scholarly journals The Frailty Phenotype in Hemodialysis Patients and its Association with Biochemical Markers of Mineral Bone Disorder, Inflammation and Nutrition

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alma Mutevelić-Turković ◽  
Halima Resić ◽  
Badema Čengić Roljić ◽  
Amela Dervišević ◽  
Amela Bećiragić
Keyword(s):  
Biochemical Markers ◽  
Venous Blood ◽  
Bone Alkaline Phosphatase ◽  
Frailty Phenotype ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Positive Correlations ◽  
Stage Renal Disease ◽  
End Stage ◽  
Frailty Score

Abstract Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD). The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers. Methods: For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin. Results: Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001). Conclusions: The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.

scholarly journals Uremic lion face syndrome

2019 ◽  
Vol 41 (2) ◽  
pp. 304-305
Author(s):  
Joana Gameiro ◽  
Inês Duarte ◽  
Cristina Outerelo ◽  
José António Lopes
Keyword(s):  
End Stage Renal Disease ◽  
Rare Case ◽  
Bone Fractures ◽  
Early Recognition ◽  
Rare Complication ◽  
Facial Deformity ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Stage Renal Disease ◽  
End Stage

Abstract Mineral bone disorder is a common feature of chronic kidney disease. Lion face syndrome is rare complication of severe hyperparathyroidism in end-stage renal disease patients, which has been less commonly reported due to dialysis and medical treatment advances in the last decade. The early recognition of the characteristic facial deformity is crucial to prompt management and prevent severe disfigurement. The authors present a rare case of severe hyperparathyroidism presenting with lion face syndrome and bone fractures.

P1424IMPACT OF DIRECTLY OBSERVED TREATMENT OF ONE ALFACALCIDOL ON MINERAL BONE DISORDER PROFILE IN DIALYSIS PATIENTS-A SINGLE UNIT PILOT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mirza Yasar Baig ◽  
Rajkumar Chinnadurai ◽  
Tina Chrysochou
Keyword(s):  
Pilot Study ◽  
End Stage Renal Disease ◽  
Single Unit ◽  
Dialysis Patients ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Directly Observed Treatment ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Abstract Impact of directly observed treatment of one-alfacalcidol on mineral bone disorder profile in dialysis patients- A single unit pilot study Background and Aims Secondary hyperparathyroidism (SHPT) is a common mineral bone disorder observed in patients with end-stage renal disease. Management of SHPT can be challenging mainly due to poor medication compliance. Directly observed treatment (DOT) has shown to improve management outcomes in other conditions like tuberculosis. We conducted a pilot study to investigate the impact of DOT with one alfacalcidol for SHPT in our cohort of dialysis patients. Method This prospective observational study was conducted on 21 end stage renal disease patients on dialysis from a single centre who were commenced on one alfacalcidol on dialysis days under direct observation .All patients had not shown any improvement in PTH despite increase in one alfacalcidol either admitted to or were suspected to have medication non-adherence. Serum bone mineral profile including parathormone (PTH), corrected calcium, phosphate and alkaline phosphatase were recorded before and after initiation of DOT. Treatment outcome was measured by comparing the mean change in the biochemical profile prior DOT initiation and at the lowest PTH value achieved on DOT. Data was analysed by paired t test using SPSS software. Results The mean age of our sample at the time of commencing DOT therapy was 52 years. Our sample had a predominance of males (67%) and Asian ethnicity (62%). 71% had a history of hypertension and 43% were diabetic. DOT one alfacalcidol therapy produced a significant reduction in the mean PTH value (pre-DOT- 92.2 vs post DOT-36.1 pmol/L, p&lt;0.001). There was a significant rise in the corresponding mean corrected calcium levels (pre-DOT- 2.22 vs post-DOT-2.45 mmol/L, p=0.001) (table–1). Over a mean follow up of 8 months, a significant reduction in the one alfacalcidol dose requirement was observed in 52.38% of our cohort. Conclusion DOT one alfacalcidol therapy produced a significant improvement in the mineral bone profile in our cohort of dialysis patients. DOT approach can help to improve the outcomes in dialysis patients with poor compliance.

scholarly journals Contrasting PTH Response of Denosumab Use in Dialysis Patients: A Report of 2 Cases

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 59
Author(s):  
Soo Min Jang ◽  
Smitha Anam ◽  
Tara Pringle ◽  
Paul Lahren ◽  
Sergio Infante
Keyword(s):  
Calcium Release ◽  
Hemodialysis Patient ◽  
Compensatory Mechanism ◽  
Normal Range ◽  
Mineral And Bone Disorder ◽  
Bone Disorder ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Pth Level

A common complication of end-stage renal disease (ESRD) is mineral and bone disorder. Yet, many anti-osteoporotic drugs are contraindicated in ESRD patients. Denosumab, a monoclonal antibody, does not require renal dose adjustment. However, its use is uncertain due to a lack of safety and efficacy of data in this population. Two hemodialysis patient cases of contrasting responses in parathyroid hormone (PTH) after denosumab administration were observed. Patient 1, a 62-years-old male received denosumab 60 mg at Day 0. His calcium decreased from 8.8 mg/dL to 6.8 mg/dL on Day 30. The PTH level increased from 265 pg/mL to 372 pg/mL after 30 days. Calcium and PTH levels approached normal range after increasing doses of vitamin D/calcium supplements, and calcitriol. Patient 2, a 72-years-old male on hemodialysis also received denosumab 60 mg on Day 0. His baseline calcium and PTH were 9.2 mg/dL and 420 pg/mL, respectively. On Day 30, his calcium level decreased (6.8 mg/dL) but, PTH level drastically increased (>5000 pg/mL). Denosumab commonly causes hypocalcemia and hyperparathyroidism since it inhibits osteoclast activation, reduces calcium release from bone and increases PTH levels as a compensatory mechanism. With a wait-and-watch approach, Patient 2’s levels approached the normal range (calcium 9.6 mg/dL and PTH 274 pg/mL at Day 90).

scholarly journals EEG Delta/Theta Ratio and Microstate Analysis Originating Novel Biomarkers for Malnutrition-Inflammation Complex Syndrome in ESRD Patients

2022 ◽  
Vol 15 ◽  
Author(s):  
Tirapoot Jatupornpoonsub ◽  
Paramat Thimachai ◽  
Ouppatham Supasyndh ◽  
Yodchanan Wongsawat
Keyword(s):  
Risk Group ◽  
Binary Logistic Regression ◽  
High Risk Group ◽  
Low Risk ◽  
Binary Logistic Regression Model ◽  
Positive Correlations ◽  
Microstate Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

The Malnutrition-Inflammation Score (MIS) was initially proposed to evaluate malnutrition-inflammation complex syndrome (MICS) in end-stage renal disease (ESRD) patients. Although MICS should be routinely evaluated to reduce the hospitalization and mortality rate of ESRD patients, the inconvenience of the MIS might limit its use. Cerebral complications in ESRD, possibly induced by MICS, were previously assessed by using spectral electroencephalography (EEG) via the delta/theta ratio and microstate analysis. Correspondingly, EEG could be used to directly assess MICS in ESRD patients, but the relationships among MICS and these EEG features remain inconclusive. Thus, we aimed to investigate the delta/theta ratio and microstates in ESRD patients with high and low risks of MICS. We also attempted to identify the correlation among the MIS, delta/theta ratio, and microstate parameters, which might clarify their relationships. To achieve these objectives, a total of forty-six ESRD subjects were willingly recruited. We collected their blood samples, MIS, and EEGs after receiving written informed consent. Sixteen women and seven men were allocated to low risk group (MIS ≤ 5, age 57.57 ± 14.88 years). Additionally, high risk group contains 15 women and 8 men (MIS &gt; 5, age 59.13 ± 11.77 years). Here, we discovered that delta/theta ratio (p &lt; 0.041) and most microstate parameters (p &lt; 0.001) were significantly different between subject groups. We also found that the delta/theta ratio was not correlated with MIS but was strongly with the average microstate duration (ρ = 0.708, p &lt; 0.001); hence, we suggested that the average microstate duration might serve as an alternative encephalopathy biomarker. Coincidentally, we noticed positive correlations for most parameters of microstates A and B (0.54 ≤ ρ ≤ 0.68, p &lt; 0.001) and stronger negative correlations for all microstate C parameters (−0.75 ≤ ρ ≤ −0.61, p &lt; 0.001). These findings unveiled a novel EEG biomarker, the MIC index, that could efficiently distinguish ESRD patients at high and low risk of MICS when utilized as a feature in a binary logistic regression model (accuracy of train-test split validation = 1.00). We expected that the average microstate duration and MIC index might potentially contribute to monitor ESRD patients in the future.

scholarly journals P0197CLINICAL FRAILTY SCORING IN PATIENTS WITH END STAGE RENAL DISEASE: A PREDICTOR OF DECLINING HEALTH?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lucy Hetherington ◽  
Joanna Prentice ◽  
Mark Findlay ◽  
Tara Collidge
Keyword(s):  
Diabetic Nephropathy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Frailty Scale ◽  
Simple Method ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage ◽  
Frailty Score

Abstract Background and Aims The incidence of frailty increases as GFR decreases. In the end stage renal disease (ESRD) population frailty is associated with early mortality, increased hospitalisations, and significant symptom burden. We examined the use of formal frailty scoring and its role in identifying deteriorating patients with advanced renal disease. Method The Rockwood Clinical Frailty Scale (CFS) has high inter-rater reliability and correlates well with objective measures of frailty. We introduced routine recording of the CFS from January 2018 in the renal electronic record for patients on hospital haemodialysis therapy and those undergoing renal replacement therapy (RRT) planning. Based on CFS scoring patients were divided into ‘frail’ (CFS≥6) or ‘robust’ based (CFS&lt;6) and patient demographics are described. The association of being ‘frail’ or a decline in score with mortality at seven months were described using adjusted logistic regression analyses. Results A total of 1663 scores were recorded in 800 patients. 57.3% of patients were male. The median age at entry date was 66 (IQR 55,75) years. The median CFS score was 4 (IQR 3,5). At follow-up 74 (9.3%) had died. The median score prior to death was 5.5. 182 (22.8%) were ‘frail’. During the study period 469 patients had more than one score documented. Death at follow-up was more common in those who were ‘frail’, 20.9 vs 5.8%, p&lt;0.001. Patients who were deceased at follow-up were more likely to have had a deterioration in frailty score, 51.9% vs 24.4%, p=0.002. Being ‘frail’ or having a deteriorating frailty score was associated with death at seven-month follow-up independent of age, sex or diabetic nephropathy status. Conclusion The presence of ‘frailty’ as measured by CFS, or deterioration in CFS is associated with death at follow-up, independent of age, sex or diabetic nephropathy. Routine monitoring of frailty using the CFS provides a simple method to identify patients who are deteriorating and at risk of death. High or deteriorating CFS score should trigger clinical review and anticipatory care planning where appropriate.

scholarly journals The Relationship between IL-1β, IL-17, IL-33 and Bcl-2 and the Development of Diabetic Nephropathy

2021 ◽  
Author(s):  
Ahmed Nabil ◽  
Basant Mahmoud ◽  
Adel Abdel-Moneim ◽  
Zinab Negeem
Keyword(s):  
Diabetic Nephropathy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cell Lymphoma ◽  
Chronic Renal Disease ◽  
Sodium Concentration ◽  
Positive Correlations ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Relationship

Abstract Background: Diabetic nephropathy (DN) is among the main complications of diabetes mellitus, and it has been the major factor of renal failure. The current investigation aims to address the association between beta-cell lymphoma-2 (Bcl-2), interleukin (IL)-1β, IL-17, and IL-33 with the development of DN. Methods: In this study, twenty healthy volunteers plus hundred patients have been signed up. According to their biochemical markers, patients were categorized into 5 groups; diabetic, chronic renal disease, diabetic chronic renal disease, end-stage renal disease, and diabetic end-stage renal disease. Results: Our results showed a noticeable elevation in IL-1β and IL-17 levels and a reduce in IL-33 and Bcl-2 levels in all investigated groups relative to the healthy group. Positive correlations were reported between IL-1β with FBS and creatinine levels, IL-17, with HbA1c% and sodium levels. However, negative correlations were exerted between IL-33 with urea and sodium concentration, Bcl2 with HbA1c%, and creatinine levels.Conclusion: The present data revealed a marked relationship between Bcl-2, IL-1β, IL-17, and IL-33 levels and the progression of DN. Therefore, understanding the molecular pathways of inflammatory and apoptotic activities-related DN could be translated into the development of therapeutic strategies.

scholarly journals Hemodialysis and Plasma Oxylipin Biotransformation in Peripheral Tissue

Metabolites ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 34
Author(s):  
Tong Liu ◽  
Inci Dogan ◽  
Michael Rothe ◽  
Julius V. Kunz ◽  
Felix Knauf ◽  
...  
Keyword(s):  
Epoxide Hydrolase ◽  
Venous Blood ◽  
Blood Stream ◽  
Arterial Blood ◽  
Cardiovascular Morbidity And Mortality ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Esrd Patients

(1) Background: Factors causing the increased cardiovascular morbidity and mortality in hemodialysis (HD) patients are largely unknown. Oxylipins are a superclass of lipid mediators with potent bioactivities produced from oxygenation of polyunsaturated fatty acids. We previously assessed the impact of HD on oxylipins in arterial blood plasma and found that HD increases several oxylipins. To study the phenomenon further, we now evaluated the differences in arterial and venous blood oxylipins from patients undergoing HD. (2) Methods: We collected arterial and venous blood samples in upper extremities from 12 end-stage renal disease (ESRD) patients before and after HD and measured oxylipins in plasma by LC-MS/MS tandem mass spectrometry. (3) Results: Comparison between cytochrome P450 (CYP), lipoxygenase (LOX), and LOX/CYP ω/(ω-1)-hydroxylase metabolites levels from arterial and venous blood showed no arteriovenous differences before HD but revealed arteriovenous differences in several CYP metabolites immediately after HD. These changes were explained by metabolites in the venous blood stream of the upper limb. Decreased soluble epoxide hydrolase (sEH) activity contributed to the release and accumulation of the CYP metabolites. However, HD did not affect arteriovenous differences of the majority of LOX and LOX/CYP ω/(ω-1)-hydroxylase metabolites. (4) Conclusions: The HD treatment itself causes changes in CYP epoxy metabolites that could have deleterious effects in the circulation.

Bone Alkaline Phosphatase in CKD–Mineral Bone Disorder

2013 ◽  
Vol 62 (4) ◽  
pp. 810-822 ◽  
Author(s):  
Sunita Sardiwal ◽  
Per Magnusson ◽  
David J.A. Goldsmith ◽  
Edmund J. Lamb
Keyword(s):  
Alkaline Phosphatase ◽  
Bone Alkaline Phosphatase ◽  
Mineral Bone Disorder ◽  
Bone Disorder

scholarly journals MICS, an easily ignored contributor to arterial calcification in CKD patients

2016 ◽  
Vol 311 (4) ◽  
pp. F663-F670 ◽  
Author(s):  
Kun Zhang ◽  
Jingwei Gao ◽  
Jie Chen ◽  
Xun Liu ◽  
Qingqing Cai ◽  
...  
Keyword(s):  
Early Stage ◽  
Arterial Calcification ◽  
Reverse Epidemiology ◽  
Multiple Risk Factors ◽  
Mineral Bone Disorder ◽  
Potential Strategy ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

In chronic kidney disease (CKD), simultaneous mineral and skeleton changes are prevalent, known as CKD-mineral bone disorder (CKD-MBD). Arterial calcification (AC) is a clinically important complication of CKD-MBD. It can increase arterial stiffness, which leads to severe cardiovascular events. However, current treatments have little effect on regression of AC, as its mechanisms are still unclear. There are multiple risk factors of AC, among which Malnutrition-Inflammation Complex Syndrome (MICS) is a new and crucial one. MICS, a combined syndrome of malnutrition and inflammation, generally begins at the early stage of CKD and becomes obvious in end-stage renal disease (ESRD). It was linked to reverse epidemiology and associated with increased cardiovascular mortality in ESRD patients. Recent data suggest that MICS can trigger CKD-MBD and accelerate the course of AC. In this present review, we summarize the recent understanding about the aggravating effects of MICS on AC and discuss the possible underlying mechanisms. A series of findings indicate that targeting MICS will provide a potential strategy for treating AC in CKD.

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