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| 2. |
- Axelsson, J
(author)
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Obesity in chronic kidney disease: good or bad?
- 2008
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In: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:1, s. 23-29
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Journal article (peer-reviewed)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.
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| 3. |
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| 4. |
- Carrero, JJ, et al.
(author)
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Cytokine dysregulation in chronic kidney disease: how can we treat it?
- 2008
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In: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:3, s. 291-299
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Journal article (peer-reviewed)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.
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| 5. |
- Chmielewski, M, et al.
(author)
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Lipoprotein lipase 1595 c/g and hepatic lipase -480 c/t polymorphisms--impact on lipid profile in incident dialysis patients
- 2008
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In: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:6, s. 555-560
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Journal article (peer-reviewed)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.
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| 6. |
- Chung, SH, et al.
(author)
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Impact of incremental risk factors on peritoneal dialysis patient survival: proposal of a simplified clinical mortality risk score
- 2009
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In: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 27:2, s. 165-171
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Journal article (peer-reviewed)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.
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| 7. |
- Grahl, DA, et al.
(author)
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Associations between the CYBA 242C/T and the MPO -463G/A polymorphisms, oxidative stress and cardiovascular disease in chronic kidney disease patients
- 2007
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In: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 25:2, s. 210-218
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Journal article (peer-reviewed)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.
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| 8. |
- Gu, Y, et al.
(author)
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Strong association between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients
- 2008
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In: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:4, s. 340-346
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Journal article (peer-reviewed)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.
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| 10. |
- Jiang, N, et al.
(author)
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Initiation of glucose-based peritoneal dialysis is associated with increased prevalence of metabolic syndrome in non-diabetic patients with end-stage renal disease
- 2008
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In: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:5, s. 423-428
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Journal article (peer-reviewed)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.
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