cases and glomerulopathy in 12.5% of cases; however, it remains unknown in half of the patients. Over 18 years, 74% of patients are without profession, it is active in 13% of cases, and pursuing studies are only in 13% of cases. Patients under 5 years and those with a low weight are rarely taken care of in chronic hemodialysis with little individualization of prescription. Greater attention should be paid to renal transplantation that is desired by the majority of these patients (92%).

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Longitudinal follow–up of chronic hemodialysis patients without vitamin supplementation

Kidney International ◽

10.1038/ki.1986.157 ◽

1986 ◽

Vol 30 (1) ◽

pp. 99-106 ◽

Cited By ~ 30

Author(s):

German Ramirez ◽

Marianne Chen ◽

H. Worth Boyce ◽

Suzanne M. Fuller ◽

Rama Ganguly ◽

...

Keyword(s):

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Vitamin Supplementation

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Development of the “Peritoneal Dialysis First” Model in Hong Kong

Peritoneal Dialysis International ◽

10.1177/089686080702702s09 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 53-55 ◽

Cited By ~ 5

Author(s):

Alex Wai-Yin Yu ◽

Ka-Foon Chau ◽

Yiu-Wing Ho ◽

Philip Kam-Tao Li

Keyword(s):

Hong Kong ◽

Peritoneal Dialysis ◽

Survival Rates ◽

Chronic Hemodialysis ◽

Dialysis Unit ◽

Number Of Patients ◽

Maintenance Dialysis ◽

The 1960S ◽

Stage Renal Disease ◽

End Stage

Maintenance dialysis is an expensive treatment modality for patients with end-stage renal-disease (ESRD). The number of patients on maintenance dialysis is rising rapidly and will reach 2.5 million globally by 2010. The predicted expenditure will be US$1 trillion. Since the 1960s, Hong Kong has faced financial restraints on the provision of dialysis. Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis at home were found to be less expensive than in-centre chronic hemodialysis. The development of a “peritoneal dialysis first” (PD-First) policy has contributed significantly to a successful dialysis program in Hong Kong since 1960. Currently in Hong Kong, 80% of ESRD patients on maintenance dialysis are on PD, mainly CAPD; 20% are on hemodialysis. The success of the PD-First policy is a combination of accumulated experience of PD in each dialysis unit that has at least 200 CAPD patients under care and of impressive technique and patient survival rates for this modality. Concerted effort by government and charity organizations and commitment on the part of nephrologists and nursing staff to patient education are also important in making the PD program in Hong Kong a successful one.

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Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection

The Journal of Vascular Access ◽

10.1177/11297298211021253 ◽

2021 ◽

pp. 112972982110212

Author(s):

Ahmet Murt ◽

Serap Yadigar ◽

Serkan Feyyaz Yalin ◽

Mevlut Tamer Dincer ◽

Ergun Parmaksiz ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

High Mortality ◽

End Stage Renal Disease ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Stage Renal Disease ◽

End Stage ◽

Near Future

Background: While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. Methods: One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. Results: COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels ( p = 0.02) and longer hospital stay ( p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05–10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53–41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival ( p = 0.000) Conclusions: AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.

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No Association between Hyperhomocysteinemia and Vascular Access Thrombosis in Chronic Hemodialysis

The Journal of Vascular Access ◽

10.1177/112972980300400104 ◽

2003 ◽

Vol 4 (1) ◽

pp. 14-20 ◽

Cited By ~ 2

Author(s):

R. Lévesque ◽

M. Dumont ◽

M. Leblanc

Keyword(s):

Risk Factor ◽

Vascular Access ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Access Time ◽

Before And After ◽

Potential Benefits ◽

Total Homocysteine ◽

Life Prolongation ◽

Methyltetrahydrofolate Reductase

Purpose Hyperhomocysteinemia, recognized as a risk factor for cardiovascular diseases, has also been related with controversy to vascular access thrombosis in hemodialysis. Our objective was to determine if such an association could be found in our hemodialysis population. Methods The survey was conducted in a cohort of 165 chronic hemodialysis patients. Their vascular access history was considered from hemodialysis initiation until November 1999, including the number of vascular accesses created (either native or synthetic fistulae), focussing on vascular access thrombotic events, and excluding primary vascular access dysfunction. Diabetes, hemoglobin, erythropoietin dose, anticoagulation, and methyltetrahydrofolate reductase (MTHFR) status were considered. Serum total homocysteine (tHcy) measures were sampled for all patients in June 1998 and repeated yearly. Patients had not been supplemented routinely with hydrosoluble vitamins until June 1998, after which all received DiaVite® (R&D Laboratories, CA, USA) daily. Results Median survival of native fistulae was significantly longer (81 months, 95%CI 35–127) than for synthetic fistulae (31 months, 95%CI 27–51). Median vascular access survival was reduced for diabetics vs non diabetics (28 vs 57 months) (P<0.05), whereas sex, age and smoking had no impact. No correlation was found between tHcy concentration and the number of vascular access thrombotic events; homozygotes for MTHFR had higher tHcy but no more vascular access thrombotic events. The 38 patients with a mean vascular access survival of less than 12 months (6±3 months) were compared to the 127 patients with a mean vascular access survival of ≥ 12 months (39±25 months) (P<0.05): no difference in their respective tHcy concentrations before and after DiaVite® introduction was found (31±13 and 20±8 vs 34±17 and 22±6 μmol/L), but the first group presented more numerous synthetic fistulae (p<0.0001), lower hemoglobin levels, and higher erythropoietin doses. Conclusions No significant association between hyperhomocysteinemia and vascular access thrombosis could be found in our population. DiaVite® introduction allowed a significant reduction in tHcy, but had no impact on vascular access survival, except for a slight but not significant reduction in the prevalence of vascular access thrombotic events during the year on DiaVite®. Potential benefits of approaches to reduce tHcy for vascular access time-life prolongation remain to be demonstrated.

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Platelet Activation and Platelet-erythrocyte Aggregates in End-stage Renal Disease Patients on Hemodialysis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1616140 ◽

2001 ◽

Vol 86 (09) ◽

pp. 834-839 ◽

Cited By ~ 27

Author(s):

Vittorio Sirolli ◽

Luigi Strizzi ◽

Silvio Di Stante ◽

Iole Robuffo ◽

Antonio Procopio ◽

...

Keyword(s):

Platelet Activation ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Activation Mechanism ◽

Complement Factor ◽

Synthetic Membranes ◽

Activated Platelets ◽

Stage Renal Disease ◽

End Stage

SummaryActivated platelets may engage in dynamic interplay with other blood cells. We examined the evidence for platelet activation and the formation of platelet-erythrocyte aggregates in chronic hemodialysis patients. Circulating activated platelets (P-selectin/CD63-positive platelets) were higher than normal controls (p <0.001) and further increased during hemodialysis sessions, the increase being higher when patients were dialyzed with cellulosic than with synthetic membranes. We found direct evidence of uremic platelet-erythrocyte adherence in vitro and increased levels of circulating platelet-erythrocyte aggregates in dialysis patients, which represents a new observation in uremia. Platelet-erythrocyte aggregates were subject to further increase during hemodialysis, and again higher levels were found with cellulosic than synthetic membranes. This phenomenon was reproduced in vitro by both ADP and PAF, but not by either complement factor C3a or by heparin concentrations corresponding to those used for clinical hemodialysis. We conclude that platelet-erythrocyte aggregates occur in hemodialysis patients probably owing to a primary platelet activation mechanism.

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