scholarly journals Hemodynamics and Metabolic Parameters in Normothermic Kidney Preservation Are Linked With Donor Factors, Perfusate Cells, and Cytokines

2022 ◽  
Vol 8 ◽  
Author(s):  
Annemarie Weissenbacher ◽  
John P. Stone ◽  
Maria Letizia Lo Faro ◽  
James P. Hunter ◽  
Rutger J. Ploeg ◽  
...  
Keyword(s):  
Arterial Flow ◽  
Metabolic Parameters ◽  
Kidney Preservation ◽  
Gm Csf ◽  
Study Results ◽  
Donor Factors ◽  
Stage Renal Disease ◽  
Biomarker Research ◽  
End Stage ◽  
Donor Characteristics

Kidney transplantation is the best renal-replacement option for most patients with end-stage renal disease. Normothermic machine preservation (NMP) of the kidney has been studied extensively during the last two decades and implemented in clinical trials. Biomarker research led to success in identifying molecules with diagnostic, predictive and therapeutic properties in chronic kidney disease. However, perfusate biomarkers and potential predictive mechanisms in NMP have not been identified yet. Twelve discarded human kidneys (n = 7 DBD, n = 5 DCD) underwent NMP for up to 24 h. Eight were perfused applying urine recirculation (URC), four with replacement of urine (UR) using Ringer's lactate. The aim of our study was to investigate biomarkers (NGAL, KIM-1, and L-FABP), cells and cytokines in the perfusate in context with donor characteristics, perfusate hemodynamics and metabolic parameters. Cold ischemia time did not correlate with any of the markers. Perfusates of DBD kidneys had a significantly lower number of leukocytes after 6 h of NMP compared to DCD. Arterial flow, pH, NGAL and L-FABP correlated with donor creatinine and eGFR. Arterial flow was higher in kidneys with lower perfusate lactate. Perfusate TNF-α was higher in kidneys with lower arterial flow. The cytokines IL-1β and GM-CSF decreased during 6 h of NMP. Kidneys with more urine output had lower perfusate KIM-1 levels. Median and 6-h values of lactate, arterial flow, pH, NGAL, KIM-1, and L-FABP correlated with each other indicating a 6-h period being applicable for kidney viability assessment. The study results demonstrate a comparable cytokine and cell profile in perfusates with URC and UR. In conclusion, clinically available perfusate and hemodynamic parameters correlate well with donor characteristics and measured biomarkers in a discarded human NMP model.

scholarly journals Effects of Variability in Blood Pressure, Glucose, and Cholesterol Concentrations, and Body Mass Index on End-Stage Renal Disease in the General Population of Korea

2019 ◽  
Vol 8 (5) ◽  
pp. 755 ◽  
Author(s):  
Mee Kyoung Kim ◽  
Kyungdo Han ◽  
Hun-Sung Kim ◽  
Yong-Moon Park ◽  
Hyuk-Sang Kwon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
General Population ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
High Variability ◽  
Metabolic Parameters ◽  
Metabolic Parameter ◽  
Stage Renal Disease ◽  
End Stage

Aim: Metabolic parameters, such as blood pressure, glucose, lipid levels, and body weight, can interact with each other, and this clustering of metabolic risk factors is related to the progression to end-stage renal disease (ESRD). The effect of variability in metabolic parameters on the risk of ESRD has not been studied previously. Methods: Using nationally representative data from the Korean National Health Insurance System, 8,199,135 participants who had undergone three or more health examinations between 2005 and 2012 were included in this analysis. Intraindividual variability in systolic blood pressure (SBP), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) was assessed by examining the coefficient of variation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability and low variability was defined as the lower three quartiles of variability. Results: Over a median (5–95%) of 7.1 (6.5–7.5) years of follow-up after the variability assessment period, 13,600 (1.7/1000 person-years) participants developed ESRD. For each metabolic parameter, an incrementally higher risk of ESRD was observed for higher variability quartiles compared with the lowest quartile. The risk of ESRD was 46% higher in the highest quartile of SBP variability, 47% higher in the highest quartile of FBG variability, 56% higher in the highest quartile of BMI variability, and 108% higher in the highest quartile of TC variability. Compared with the group with low variability for all four parameters, the group with high variability for all four parameters had a significantly higher risk for incident ESRD (hazard ratio (HR) 4.12; 95% CI 3.72–4.57). Conclusions: Variability in each metabolic parameter was an independent predictor of the development of ESRD among the general population. There was a composite effect of the variability in additional metabolic parameters on the risk of ESRD.

scholarly journals MO912INMUNE STATUS ON HAEMODIALYSIS PATTIENTS AFFECTED WITH COVID19 INFECTION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Justo Sandino Pérez ◽  
Alberto Utrero-Rico ◽  
Claudia Yuste ◽  
Elena Gutierrez-Solis ◽  
Enrique Morales ◽  
...  
Keyword(s):  
Mononuclear Cells ◽  
Clinical Deterioration ◽  
Membrane Expression ◽  
Peripheral Blood Mononuclear ◽  
Gm Csf ◽  
Hla Dr ◽  
Poor Tolerance ◽  
And Migration ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims End-stage renal disease patients on haemodialysis (HD) seem more likely to develop severe COVID19 disease. Over the course of COVID disease, we observed a poor tolerance to HD sessions with a marked tendency of clinical deterioration over them. The objective is to evaluate changes on immunological system over HD session on patients affected with COVID19 compared with patients without COVID19. Method Fourteen HD patients were studied including 9 confirmed COVID19 infection and 5 healthy controls. Predialysis and postdialysis blood samples were compared to study alterations on immune status. We identified cytoKines by Luminex (CCL2, CXCL10, IL1Ra, IL10, IL12p70, TNFα, IL17Ra, IL6, IL7) and adaptive lymphocyte subsets (CD4/CD8 naïve, CD4/CD8 MC, CD4/CD8 MP, CD19, CD56). Monocyte subsets (CD14+CD16-, CD14+CD16+, CD14-CD16+) were detected from peripheral blood mononuclear cells (PBMC), as well as immune activation (CD11b, HLA-DR, CD86) and migration factors (CCR2, CCR5). The supernatant of isolated CD14+ cells after 4-hour stimulation with LPS where analysed by Luminex to measure cytokines (CCL2, CXCL10, GM-CSF, IL10, IL12p70, IL17Ra, IL6, IL7, TNFα). Results Patients with COVID19 presented predialysis: (1) higher plasmatic levels of IL12p70, TNFα e IL7, (2) lymphopenia and neutrophilia, (3) higher percentage of intermediate monocytes and lower of non-classical, (4) lower membrane expression of CCR2, HLA-DR y CD86 over Cd14+ cells, and (5) higher production of CCL2, GM-CSF, IL10, IL12p70 y IL17Ra by LPS stimulated monocytes compared with patients without COVID19. When analysed the fold-change between pre and postdialysis values, patients with COVID19 infection present a: (a) higher plasmatic levels of IL6, IL1Ra, CCL2 e CXCL10, (b) reductions of total lymphocites, (c) higher membrane expression of CCR2, CD33 y CD86 on CD14+ cells, and (d) higher production of TNFα, GM-CSF, IL10, IL17, IL6 e IL7 by LPS stimulated monocytes compared with patients without COVID19. No differences on lymphocite subset were found. Conclusion The clinical deterioration on COVID19 infected patients over HD session could be related with monocyte activation and pro-inflammatory cytokines secretion.

scholarly journals Single-Center Open-Label Randomized Study of Anemia Management Improvement in ESRD Patients with Secondary Hyperparathyroidism

2016 ◽  
Vol 2 (1) ◽  
pp. pocj.5000196
Author(s):  
Antonio Bellasi ◽  
Stefano Mangano ◽  
Claudio Minoretti ◽  
Carlo Campana ◽  
Biagio Di Iorio ◽  
...  
Keyword(s):  
Randomized Study ◽  
Poor Quality ◽  
Probe Design ◽  
Single Center ◽  
Open Label ◽  
End Point ◽  
Study Results ◽  
Stage Renal Disease ◽  
End Stage ◽  
Anemia Treatment

Background Whether anemia and mineral bone abnormalities (chronic kidney disease–mineral bone disorder [CKD-MBD]) are associated still remains to be elucidated. Both anemia and CKD-MBD have been associated with adverse cardiovascular outcome and poor quality of life. However, recent evidence suggests that use of large doses of erythropoietin-stimulating agents (ESAs) to correct hemoglobin (Hb) may be detrimental in CKD. The Optimal Anemia Treatment in End Stage Renal Disease (ESRD) (Optimal ESRD Treatment) study will assess whether lowering of parathyroid hormone (PTH) is associated with a reduction in ESA consumption. Methods The Optimal ESRD Treatment study is a pilot single-center open-label study with blinded end point (a prospective randomized open blinded end-point [PROBE] design) enrolling 50 patients on maintenance dialysis. Eligible patients with intact PTH (iPTH) 300–540 pg/mL and Hb 10–11.5 g/dL will be randomized 1:1 to strict PTH control (150–300 pg/mL) versus standard care (PTH range 300–540 pg/mL). Available drugs for CKD-MBD and anemia treatment will be managed by the attending physician to maintain the desired levels of PTH (according to study arm allocation) and Hb (10–11.5 g/dL). Echocardiographic data for cardiac structure and function as well as arterial stiffness will be assessed at study inception and completion. Conclusions The Optimal ESRD Treatment study should shed light on the complicated interplay of anemia and CKD-MBD and on the feasibility of clinical trials in this domain. The study results are expected in the spring of 2017.

scholarly journals Frequency of anemia in patients with increased level of parathyroid hormone among patients on maintenance hemodialysis.

2020 ◽  
Vol 27 (06) ◽  
pp. 1255-1258
Author(s):  
Saad Muzaffar Azeem ◽  
Anita Haroon ◽  
Ishtiaque Alam ◽  
Sadia Azeem ◽  
Mahrukh Sultana ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Study Results ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Objectives: One of the most frequently occurring complication of end stage renal disease is anemia. It can be defined as decrease in red blood cells with hemoglobin concentration less than 12 g/dl in women and less than 13 g/dl in men. Parathyroid hormone levels are also raised among patients with end stage renal disease to maintain serum calcium levels. The objective of this study is to evaluate the degree of anemia in patients with end stage renal disease currently on maintenance hemodialysis and have raised PTH levels. Study Design: Cross-sectional study. Setting: Kidney Center, Karachi. Period: November 2015 to July 2016. Material & Method: Patients undergoing maintenance hemodialysis during the study duration with PTH levels greater than 300 ng/L were included in the study. Patients with other co-morbid conditions like chronic liver disease and hypersplenism were excluded from the study. Results: The total number of patients on maintenance hemodialysis in the kidney center that matched our inclusion criteria was 110. Amongst them there were 47.3% (n=52) males and 52.7% (n=58) females. The mean age of patients in our study is 50.15 ± 12.92 years. The mean PTH level of patients was found to be 642 ± 405.9U. Since all the participants of the study are on maintenance dialysis, the mean duration of hemodialysis was found to be 4.2 ± 3.19 months. The mean hemoglobin level of patients was found to be 9.75 ± 1.47 g/dl. Conclusion: Patients with hyperparathyroidism and undergoing maintenance hemodialysis frequently develops anemia. Many factors account for this including raised PTH levels causing bone marrow fibrosis, decreased production of erythropoietin and resistance of produced erythropoietin are some factors responsible for the anemia.

scholarly journals Exercise Training and Outcomes in Hemodialysis Patients: Systematic Review and Meta-Analysis

2019 ◽  
Vol 50 (4) ◽  
pp. 240-254 ◽  
Author(s):  
Mei Huang ◽  
Aili Lv ◽  
Jing Wang ◽  
Na Xu ◽  
Gairong Ma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Aerobic Exercise ◽  
Meta Analysis ◽  
Renal Hypertension ◽  
Combined Exercise ◽  
Study Results ◽  
Walking Capacity ◽  
Stage Renal Disease ◽  
End Stage

Background: Inadequate dialysis, renal hypertension, and impaired exercise capacity are factors that affect the quality of life (QoL) and mortality of adults with end-stage renal disease (ESRD) undergoing hemodialysis (HD). This systematic review provided valid evidence about the effect of exercise training on single-pool Kt/V (sp Kt/V), blood pressure, and peak uptake oxygen (VO2 peak). Method: A systematic review and meta-analysis of published randomized controlled trials (RCTs) that evaluated the effects of no <8 weeks’ exercise training on the physical fitness outcomes for adults with ESRD undergoing HD were accepted in this study. Results: Included 20 trials (677 participants) indicated that various exercise types improved aerobic capacity, walking capacity, and health-related QoL totally. Of note, aerobic exercise and combined exercise were the predominant exercise types. Conclusion: Based on our evidence, aerobic exercise or combined exercise at least for 8 weeks to 12 months, 3 times weekly, will be beneficial to physical conditions of the patients with ESRD undergoing HD. The clinical staff can treat patients with the evidence above. Future studies need to provide more information basis for the construction of patient exercise system by adding various exercise combinations.

SERUM OSTEOPROTEGERIN LEVEL IN CHRONIC HAEMODIALYSIS PATIENTS

2017 ◽  
pp. 48-51
Author(s):  
Tam Vo ◽  
Viet Thang Le ◽  
Minh Tuan Nguyen ◽  
Toan Trung Duong
Keyword(s):  
Vascular Calcification ◽  
Cross Sectional Study ◽  
High Serum ◽  
Chronic Haemodialysis ◽  
Cross Sectional ◽  
Maintenance Haemodialysis ◽  
Study Results ◽  
Serum Pth ◽  
Stage Renal Disease ◽  
End Stage

Background: Osteoprotegerin is a powerful inhibitor of osteoclast activity, and it plays an important role in bone metabolism. In hemodialysis (HD) patients, the serum OPG level had been found significantly increased and associated to vascular calcification. Elevated OPG level was noted as a mortality predictor in HD patients. Objective: To assess mean serum osteoprotegerin level in HD patients and to approach the probably relationship between serum osteoprotegerin level and serum PTH, Creatinin, BUN levels in HD patients. Method: Cross – sectional study. Results: Mean serum osteoprotegerin level: 242.49 ± 115.65 pg/ ml. Mean serum BUN level: 58.12 ± 16.83 mg/dL. Mean serum Creatinin level: 6.80 ± 5.23 mg/dL. Mean serum PTH level: 148.52 ± 198.24 pmol/L, median at 66.8 pmol/L [9.2-1140] pmol/L High serum OPG levels were associated with older ages (r=0.464, p<0.001). High serum OPG levels were associated with high BUN (r=0.028, p=0.137) High serum OPG levels were associated with serum Creatinin levels.(r=-0.189, p=0.032). High serum OPG levels were associated with high serum PTH levels (r=0.045, p=0.611). Conclusions: Mean serum osteoprotegerin level in hemodialysis patient: 242.49 ± 115.65 pg/ml. High serum OPG levels were associated with high BUN (r=0.028, p=0.137), with serum Creatinin levels. (r=-0.189, p=0.032), with high serum PTH levels (r=0.045, p=0.611). Key words: End stage renal disease, maintenance haemodialysis, osteoprotegerin, vascular calcification

scholarly journals MORBIDITY DATA ON HYPERTENSION

2006 ◽  
Vol 13 (01) ◽  
pp. 68-71
Author(s):  
HAMZULLAH KHAN ◽  
MOHAMMAD HAFIZULLAH
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Left Ventricular ◽  
Study Results ◽  
Morbidity Data ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage

Objectives: To find out morbidity data on hypertension, in a hospital basedstudy in Peshawar. Study Design: Prospective observational study. Duration: From march 2004 to July 2005. Setting:Cardiology Department of Lady Reading Hospital and Medical Department of Khyber Teaching Hospital Peshawar.Patients and Methods: A total of 718 patients with established diagnosis of associated complications of hypertensionwere included. Relevant information were recorded from the patients with the help of a pre-designed questionnaireprepared in accordance with the objectives of study. Results: A total of 718 patients were selected. Age ranged frompatients was from 25 to 92 years with mean age of 58.5 years were included. Out of 718 sampling 433 were femalesand 285 were males. Three hundred and eighty three patients had more than ten years duration of the disease. Thedistribution of associated complications of hypertension was: coronary artery disease (61.42%), left ventricularhypertrophy/left ventricular failure (19.63%), stroke (11%), retinopathies (3.62%), end stage renal disease (1.39%), andmultiple complications (2.50%). Conclusion: Hypertension is a major modified risk factor for coronary artery disease,stroke, eye abnormalities and end stage renal disease, which require proper counseling and management of patients.

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