| 1. |
- Alvestrand, A, et al.
(författare)
-
Left ventricular hypertrophy in incident dialysis patients randomized to treatment with hemofiltration or hemodialysis: results from the ProFil study
- 2011
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 32:1, s. 21-29
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Introduction:</i> Left ventricular hypertrophy (LVH) is present in a majority of hemodialysis (HD) patients and is among the strongest risk factors for cardiovascular events and mortality. Hemofiltration (HF), a purely convective dialysis treatment, has been associated with enhanced hemodynamic stability compared with HD, possibly as a result of a more physiologic removal of fluid and solutes. <i>Methods:</i> In a randomized controlled study conducted at ten dialysis centers in Sweden and Denmark, incident patients (HD <3 months) without clinical signs or history of cardiovascular disease were randomized to treatment with either online, predilution HF or low-flux HD. The primary endpoint was change in left ventricular mass index (LVMI), as measured by two-dimensional M-mode and Doppler echocardiography. <i>Results:</i> The analyses included 34 patients (18 HF, 16 HD) followed for up to 2 years. At baseline, 65% of the patients had LVH, but LVMI did not differ between the study groups. In the HF group, LVMI decreased by 22 ± 48 g/m<sup>2</sup> during a mean treatment time of 19 ± 7 months, while in the HD group the decrease was 15 ± 57 g/m<sup>2</sup> during 16 ± 7 months. As analyzed by MANOVA (mixed model), the difference in LVMI over the whole period was statistically significant (p = 0.03) with a more favorable outcome in HF. Blood pressure and other study variables did not differ between the groups, but at baseline and throughout the study, HF patients required heavier antihypertensive treatment. <i>Conclusions:</i> In incident dialysis patients, long-term predilution HF, a purely convective dialysis treatment, is associated with a significantly more favorable development of LVMI compared with regular low-flux HD. Considering the predictive strength of LVMI as a risk factor, the quantitative difference between the treatments is of clinical importance.
|
|
| 2. |
|
|
| 3. |
- Arnadottir, Margret, et al.
(författare)
-
The postdialytic rise in the plasma total homocysteine concentration is delayed
- 2002
-
Ingår i: Blood Purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 20:4, s. 334-337
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: The mechanism behind the uremic hyperhomocysteinemia has not been elucidated. Possibly, dialyzable uremic toxins play a role, e.g. as enzyme inhibitors. If so, the conditions for enzymatic removal would be expected to improve after dialysis. Therefore, we studied the postdialytic pattern of the plasma total homocysteine (tHcy) concentration. METHODS: We collected blood samples from 19 stable, vitamin-supplemented hemodialysis patients before and at 5, 60, as well as at 480 min after a dialysis session. The patients were studied after dialysis with a low-flux dialyzer (Polyflux 6L) and a high-flux dialyzer (Polyflux 14S). RESULTS: The mean predialytic plasma tHcy concentration was 13.3 micromol/l which is considerably lower than the concentrations observed in our previous studies. In all patients, the plasma tHcy concentration fell during treatment with both types of dialyzers (average decrease 28 +/- 7%, p < 0.0001, and 31 +/- 8%, p < 0.0001, respectively). No postdialytic change in the plasma tHcy concentration was observed at 60 min after low-flux dialysis, however, after high-flux dialysis, the plasma tHcy concentration was significantly lower at 60 min postdialysis than at 5 min (3 +/- 8%, p < 0.05). At 480 min after dialysis, a significant postdialytic increase in the plasma tHcy concentration was found (6 +/- 9%, p < 0.01, and 11 +/- 5%, p < 0.0001, respectively) both in the case of low-flux and high-flux treatment. CONCLUSION: In the postdialytic phase, we observed a short-lived stability in the plasma tHcy concentration, and in the case of high-flux dialysis, even a slight decrease in the plasma tHcy concentration. The results support the hypothesis that dialyzable substances interfere with homocysteine removal.
|
|
| 4. |
|
|
| 5. |
- Axelsson, J
(författare)
-
Obesity in chronic kidney disease: good or bad?
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:1, s. 23-29
-
Tidskriftsartikel (refereegranskat)abstract
- Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in chronic kidney disease (CKD) patients. As traditional risk factors cannot alone explain the high prevalence and incidence of CVD in this high-risk population, the complex of insulin resistance, oxidative stress, and endothelial dysfunction has increasingly been studied as important non-traditional risk factors. Recent studies show that the adipose tissue is a complex organ with functions far beyond the mere storage of energy. Indeed, it has recently been shown that fat tissue secretes a number of adipokines – including leptin, adiponectin and retinol-binding protein, as well as cytokines such as resistin, visfatin, tumor necrosis factor and interleukin-6. Adipokine serum levels are furthermore markedly elevated in CKD, likely due to a decreased renal excretion. Evidence suggests that these pluripotent signaling molecules may have multiple effects modulating insulin signaling, endothelial health and putatively CVD. As fat tissue is also a storage depot for energy, much needed in the catabolic milieu of uremia, further research is still needed to elucidate the likely complex interactions between these signaling networks, vascular health and outcome in this high-risk population.
|
|
| 6. |
- Bell, M, et al.
(författare)
-
Comparison of the Accuracy of the Novel PrisMax Continuous Renal Replacement Therapy System to the Classic Prismaflex System
- 2019
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 47:1-3, s. 166-170
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background/Aims:</i></b> We assessed how the novel PrisMax continuous renal replacement therapy (CRRT) system performed in an international multicentre setting. The system has multiple novel tools aiming to increase accuracy and dose delivery. <b><i>Methods:</i></b> Data was prospectively collected from 7 intensive care units in 6 countries. The PrisMax device data logs constituted the raw material and last generation Prismaflex data was used as comparison. Clinical parameters like treatment time, filter life span, downtime as well as prescribed and delivered dose were recorded. <b><i>Results:</i></b> PrisMax delivered/prescribed effluent ratios (mean ± SD) 0.92 ± 0.15 vs. Prismaflex ratios 0.85 ± 0.21, <i>p</i> < 0.001; delivered effluent dose (mL/kg/h) was 18.16 ± 12.93 vs. 10.95 ± 10.96, <i>p</i> < 0.0001; and (Kt/V) 0.76 ± 0.52 vs. 0.44 ± 0.44, <i>p</i> < 0.0001. Moreover, downtime was 27 minutes less for the newer device. <b><i>Conclusion:</i></b> The PrisMax CRRT device outperforms its predecessor with regard to dose delivery and accuracy.
|
|
| 7. |
- Bellomo, R, et al.
(författare)
-
Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose
- 2016
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 41:1-3, s. 11-17
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Aims:</i></b> The study aims to describe the use of dialysis catheters in critically ill patients treated with continuous renal replacement therapy (CRRT) and to study the impact of femoral versus non-femoral access on CRRT dose. <b><i>Methods:</i></b> Statistical analysis and predictive modelling of data from the Randomized Evaluation of Normal vs. Augmented Level renal replacement therapy trial. <b><i>Results:</i></b> The femoral vein was the first access site in 937 (67%) of 1,399 patients. These patients had higher Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores (p = 0.009) and lower pH (p < 0.001) but similar mortality to patients with non-femoral access (44 vs. 45%; p = 0.63). Lower body weight was independently associated with femoral access placement (OR 0.97, 95% CI 0.96-0.98). Femoral access was associated with a 1.03% lower CRRT dose (p = 0.05), but a 4.20% higher dose was achieved with 13.5 Fr catheters (p = 0.03). <b><i>Conclusions:</i></b> Femoral access was preferred in lighter and sicker patients. Catheter gauge had greater impact than catheter site in CRRT dose delivery. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=439581.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Bomholt, Tobias, et al.
(författare)
-
The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis
- 2022
-
Ingår i: Blood Purification. - : S. Karger. - 0253-5068 .- 1421-9735. ; 51:7, s. 608-616
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The accuracy of hemoglobin A1c (HbA1c) as a glycemic marker in patients with type 2 diabetes (T2D) receiving hemodialysis (HD) remains unknown. To assess accuracy, we compared HbA1c and fructosamine levels with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with T2D receiving HD.METHODS: Thirty patients in the HD group and 36 patients in the control group (T2D and an estimated glomerular filtration rate >60 mL/min/1.73 m2) completed the study period of 17 weeks. CGM (Ipro2®, Medtronic) was performed 5 times for periods of up to 7 days (with 4-week intervals) during a 16-week period. HbA1c (mmol/mol), the estimated mean plasma glucose from HbA1c (eMPGA1c [mmol/L]) and fructosamine (μmol/L) was measured at week 17 and compared with mean sensor glucose levels from CGM.FINDINGS: In the HD group, mean sensor glucose was 1.4 mmol/L (95% confidence interval [CI]: 1.0-1.8) higher than the eMPGA1c, whereas the difference for controls was 0.1 mmol/L (95% CI: -0.1-[0.4]; p < 0.001). Adjusted for mean sensor glucose, HbA1c was lower in the HD group (-7.3 mmol/mol, 95% CI: -10.0-[-4.7]) than in the control group (p < 0.001), with no difference detected for fructosamine (p = 0.64).DISCUSSION: HbA1c evaluated by CGM underestimates plasma glucose levels in patients receiving HD. The underestimation represents a clinical challenge in optimizing glycemic control in the HD population. Fructosamine is unaffected by the factors affecting HbA1c and appears to be more accurate for glycemic monitoring. CGM or fructosamine could thus complement HbA1c in obtaining more accurate glycemic control in this patient group.
|
|
| 11. |
- Broman, M, et al.
(författare)
-
The Novel PrisMax Continuous Renal Replacement Therapy System in a Multinational, Multicentre Pilot Setting
- 2018
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 46:3, s. 220-227
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background/Aims:</i></b> We assessed how the novel PrisMax continuous renal replacement therapy (CRRT) system performed in a prospective international multicentre setting. We compared this device to its predecessor, the Prismaflex, with regards to multiple treatment parameters. Additionally, we performed a survey, aiming to measure user satisfaction. <b><i>Methods:</i></b> Data was prospectively collected from 7 intensive care units (ICU) in 6 countries. The PrisMax device data logs constituted the raw material. Clinical parameters like treatment time, filter life span, downtime, delivered dose and number and type of alarms were recorded. A user questionnaire was sent out to 3 of the participating ICUs. <b><i>Results:</i></b> Filter life, downtime, blood pump stops, bag changing time and number of malfunction alarms showed significantly improved values compared to the historic Prismaflex data. The survey showed high scores with regards to user friendliness. <b><i>Conclusion:</i></b> The PrisMax CRRT device is safe and outperformed its’ previous generation counterpart in virtually all aspects. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=489213.
|
|
| 12. |
- Calabia, J, et al.
(författare)
-
Does the obesity survival paradox of dialysis patients differ with age?
- 2015
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 39:1-3, s. 193-199
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> The obesity paradox of hemodialysis patients (the association between obesity and survival) could be modified by age. We hypothesize that whereas obesity associates with survival in elderly patients, it behaves as a mortality risk marker in younger individuals. <b><i>Methods:</i></b> Retrospective study of 2002-2010 adult incident hemodialysis to analyze the relationship between body mass index (BMI) and annual body weight changes with mortality in different age strata. <b><i>Results:</i></b> Included in the study were 6,290 individuals. A progressive decrease in mortality was associated with increasing BMI ranges. Both annual body weight gains and losses were associated with mortality. Similar results were observed in elderly individuals, but in the BMI values of young patients, there were no significant differences in mortality. <b><i>Conclusion:</i></b> There is a survival benefit with increasing BMI in patients overall. However, while these results persist in patients >65 years, in young people there are no changes in mortality. Patients with the highest inter-annual variability in weight have an increased risk.
|
|
| 13. |
- Carlsson, Axel C, et al.
(författare)
-
Endostatin, cathepsin S, and cathepsin L, and their association with inflammatory markers and mortality in patients undergoing hemodialysis
- 2015
-
Ingår i: Blood Purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 39:4, s. 259-265
-
Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Although both endostatin and cathepsins S have been associated with higher mortality, data in patients with end-stage renal disease (ESRD) are scarce.Methods: A longitudinal cohort study of 207 prevalent patients undergoing hemodialysis.Results: Cathepsins S and L were associated with soluble receptors for tumor necrosis factor (sTNFR1 and sTNFR2, rho between 0.28 and 0.43, p < 0.001 for all). Weaker or absent associations between endostatin, cathepsins S and L were seen with other inflammatory biomarkers, that is, CRP, interleukin 6, pentraxin 3, and TNF. In Cox and Laplace regression models adjusted for age, sex, dialysis vintage, and diabetes: standard deviation increments of endostatin was associated with a lower mortality (hazard ratio 0.75, 95% confidence interval (CI) 0.57-0.98), and with 6.8 months longer median survival.Conclusions: The high levels of endostatin, cathepsins S and L, and their associations with sTNFR1 and sTNFR2 warrant further studies exploring mortality, and the angiogenic and inflammatory pathways in ESRD. (C) 2015 S. Karger AG, Basel
|
|
| 14. |
- Carrero, JJ, et al.
(författare)
-
Cytokine dysregulation in chronic kidney disease: how can we treat it?
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:3, s. 291-299
-
Tidskriftsartikel (refereegranskat)abstract
- As the kidney is the major site for elimination of many cytokines, the delicate equilibrium of pro-inflammatory cytokines and their inhibitors is clearly dysregulated in chronic kidney disease (CKD) patients. The consequences of the altered immune response in uremia lead to a state of persistent inflammation which is highly prevalent among CKD patients and is linked to complications such as the development of protein-energy wasting and atherosclerotic vascular disease. The present review aims at reviewing this complex orchestration of uremic cytokines beyond the well-studied interleukin-6 and tumor necrosis factor-α. Finally, we update our current understanding on anti-inflammatory treatment strategies in CKD patients, including nutritional and lifestyle measurements, pharmacological intervention and specific anticytokine strategies targeting the dialytic procedure.
|
|
| 15. |
- Chmielewski, M, et al.
(författare)
-
Lipoprotein lipase 1595 c/g and hepatic lipase -480 c/t polymorphisms--impact on lipid profile in incident dialysis patients
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:6, s. 555-560
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Dyslipidemia is a common complication of chronic kidney disease. Lipoprotein lipase (LPL) 1595 C/G and hepatic lipase (HL) –480 C/T single nucleotide polymorphisms (SNPs) influence lipid profile and predisposition for cardiovascular disease in the general population. The present study was undertaken to clarify the impact of the two polymorphisms on lipid parameters and cardiovascular risk in incident dialysis patients. <i>Methods:</i> LPL 1595 C/G and HL –480 C/T SNPs were evaluated in 293 chronic kidney disease patients close to dialysis initiation. Associations with lipid parameters, presence of cardiovascular disease, and survival were assessed. <i>Results:</i> LPL 1595 C/G SNP was associated with significantly lower triglyceride levels [1.55 (1.00–2.20) vs. 1.90 (1.40–2.48) m<i>M</i>; p < 0.01], while HL –480 C/T polymorphism was associated with increased high density lipoprotein cholesterol concentration [1.30 (1.00–1.60) vs. 1.10 (0.90–1.40) m<i>M</i>; p < 0.05]. Neither of the polymorphisms showed any relationship with patient survival. <i>Conclusions:</i> LPL 1595 C/G and HL –480 C/T polymorphisms affect lipid profile in incident dialysis patients.
|
|
| 16. |
- Chung, SH, et al.
(författare)
-
Impact of incremental risk factors on peritoneal dialysis patient survival: proposal of a simplified clinical mortality risk score
- 2009
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 27:2, s. 165-171
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background/Aim:</i> Peritoneal dialysis (PD) patient survival is influenced by many factors and there is no consensus on the relative importance of these predictors, independently or combined. This study was designed to evaluate how these independent factors, alone or in various combinations, may influence PD patient survival. <i>Methods:</i> A peritoneal equilibration test, subjective global assessment (SGA), and comorbid diseases (CMD) were assessed. <i>Results:</i> On multivariate analysis, age (>60 years), CMD, malnutrition, and low RRF (≤2 ml/min) were independent predictors of mortality. Three-year patient survival was 100, 95, 75, 49, and 0%, and the risk ratio for mortality was 1.0, 6.6, 21.9, and 85.9 in patients with none, one, two, three, and four of these risk factors, respectively. <i>Conclusions:</i> The combination of independent predictors of mortality in PD patients leads to a markedly increasing risk for mortality. Evaluation of a single risk factor underestimates the true impact of risk factors.
|
|
| 17. |
- Debowska, M, et al.
(författare)
-
Association between Biomarkers of Mineral and Bone Metabolism and Removal of Calcium and Phosphate in Hemodialysis
- 2020
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 49:1-2, s. 71-78
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> A significant drop of serum phosphate and calcium removal or loading during hemodialysis induce reactions in mineral and bone remodeling that may inversely affect phosphate and calcium removal during dialysis. <b><i>Objectives:</i></b> We aimed to analyze the interdependencies between biomarkers of mineral and bone metabolism and removal of phosphate and calcium during hemodialysis, as this complex relationship is not fully understood. <b><i>Methods:</i></b> Three subsequent hemodialysis sessions during a 1-week treatment cycle with interdialytic periods of 2–2-3 days were monitored in 25 anuric patients. Calcium and phosphate concentrations were measured in serum before, at 1, 2, and 3 h, at the end, and 45 min after each session and in the outlet dialysate every 30 min. Biomarkers associated with mineral and bone metabolism: parathyroid hormone (PTH 1–34 and PTH 1–84), calcitonin, 25(OH)-vitamin D, fetuin-A, osteopontin, osteocalcin 1–43/49, and intact osteocalcin were assayed once in each patient before the midweek hemodialysis session. <b><i>Results:</i></b> Post-dialytic and intra-dialytic serum phosphate of midweek hemodialysis session and phosphate mass removed within 1 week correlated positively with serum PTH (0.40 < rho <0.46, <i>p</i> value <0.05). Higher concentration of serum PTH was associated with an increased level of osteocalcin. Pre-dialytic, post-dialytic, average for treatment time and average weekly concentrations of ionized calcium in serum correlated positively with serum osteocalcin. Serum osteocalcin and osteopontin levels were associated with the masses of total and ionized calcium, respectively, removed during 3 hemodialysis sessions. <b><i>Conclusions:</i></b> During hemodialysis, phosphate removal was associated with serum PTH, whereas calcium kinetics was influenced by serum osteocalcin and osteopontin. These results demonstrate that active processes involving biomarkers of mineral and bone metabolism are affected by the phosphate and calcium kinetics already within 4 h hemodialysis sessions.
|
|
| 18. |
|
|
| 19. |
- Fadul, Jamal E., et al.
(författare)
-
Effects of LDL apheresis on blood rheology in two patients with homozygous familial hypercholesterolaemia
- 1997
-
Ingår i: Blood Purification. - 0253-5068 .- 1421-9735. ; 15:3, s. 182-187
-
Tidskriftsartikel (refereegranskat)abstract
- Changes in haemorheological and lipid variables were investigated in 2 patients with homozygous familial hypercholesterolaemia (FH) treated with low-density lipoprotein (LDL) apheresis using dextran sulphate adsorbent. The immediate effect of LDL apheresis was a fall in plasma fibrinogen by 50%, total and LDL cholesterol by 60%, plasma viscosity by 12% and whole blood viscosity by 17%. Before the 12th treatment session, plasma fibrinogen concentration remained reduced by 22%, whole blood viscosity by 17% and the plasma viscosity by 11% compared with the initial values. Total and LDL cholesterol in plasma also remained reduced by about 50%. We conclude that LDL apheresis, using dextran sulphate adsorbent, improves blood rheology. The decrease in plasma fibrinogen concentrations, plasma viscosity and LDL cholesterol might be factors contributing to the improved haemorheological properties.
|
|
| 20. |
- Goncalves, SM, et al.
(författare)
-
Lack of adequate predialyis care and previous hemodialysis, but not hemoglobin variability, are independent predictors of anemia-associated mortality in incident Brazilian peritoneal dialysis patients: results from the BRAZPD study
- 2012
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 34:3-4, s. 298-305
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background/Aims:</i></b> The objective of this study was to analyze the prevalence of anemia and variability of hemoglobin (Hb) values in peritoneal dialysis (PD) patients, to establish its associated factors and their impact on clinical outcomes in a large cohort of patients starting PD treatment. <b><i>Methods:</i></b> Data were collected monthly in incident patients, who were followed until the primary endpoint (death from all causes) or until leaving the study. <b><i>Results:</i></b> 2,156 patients starting PD were included. The prevalence of Hb lower than 11 g/dl was 57% at baseline and decreased to 38% at the 4th month. Lack of adequate predialysis care and previous treatment with hemodialysis were the most important factors associated with anemia. Anemia was an independent predictor of mortality. There were no differences in patient survival throughout the different groups of Hb variability. <b><i>Conclusion:</i></b> Our data point to the need of identifying other risk factors for anemia and aggressively interfere with the modifiable ones in order to correct anemia and decrease mortality in this group of high-risk patients.
|
|
| 21. |
- Grahl, DA, et al.
(författare)
-
Associations between the CYBA 242C/T and the MPO -463G/A polymorphisms, oxidative stress and cardiovascular disease in chronic kidney disease patients
- 2007
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 25:2, s. 210-218
-
Tidskriftsartikel (refereegranskat)abstract
- Genetic variations in the NADPH/MPO system in chronic kidney disease (CKD) patients might lead to altered activity of these enzymes, and thus to altered risk for oxidative stress (OS) and cardiovascular disease (CVD). We evaluated the impact of 242C/T <i>CYBA</i> and –463G/A <i>MPO</i> polymorphisms on OS and CVD mortality in stage 5 CKD patients starting dialysis. Two hundred and fifty-seven patients were genotyped using Pyrosequencing. Plasmalogen [dimethylacetal (DMA) 16/C16:0] was used as OS marker. CVD was assessed from patient history and clinical symptoms. Prevalence of CVD was higher (35%) in GG patients (<i>MPO</i>) compared to AG (26%) and AA (0%) patients (p < 0.01). Patients with CC genotype (<i>CYBA</i>) had lower levels of DMA 16/C16:0 (ratio 0.071 ± 0.003) compared to TT patients (0.089 ± 0.006; p < 0.05). These patients also had increased CVD mortality compared to CT and TT patients (χ<sup>2</sup> 2.19; p < 0.05). We conclude that genetic variations in the NADPH/MPO system are associated with OS, presence of CVD and CVD-related mortality in CKD patients.
|
|
| 22. |
- Gu, Y, et al.
(författare)
-
Strong association between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:4, s. 340-346
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Malnutrition is a predictor of cardiovascular disease in dialysis patients, but the mechanisms remain unknown. We investigated links between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients. <i>Methods:</i> We evaluated the relationship between arterial stiffness evaluated by pulse-wave velocity (PWV) and four estimates of nutritional status (serum albumin, handgrip strength [HGS], subjective global assessment [SGA], and bioelectrical impedance analysis phase angle [PA]) in 124 PD patients. <i>Results:</i> Malnourished patients exhibited a significantly higher PWV than those classified as well-nourished by SGA (p < 0.05). Furthermore, PWV correlated negatively with albumin, HGS and PA (p < 0.001, respectively). PWV was also correlated with age, systolic blood pressure, and C-reactive protein. In multivariate regression analysis, albumin, HGS, SGA and PA were each independently associated with PWV after adjustment. <i>Conclusions:</i> The significant association between each nutritional marker and PWV in PD patients was independent of inflammation and diabetic state, suggesting that malnutrition may contribute to vascular dysfunction.
|
|
| 23. |
|
|
| 24. |
|
|
| 25. |
- Hertzberg, D, et al.
(författare)
-
Experiences of Renal Replacement Therapy Delivery in Swedish Intensive Care Units during the COVID-19 Pandemic
- 2022
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 51:7, s. 584-589
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> The COVID-19 pandemic led to a rapidly increased demand for intensive care unit (ICU) and renal replacement therapy (RRT) worldwide. RRT delivery was threatened by a lack of specially trained staff and equipment. We investigated how the first wave of COVID-19 affected RRT delivery in Swedish ICUs. <b><i>Methods:</i></b> An Internet-based questionnaire was sent to ICU lead physicians which included quantitative and qualitative questions regarding RRT demand, equipment availability, and use of continuous renal replacement therapy (CRRT), intermittent haemodialysis (IHD), and peritoneal dialysis (PD) during spring 2020. <b><i>Results:</i></b> Twenty-five ICUs responded and these treated 64% of COVID-19 ICU patients in Sweden. ICU capacity increased by 292% (IQR 171–347%). Median peak capacity was reached during the 18th week of the year. RRT use increased overall by 133% and in Stockholm by 188%. 36% of units sequestered CRRT machines. IHD was used in 68% and PD in 12% of ICUs. RRT fluid and filter shortages were experienced by 45% and 33% of wards, respectively; consequently, prescription alterations were made by 24% of ICUs. Calcium solution shortages were reported in 12% of units that led to citrate protocol changes. Staffing shortages resulted in RRT sometimes being delivered by non-RRT-trained staff, safety incidents relating to this occurred, although no patient harm was reported. <b><i>Conclusion:</i></b> During the first wave of the COVID-19 pandemic, RRT demand increased extensively causing staff and equipment shortages, altered CRRT protocols, and increased use of IHD and PD. The impact on patient outcomes should be assessed to effectively plan for further surge capacity RRT demand.
|
|
| 26. |
- Hoppe, K, et al.
(författare)
-
Cardiac Troponin T and Hydration Status as Prognostic Markers in Hemodialysis Patients
- 2015
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 40:2, s. 139-145
-
Tidskriftsartikel (refereegranskat)abstract
- This study aimed to assess cardiac troponin T (cTnT) and hydration state as cardiovascular (CV) risk markers in hemodialysis (HD) patients. Two hundred and forty one patients were divided according to HD vintage into two groups: SV (HD ≤24 months) and LV. Water balance was assessed with overhydration (OH%; bioimpedance analysis) and daily diuresis (DD); CV dysfunction with cTnT and heart ultrasound; nutrition with subjective global assessment (SGA), cholesterol (TC) and albumin. SV had lower OH% (2.8 vs. 3.5, p < 0.05) and higher DD (1,161 vs. 637 ml, p < 0.001), while LV had higher cTnT (0.1 ± 0.04 vs. 0.1 ± 0.07 ng/ml, p < 0.05) and lower interventricular septum thickness (IVS; 13.4 vs. 14.5 mm, p < 0.05). Nutritional state as reflected by lower TC was worse in LV (184.7 vs. 169.5 mg/dl, p < 0.05). Mortality was higher in patients in the LV group (15 vs. 27 deaths, p < 0.05). OH% correlated inversely with albumin (r = -0.36, p < 0.001), TC (r = -0.31, p < 0.001) and cTnT (r = -0.4, p < 0.001). cTnT correlated positively with IVS (r = 0.39, p < 0.001), SGA (r = 0.23, p = 0.001) and mortality rate (r = 0.21, p < 0.01), and negatively with DD (r = -0.34, p < 0.001) and albumin (r = -0.25, p < 0.001). Longer dialysis vintage associates with CV dysfunction, overhydration and increased mortality, which may be predicted with OH% and cTnT. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=376603.
|
|
| 27. |
- Jerotskaja, Jana, et al.
(författare)
-
Optical Online Monitoring of Uric Acid Removal during Dialysis
- 2010
-
Ingår i: BLOOD PURIFICATION. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 29:1, s. 69-74
-
Tidskriftsartikel (refereegranskat)abstract
- This study estimates the total removal of uric acid (TRUA) by online UV absorbance measurements in the spent dialysate in two different dialysis centers in Estonia and Sweden. Sixteen dialysis patients were included. All dialysate was collected that gave the reference for TRUA. Two regression models were investigated: one for each patient (UV1) and one for the entire material (UV2). TRUA from the three methods was in the same order but showed a statistically significant difference when the UV2 model was built on data from both centers together. TRUA, (n = 56) was (mean +/- SD, mu mol): 5,854 +/- 1,377 for reference, 6,117 +/- 1,795 for UV1 and 5,762 +/- 1,591 for UV2. Six patients were monitored 1 year after the first study session, using the same models as the previous year, still having a nonsignificant difference. The results show the possibility of estimating TRUA by using UV absorbance. The method appeared to be reliable also in long-term patient monitoring.
|
|
| 28. |
- Jiang, N, et al.
(författare)
-
Initiation of glucose-based peritoneal dialysis is associated with increased prevalence of metabolic syndrome in non-diabetic patients with end-stage renal disease
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:5, s. 423-428
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Glucose-based peritoneal dialysis (PD) is the original PD form. However, glucose uptake from the peritoneal cavity may contribute to dysmetabolism. <i>Methods:</i> We retrospectively assessed metabolic syndrome (MS) and its components in 195 non-diabetic incident PD patients at baseline and after 34.3 (20.5–60.0) months of PD. MS was defined according to the Adult Treatment Panel III criteria. <i>Results:</i> While 22.1% of the patients met MS criteria at baseline, 69.2% (p < 0.01) exhibited MS during PD. MS burden increased significantly after PD (p < 0.01). The disorder BMI and lipids, and MS components number, correlated with peritoneal glucose exposure and PD duration (p < 0.05). In Cox analysis, age, BMI, triglyceride, C-reactive protein (CRP) and glucose exposure were all independently associated with MS development. <i>Conclusions:</i> PD commencement in end-stage renal disease patients was associated with an increased MS prevalence. High glucose exposure and long PD duration were associated with MS existence, along with old age, high BMI, triglyceride and CRP.
|
|
| 29. |
- Kashani, K, et al.
(författare)
-
Proposal for a New Classification of Solutes of Interest in Uremia and Hemodialysis
- 2023
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 52:3, s. 233-241
-
Tidskriftsartikel (refereegranskat)abstract
- Uremic toxins contribute to clinical manifestations of kidney dysfunction. These toxins include organic and inorganic elements or compounds. While the kidney typically clears uremic toxins, gut dysbiosis, and tissue inflammation could lead to increased production of substances that can further the clinical manifestations of uremia. The uremic toxins are quantitatively measurable in biological fluids and have an established relationship with azotemia signs and symptoms. Their elimination is associated with mitigated uremic manifestations, while their administration to the uremic levels leads to uremic signs in animal or human models or in vitro studies. Besides, the uremic toxins have an established and plausible pathophysiologic relationship with uremic manifestations. The previous classification of uremic toxins was mainly focused on the physicochemical characteristics of these substances to divide them into three categories, (1) free water-soluble low-molecular-weight (<500 Da) solutes, (2) protein-bound, water-soluble, low molecular weight (<500 Da), (3) middle molecular weight (>500 Da and <12,000 Da), and (4) high molecular weight (>12,000 Da). Unfortunately, the classification named above was not centered around patient outcomes and quality of life among those with severe kidney failure. Therefore, a panel of experts convened virtually to provide additional insights into the current state and propose a new uremic toxin classification. This article describes the group’s consensus recommendations regarding the new classification of uremic toxins into more clinically oriented categories.
|
|
| 30. |
- Kato, S, et al.
(författare)
-
High Ferritin Level and Malnutrition Predict High Risk of Infection-Related Hospitalization in Incident Dialysis Patients: A Japanese Prospective Cohort Study
- 2016
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 42:1, s. 56-63
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Aims:</i></b> The aim of the study was to clarify the relationship between serum ferritin and infectious risks. <b><i>Methods:</i></b> We evaluated all hospital admissions due to infections, clinical biomarkers and nutrition status in 129 incident Japanese dialysis patients during a median follow-up of 38 months. <b><i>Results:</i></b> Kaplan-Meier analysis revealed that the period without infections requiring hospitalization was significantly shorter in ferritin > median (82.0 ng/ml) group than in the ferritin < median group (log-rank test 4.44, p = 0.035). High ferritin was associated with significantly increased relative risk of hospitalization for infection (Cox hazard model 1.52, 95% CI 1.06-2.17). The number of hospitalization days was gradually longer in patients with high ferritin levels and malnutrition. <b><i>Conclusion:</i></b> Although serum ferritin levels were low, and doses of iron administered to dialysis patients in Japan are generally lower than in Western countries, an elevated ferritin level was associated with increased risk of infection, particularly in patients with poor nutritional status.
|
|
| 31. |
- Kato, S, et al.
(författare)
-
Telomere Attrition and Elongation after Chronic Dialysis Initiation in Patients with End-Stage Renal Disease
- 2016
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 41:1-3, s. 25-33
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Aims:</i></b> To analyze changes in telomere length (TL) after dialysis initiation. <b><i>Methods:</i></b> In 59 Japanese incident dialysis patients, associations between TL in peripheral blood leukocytes, inflammatory biomarkers and nutritional status at baseline and changes in TL during 1 year of dialysis, were investigated. <b><i>Results:</i></b> Whereas relative TL decreased by 8.6% (median 14.4%), TL elongation occurred in 16 patients (27%). Change in TL (ΔTL), defined as TL at 1 year minus TL at baseline, was associated with baseline TL (ρ = -0.70, p < 0.0001) and leukocyte count (ρ = 0.26, p = 0.044). In a logistic regression model, baseline TL (p < 0.0001) and leukocyte count (p = 0.047) were associated with ΔTL. <b><i>Conclusions:</i></b> TL shortening was observed in most incident dialysis patients. In 16 of the 59 patients, TL elongation occurred, possibly reflecting a more robust biological aging in patients whose naïve leukocytes may have undergone less proliferation to replace lost leukocytes.
|
|
| 32. |
- Leurs, P, et al.
(författare)
-
Effects of hemodiafiltration on uremic inflammation
- 2013
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 3535 Suppl 1, s. 11-17
-
Tidskriftsartikel (refereegranskat)abstract
- Chronic inflammation is highly prevalent among end-stage renal disease patients and is linked to, and thought to contribute to, the high morbidity and mortality in this patient population. Hemodiafiltration (HDF) may potentially reduce inflammatory stimuli induced by the bioincompatibility of conventional hemodialysis (HD) systems. In addition, HDF may more efficiently remove inflammatory mediators. This brief review shows that the circulating levels of various markers of systemic inflammation in general are somewhat reduced in patients treated by HDF as compared to HD. On the other hand, according to the current literature, this favorable small impact on inflammation biomarkers does not seem to translate into better clinical outcomes. It is possible that this is due to inadequate design, inadequate number of investigated patients and too short duration of previous studies. The results of larger, better-designed ongoing prospective studies may hopefully clarify this.
|
|
| 33. |
- Lindberg, Jenny, et al.
(författare)
-
Monocyte and Neutrophil Chemotactic Activity at the Site of Interstitial Inflammation in Patients on High-Flux Hemodialysis or Hemodiafiltration
- 2009
-
Ingår i: Blood Purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 28:1, s. 47-52
-
Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: We have observed a difference between patients on low-flux hemodialysis (HD) or peritoneal dialysis and patients on hemodiafiltration (HDF) or high-flux HD in the capacity of transmigrated leukocytes to mobilize CD11b in response to inflammatory stimuli compared with healthy subjects. This could be due to different interstitial chemokine concentrations. Methods: We measured concentrations of circulating and interstitial macrophage inflammatory protein-1 alpha (MIP-1 alpha), matrix metalloproteinase-9 (MMP-9)/neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) in 10 patients on HDF or high-flux HD and 11 healthy subjects by using immunoassay. Results: The interstitial concentrations of MIP-1 alpha, MMP-9/NGAL and IL-8 were similar in patients and healthy subjects, while the corresponding concentration of MCP-1 was significantly higher in patients on HDF or high-flux HD as compared with healthy subjects (p < 0.01). Conclusion: We suggest that an equal or higher concentration of chemokines in the interstitium in patients with HDF or high-flux HD might be one mechanism responsible for the preserved function of transmigrated leukocytes. Copyright (C) 2009 S. Karger AG, Basel
|
|
| 34. |
- Lindblad, YT, et al.
(författare)
-
Hyperinsulinemia and insulin resistance, early cardiovascular risk factors in children with chronic kidney disease
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:6, s. 518-525
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background/Aims:</i> Pediatric chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease. Still, hyperinsulinemia and insulin resistance, common cardiovascular risk factors, are not extensively investigated in children with CKD. We hypothesize that insulin abnormalities are present also in pediatric mild to moderate CKD, and associated with inflammation and malnutrition. <i>Methods:</i> We enrolled 26 children with CKD, and 34 healthy controls for analyses of blood samples and body composition. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR). <i>Results:</i> The patients had higher insulin levels and HOMA-IR compared to the controls (p < 0.01 and p < 0.005), and they correlated inversely with estimated glomerular filtration rate (rho = –0.52, p < 0.01; rho = –0.37, p = 0.08). No association was found with inflammation or malnutrition. <i>Conclusion:</i> High insulin levels and HOMA-IR appear to be common in pediatric CKD patients, already in mild to moderate renal failure. We hypothesize that hyperinsulinemia and insulin resistance alone might be important risk factors for cardiovascular disease in children with CKD.
|
|
| 35. |
- Locatelli, F, et al.
(författare)
-
The MPO Study: just a European HEMO Study or something very different?
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:1, s. 100-104
-
Tidskriftsartikel (refereegranskat)abstract
- Although results from observational and epidemiological studies suggested a survival benefit associated with high-flux hemodialysis, conclusive evidence from prospective randomized clinical trials has been lacking. Both the HEMO Study in the USA and the Membrane Permeability Outcome Study (MPO Study) in Europe are randomized studies investigating the effect of high- and low-flux hemodialysis on patient outcomes, even though there were some significant differences in the design of the two studies. An earlier randomized clinical trial could not show differences on patient survival between patient groups being treated with membranes of different material and permeability, but this trial was not designed specifically to examine this particular endpoint. Based on these previous experiences, the MPO Study addressed a hemodialysis patient population which was considered to be more susceptible to the intervention with high-flux dialysis. To identify these patients with an elevated risk, low serum albumin levels were chosen as an indicator; low serum albumin is associated with malnutrition, inflammation, atherosclerosis, and with increased risk of morbidity and mortality. Together with low serum albumin, patients had to be new to dialysis to be selected for the MPO Study. These particular considerations on patient selection, together with additional methodological refinements in the study design allow the conclusion that the MPO Study is valid on its own rather than being a European version of the HEMO Study.
|
|
| 36. |
- Locatelli, F, et al.
(författare)
-
The relationship of NT-proBNP and dialysis parameters with outcome of incident haemodialysis patients: results from the membrane permeability outcome study
- 2013
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 35:1-3, s. 216-223
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background/Aims:</i></b> The association of raised levels of natriuretic peptides with elevated risk of mortality was investigated in the present analysis of the Membrane Permeability Outcome study. <b><i>Methods:</i></b> N-terminal probrain type natriuretic peptide (NT-proBNP) was measured in 618 incident haemodialysis patients, randomised to either high-flux or low-flux. Characteristics of patients with NT-proBNP levels below or above the median were descriptively analysed and survival analysis was performed. <b><i>Results:</i></b> Median NT-proBNP value was 2,124 pg/ml, with 1,854 pg/ml in the high-flux and 2,919 pg/ml in the low-flux group. Survival probability was lowest in patients with both a history of cardiovascular disease and NT-proBNP values above the median (p < 0.001). A multivariate Cox proportional hazard model showed interaction between presence of cardiovascular diseases and NT-proBNP levels above the median. <b><i>Conclusions:</i></b> NT-proBNP is an independent predictor of mortality also in incident haemodialysis patients. Lower concentrations associated with high-flux dialysis suggest a possible biological link to improved survival in this group.
|
|
| 37. |
- Lu, Q, et al.
(författare)
-
No difference in nitrogen balance between standard prescriptions of hemodialysis and peritoneal dialysis
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:6, s. 511-517
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> It has been thought that peritoneal dialysis (PD) may not achieve adequate solute removal after the loss of residual renal function when compared to hemodialysis (HD). However, it should be noted that adequate solute removal depends not only on dialysis dose but also on dietary intake. Therefore, in the present study, we compared, both theoretically and clinically, the dietary protein intake and nitrogen removal between standard HD and PD as currently practiced in China. <i>Methods:</i> The nitrogen removal for both HD and PD was calculated theoretically with defined membrane permeability. For HD, the urea removal was based on a 2-compartment model. We compared the dietary protein intake and the amount of nitrogen removed at dialysis in 38 anuric well-nourished hemodialysis patients and 44 peritoneal dialysis patients. <i>Results:</i> With the theoretical calculation, setting the blood urea level at 21 or 26 mmol/l for both dialysis modalities, with the current practice pattern (4 exchanges of 2 liters of dialysis solution a day for PD and 4 h × 3 per week for HD), HD and PD removed almost identical amounts of nitrogen, and the allowable dietary protein intakes to achieve nitrogen balance for each modality were about 0.9 and 1.0 g/kg/day, respectively. In the 38 HD patients, the peak blood urea concentration was 26.44 ± 3.96 mmol/l, significantly higher than that of PD patients (20.85 ± 4.08 mmol/l). There was no significant difference in the dietary protein intake between the 2 modalities: 1.01 ± 0.29 and 0.91 ± 0.28 g/kg/day for HD patients and PD patients, respectively. <i>Conclusions:</i> Our study suggests that to achieve the same level of blood urea level, the protein intake and nitrogen removal is almost identical between HD and PD with the current practice pattern, indicating PD could provide similar dialysis adequacy to that of HD when patients lose their residual renal function.
|
|
| 38. |
- Luik, AJ, et al.
(författare)
-
Blood pressure control and hemodynamic changes in patients on long time dialysis treatment
- 1998
-
Ingår i: Blood purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 16:4, s. 197-209
-
Tidskriftsartikel (refereegranskat)abstract
- In dialysis patients blood pressure can be well controlled with long dialysis (3 times a week for 8 h) in contrast to a more common short dialysis regime (3 times a week for 4 h). We studied whether the good blood pressure control in patients on long dialysis as compared to patients on short dialysis was associated with a decrease in extracellular fluid volume. Two-day interdialytic ambulatory blood pressure monitoring was performed in 26 non-diabetic patients on long dialysis, in 22 patients on short dialysis, matched for the years they were on dialysis treatment, and during 24 h in 19 healthy volunteers. After full equilibration, 24 h after dialysis, echography of the inferior caval vein was performed to determine fluid state. Cardiac dimensions and stroke index were measured by echocardiography. A blood sample was drawn for the determination of electrolytes and vasoactive hormones. 73% of the patients on short dialysis were using antihypertensive medication in contrast to none of the patients on long dialysis. However, blood pressure was significantly lower in patients on long dialysis (115 ± 21/67 ± 11 mm Hg) when compared to patients on short dialysis (143 ± 26/81 ± 16 mm Hg). Indexed caval vein diameter, left ventricular diameter index, and atrial natriuretic peptide were not significantly different in patients on long dialysis compared to patients on short dialysis. Also the cardiac index was comparable in patients on long and short dialysis. However, the total peripheral resistance index was significantly lower in patients on long dialysis compared to the patients on short dialysis and normal controls. The left ventricular mass index was increased in both patients on long and short dialysis compared to controls. We conclude that patients on long dialysis have adequate blood pressure control that seems mainly to be caused by a low total peripheral resistance. These data also suggest that factors other than a lower fluid state contribute to the good blood pressure control in patients on long dialysis.
|
|
| 39. |
- Mahmood, Dana, 1965-, et al.
(författare)
-
Haemodialysis with Tinzaparin Versus Dialysate Citrate as Anticoagulation
- 2018
-
Ingår i: Blood Purification. - : S. Karger. - 0253-5068 .- 1421-9735. ; 46:3, s. 257-263
-
Tidskriftsartikel (refereegranskat)abstract
- Anticoagulation with citrate-containing haemodialysate (cHD) is an alternative to tinzaparin haemodialysate (tHD). The study investigated whether cHD would differ when changed from tHD. The same 18 patients were their own controls followed up with cHD for 5 months. LDL-cholesterol decreased at the end of a cHD session (p = 0.01). Neutrophils (p = 0.013) and monocytes (p = 0.007) dropped more during a cHD session. During the follow-up period of cHD, approximately 50% needed additional tinzaparin. Before the cHD session could start, there was a lower total cholesterol at 2 weeks (p = 0.014) and LDL-cholesterol at 1 month (p = 0.011) versus an increase of LDL at 5 months (p = 0.02). Only patients without additional tinzaparin had a reduction of C-reactive protein (CRP) at 2 months of cHD (p < 0.05) but not later. Solely cHD seems possible only in half of the patients. A greater reduction in granulocytes and monocytes during cHD indicates a more extensive blood membrane interaction, while CRP may be lower.
|
|
| 40. |
- Martensson, J, et al.
(författare)
-
The rise and fall of NGAL in acute kidney injury
- 2014
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 37:4, s. 304-310
-
Tidskriftsartikel (refereegranskat)abstract
- For many years, neutrophil gelatinase-associated lipocalin (NGAL) has been considered the most promising biomarker of acute kidney injury (AKI). Commercial assays and point-of-care instruments, now available in many hospitals, allow rapid NGAL measurements intended to guide the clinician in the management of patients with or at risk of AKI. However, these assays likely measure a mixture of different NGAL forms originating from different tissues. Systemic inflammation, commonly seen in critically ill patients, and several comorbidities contribute to the release of NGAL from haematopoietic and non-haematopoietic cells. The unpredictable release and complex nature of the molecule and the inability to specifically measure NGAL released by tubular cells have hampered its use a specific marker of AKI in heterogeneous critically ill populations. In this review, we describe the nature and cellular sources of NGAL, its biological role and diagnostic ability in AKI and the increasing concerns surrounding its diagnostic and clinical value.
|
|
| 41. |
- Martola, L, et al.
(författare)
-
Why do dialysis patients develop a heart of stone and bone of china?
- 2005
-
Ingår i: Blood purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 23:3, s. 203-210
-
Tidskriftsartikel (refereegranskat)abstract
- Vascular calcification is a common complication of end-stage renal disease (ESRD). The mechanisms responsible are complex and have so far been considered to be mainly the result of a passive mechanism due to elevated PO<sub>4</sub> levels and high Ca × PO<sub>4</sub> ion product resulting in saturated plasma. However, recent results suggest that also other features, commonly observed in the uremic milieu, such as chronic inflammation, hyperleptinemia and a dysregulation of various mineral-regulating proteins might also contribute to an enhanced calcification process. Moreover, as an inverse relationship between vascular calcification and bone density has been documented in ESRD, it could be speculated that pathologically low bone remodelling (adynamic bone disease) associated with active vitamin D treatment and low parathyroid hormone (PTH) levels may predispose to ectopic calcification of vessels, valves and heart. As patients with vascular calcification have a higher intake of calcium-containing PO<sub>4</sub> binders, novel, non-calcium containing PO<sub>4</sub> binders may diminish the risk of progressive vascular calcification in this patient group. Further studies are needed to elucidate the respective role of chronic inflammation, hyperleptinemia and PTH-lowering therapies in this fatal complication of ESRD.
|
|
| 42. |
- Maruyama, Y, et al.
(författare)
-
Interleukin-1 gene cluster polymorphisms are associated with nutritional status and inflammation in patients with end-stage renal disease
- 2005
-
Ingår i: Blood purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 23:5, s. 384-393
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Wasting and inflammation are two common risk factors for death in patients with end-stage renal disease (ESRD). Interleukin-1β (IL-1β) and its receptor antagonist (IL-1Ra) may play a pivotal role in the pathogenesis of wasting and inflammation. <i>Methods:</i> To investigate effects of the <i>IL-1</i> gene cluster polymorphisms on wasting and inflammation, we studied 189 ESRD patients (52 ± 12 years, 62% males) close to the start of renal replacement therapy. 205 healthy volunteers served as controls. We analyzed the <i>IL-1B</i> –511C/T, –31C/T, and +3954C/T polymorphisms as well as a variable number of a tandem repeat (VNTR) in <i>IL-1RN</i>. Nutritional parameters included serum albumin level, subjective global nutritional assessment (SGA), and body composition evaluated by dual-energy X-ray absorptiometry (DXA). We used serum high-sensitivity C-reactive protein (hsCRP) as a marker of inflammation. <i>Results:</i> Wasting (SGA >1) was present in 31%, whereas inflammation (CRP ≧10 mg/l) was present in 36% of the patients. The male carriers of the –511T/T and –31C/C genotypes had a lower prevalence of wasting (p < 0.05), higher body mass index (BMI) (p < 0.05), and higher lean body mass (LBM) (p < 0.01). In a stepwise multiple regression model, age (p < 0.05), BMI (p < 0.01) and the <i>IL-1B</i> –511 genotype (p < 0.01) were independently associated with LBM. The carriers of the +3954T allele had a lower prevalence of inflammation (p < 0.05) and lower serum hsCRP (p < 0.05). The VNTR in <i>IL-1RN</i> was not associated with any markers. <i>Conclusion:</i> The investigated <i>IL-1</i> gene cluster polymorphisms were associated with nutritional status and inflammation in ESRD patients, but marked differences were found between the genders. These polymorphisms could have prognostic utility for predicting wasting and inflammation in ESRD patients.
|
|
| 43. |
- Maruyama, Y, et al.
(författare)
-
Role of interleukin-1beta in the development of malnutrition in chronic renal failure patients
- 2005
-
Ingår i: Blood purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 23:4, s. 275-281
-
Tidskriftsartikel (refereegranskat)abstract
- Protein-energy malnutrition and wasting are common among patients with end-stage renal disease (ESRD) and these complications are strongly associated with poor survival in these patients. Whereas both under- and overweight predict in increased mortality risk in the general population, a high body mass index is associated with better outcome in ESRD patients. Circulating levels of pro-inflammatory cytokines are markedly elevated in uremia and also predictor of a poor clinical outcome in ESRD patients. Interleukin-1β (IL-1β), which is a major pro-inflammatory cytokine, may further amplify inflammation and lead to malnutrition, through inducing anorexia, and muscle wasting due to increased protein breakdown. Several clinical studies have shown that the circulating level of IL-1β may affect nutritional status, especially body composition. Several IL-1 gene cluster polymorphisms were reported, and they may affect the prevalence of cytokine-mediated diseases. Although a number of factors are related to malnutrition and wasting in ESRD, pro-inflammatory cytokines, such as IL-1β, may play an important role. This could in part be due to genetic factors. Further research, especially regarding the IL-1 gene cluster polymorphisms, is necessary to determine this hypothesis.
|
|
| 44. |
- Matsubara, K, et al.
(författare)
-
Bone mineral density in end-stage renal disease patients: association with wasting, cardiovascular disease and mortality
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:3, s. 284-290
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Bone and mineral disorders may contribute to extraosseous ossifications and cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients. We have investigated the relationship between bone mineral density (BMD) and inflammation, wasting, CVD and mortality in ESRD patients. <i>Methods:</i> BMD (dual energy X-ray absorptiometry) and biochemical, nutritional and inflammatory markers were assessed in 277 incident ESRD patients (GFR 7.1 ± 0.2 ml/min) who were then followed prospectively for a mean of 27 (range 1–60) months. Carotid plaques were determined in 103 patients. <i>Results:</i> Patients with carotid plaques, clinical manifestation of CVD and wasting (assessed by subjective global assessment) had significantly lower BMD than their counterparts. Low BMD was associated with high all-cause and cardiovascular mortality. Even after adjustment for several confounders and risk factors, all-cause (HR = 2.1, CI: 1.1–3.9, p = 0.02) and cardiovascular (HR = 2.8, CI: 1.2–6.3, p = 0.02) mortality remained significantly associated with low BMD. <i>Conclusions:</i> Low BMD is associated with wasting and CVD, and is an independent predictor of all-cause and cardiovascular mortality in ESRD patients.
|
|
| 45. |
- Mertens, PR, et al.
(författare)
-
Long-term extracorporeal bilirubin elimination: A case report on cascade resin plasmaperfusion
- 1998
-
Ingår i: Blood purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 16:6, s. 341-348
-
Tidskriftsartikel (refereegranskat)abstract
- Acute hepatic failure develops as a disease entity of rather diverse origin. With disease progression, toxic bilirubin levels may cause severe complications which include AV-nodal blockage, cardiac arrhythmia, impaired consciousness, generalized seizures, and status epilepticus. Treatment choices to prevent clinical deterioration comprise of costly and limited available orthotopic liver transplantation, utilization of extracorporeal bioartificial liver support devices and haemoperfusion/plasmaperfusion treatment with activated charcoal/anion exchange filters. Here, we present a patient with acute drug-induced cholestatic hepatitis. Excessively elevated bilirubin levels were accompanied by cardiac and cerebral complications. Extracorporeal resin perfusion treatment (Plasorba, BR–350) was successfully performed over a 50-day period without activation of the coagulation system or side effects. Bilirubin levels were lowered to a minimum of 225 μmol/l, with concurrent clinical improvement. In conclusion, extracorporeal anion exchange plasmaperfusion may be a viable long-term treatment for hyperbilirubinaemic side effects in overt cholestatic hepatitis.
|
|
| 46. |
- Muto, R, et al.
(författare)
-
Increased Monocyte/Lymphocyte Ratio as Risk Marker for Cardiovascular Events and Infectious Disease Hospitalization in Dialysis Patients
- 2022
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 51:9, s. 747-755
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Introduction:</i></b> In dialysis patients, cardiovascular disease (CVD) and infectious disease contribute to poor clinical outcomes. We investigated if a higher monocyte/lymphocyte ratio (MLR) is associated with an increased risk of CVD events and infectious disease hospitalizations in incident dialysis patients. <b><i>Methods:</i></b> In an ongoing observational prospective cohort study, 132 Japanese dialysis patients (age 58.7 ± 11.7 years; 70% men) starting dialysis therapy were enrolled and followed up for a median of 48.7 months. Laboratory biomarkers, including white blood cell count and its differential count, were determined at baseline. Event-free time and relative risks (RRs) were calculated using the Kaplan-Meier curves and Cox models, respectively. <b><i>Results:</i></b> When divided into 2 groups according to median MLR (0.35 [range, 0.27–0.46]), the periods without CVD events were significantly shorter in the high MLR group than in the low MLR group (log-rank test = 5.60, <i>p</i> = 0.018). The RR of CVD events, after adjusting for age, sex, and diabetes, was 2.43 (1.22–4.84) in the high MLR group compared to the low MLR group. The periods without infections requiring hospitalization were also shorter (log-rank test = 4.16, <i>p</i> = 0.041). The RR of infections requiring hospitalization was 1.98 (1.02–3.83) after the same adjustments. The number of CVD events was higher in the high MLR group (18.6 events per 100 person-years at risk [pyr]) than the low MLR group (11.1 events per 100 pyr). The duration of infectious disease hospitalization was longer in the high MLR group (6.3 days per pyr) than in the low MLR group (2.8 days per pyr). <b><i>Conclusion:</i></b> A higher MLR is associated with increased risks of both CVD events and infectious disease hospitalization in dialysis patients.
|
|
| 47. |
- Nascimento, MM, et al.
(författare)
-
Inflammation, malnutrition and atherosclerosis in end-stage renal disease: a global perspective
- 2002
-
Ingår i: Blood purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 20:5, s. 454-458
-
Tidskriftsartikel (refereegranskat)abstract
- End-stage renal disease (ESRD) is characterized by an exceptional cardiovascular mortality rate. Although traditional risk factors are common in ESRD patients, they alone may not be sufficient to account for the high prevalence of cardiovascular disease (CVD). Recent evidence demonstrated that chronic inflammation, a non-traditional risk factor which is commonly observed in ESRD patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. Although both malnutrition and inflammation have been shown to be strong predictors of cardiovascular mortality in ESRD patients, it must be remembered that the majority of studies describing the presence of inflammation and malnutrition have been performed in Western and Asian industrialized countries. As it is evident that the prevalence of malnutrition and inflammation may differ markedly between different regions of the world and developing countries face a much higher prevalence of chronic infectious diseases, comparative inter-regional studies focusing on the etiology and prevalence of the malnutrition, inflammation and atherosclerosis syndrome are warranted.
|
|
| 48. |
- Naseeb, U, et al.
(författare)
-
Proteome patterns in uremic plasma
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:6, s. 561-568
-
Tidskriftsartikel (refereegranskat)abstract
- In patients with chronic kidney disease (CKD), peptides and proteins circulate at altered concentrations versus in healthy individuals. We have characterized proteome samples from 7 pooled CKD stage 5 patients not yet on dialysis and with no known co-morbidities. We also analyzed pooled plasma samples from 7 healthy age- and sex-matched controls. After immunodepletion of the 6 most abundant plasma proteins, HPLC and SDS-PAGE patterns differed between the healthy and disease groups. The differing proteins were identified by peptide mass fingerprinting using MALDI mass spectrometry and verified with electrospray tandem mass spectrometry sequence analysis. Multiple differences in at least 19 HPLC fractions were observed, from which we identified 29 proteins, 25 in greater yield and 4 in lower yield than in the healthy controls, adding at least 6 protein components to those that were previously known to be altered in CKD.
|
|
| 49. |
- Nyhlen, Kristina, et al.
(författare)
-
Leukocyte sequestration in isolated guinea pig lungs during extracorporeal circulation : effects on microvascular function
- 2000
-
Ingår i: Blood Purification. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 18:2, s. 121-127
-
Tidskriftsartikel (refereegranskat)abstract
- Neutrophils accumulate in patient lungs during clinical hemodialysis and in isolated blood-perfused guinea pig lungs due to the contact between blood and extracorporeal system. However, it is unclear how these sequestered and partly activated neutrophils affect the lung microvasculature. We, therefore, studied pulmonary vascular resistance, vascular permeability, gas exchange, and oxygen free radical production in isolated guinea pig lungs during perfusion with whole blood containing partly ‘activated’ neutrophils in comparison with perfusions using leukopenic blood. We also connected a Cuprophan hemodialysis membrane to the whole-blood perfusion system in order to investigate whether a dialyzer, which may further activate leukocytes, affects lung microvascular permeability, vascular resistances, and reactive oxygen species production. The sequestered neutrophils did not seem to markedly affect the lung microvascular function, since neither the leukocyte-free perfusion nor the hemodialysis membrane altered any of the measured variables as compared with whole-blood perfusion in a system without a dialyzer. We conclude that neutrophils, whether activated by a perfusion system or by a dialysis membrane, can accumulate in isolated lungs without adversely affecting the microvascular function.
|
|
| 50. |
- O'Brien, Z, et al.
(författare)
-
Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction
- 2018
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 45:1-3, s. 36-43
-
Tidskriftsartikel (refereegranskat)abstract
- <b><i>Aims:</i></b> To study the association between higher versus lower continuous renal replacement therapy (CRRT) intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction. <b><i>Methods:</i></b> Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. <b><i>Results:</i></b> Of 444 patients, 210 (47.3%) were randomized to higher intensity (effluent flow 40 mL/kg/h) and 234 (52.7%) to lower intensity (effluent flow 25 mL/kg/h) therapy. Overall, 79 and 86% of prescribed effluent flow was delivered in the higher-intensity and lower-intensity groups, respectively (<i>p</i> < 0.001). In total, 113 (54.1%) and 120 (51.3%) patients died in each group. On multivariable Cox regression analysis, we found no independent association between higher CRRT intensity and mortality (HR 0.93, 95% CI 0.70-1.24; <i>p</i> = 0.642). <b><i>Conclusions:</i></b> In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.
|
|
