| 1. |
- Alvestrand, A, et al.
(författare)
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Left ventricular hypertrophy in incident dialysis patients randomized to treatment with hemofiltration or hemodialysis: results from the ProFil study
- 2011
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 32:1, s. 21-29
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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.
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| 2. |
- Goncalves, SM, et al.
(författare)
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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
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 34:3-4, s. 298-305
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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.
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| 3. |
- Jerotskaja, Jana, et al.
(författare)
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Optical Online Monitoring of Uric Acid Removal during Dialysis
- 2010
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Ingår i: BLOOD PURIFICATION. - : S. Karger AG. - 0253-5068 .- 1421-9735. ; 29:1, s. 69-74
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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.
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| 4. |
- Leurs, P, et al.
(författare)
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Effects of hemodiafiltration on uremic inflammation
- 2013
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 3535 Suppl 1, s. 11-17
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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.
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| 5. |
- Locatelli, F, et al.
(författare)
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The relationship of NT-proBNP and dialysis parameters with outcome of incident haemodialysis patients: results from the membrane permeability outcome study
- 2013
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 35:1-3, s. 216-223
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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.
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| 6. |
- Martensson, J, et al.
(författare)
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The rise and fall of NGAL in acute kidney injury
- 2014
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 37:4, s. 304-310
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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.
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| 7. |
- Sjoberg, B, et al.
(författare)
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Pentraxin 3, a sensitive early marker of hemodialysis-induced inflammation
- 2012
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 34:3-4, s. 290-297
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background/Aims:</i></b> The purpose of this investigation was to determine if the long pentraxin 3 (PTX-3) may be a useful marker of intradialytic inflammation since it is rapidly released in the vasculature. <b><i>Methods:</i></b> PTX-3, interleukin-6, tumor necrosis factor-α and C-reactive protein were measured before and during a hemodialysis session in 22 patients and compared with healthy subjects. The effect of dialysis with low-flux, high-flux membranes and hemodiafiltration on the inflammatory response was compared in 11 patients. <b><i>Results:</i></b> C-reactive protein and interleukin-6 levels did not change, while a modest decrease in tumor necrosis factor-α was observed during hemodialysis. The plasma PTX-3 concentration was significantly increased (p < 0.001) after 60 min and peaked at 180 min during hemodialysis. There was no difference in the intradialytic increase in PTX-3 using different dialysis membranes and modalities. <b><i>Conclusion:</i></b> PTX-3 stands out as a rapid and sensitive marker of hemodialysis-induced inflammation. Membrane flux and hemodiafiltration did not alter the inflammatory response.
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| 8. |
- Snaedal, S, et al.
(författare)
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Determinants of N-terminal pro-brain natriuretic peptide variation in hemodialysis patients and prediction of survival
- 2014
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 37:2, s. 138-145
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background/Aims:</i></b> N-Terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor of cardiac events and death in the general population and in chronic kidney disease. There is limited information on how natriuretic peptides vary in dialysis patients. The aim of this study was to analyze NT-proBNP variability, factors predicting its variability and survival related to NT-proBNP variability. <b><i>Methods:</i></b> A prospective 3-month observational study of prevalent hemodialysis patients with monthly measurements of NT-proBNP was carried out. A total of 211 hemodialysis patients were included, and mortality was recorded during 52 months of follow-up. <b><i>Results:</i></b> Inflammation was the strongest predictor of NT-proBNP variability. Patients with constantly high NT-proBNP had an increased risk of death adjusting for age, sex, dialysis vintage and comorbidity but not when also adjusting for nutritional status. <b><i>Conclusions:</i></b> Longitudinal changes in NT-proBNP are associated with changes in inflammation, nutritional status, age and comorbidity. Due to strong interactions with predictors of mortality such as nutritional status, we were unable to confirm NT-proBNP as an independent marker for mortality in dialysis patients.
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| 9. |
- Waniewski, J, et al.
(författare)
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Can the diverse family of dialysis adequacy indices be understood as one integrated system?
- 2010
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 30:4, s. 257-265
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Dialysis adequacy indices are based on the amount of removed solute and systemized into two groups: (1) fractional solute removal (FSR, non-dimensional), and (2) equivalent continuous clearance (ECC, ml/min), which are expressed using appropriate reference method for solute concentration or mass such as: peak, peak average, time average, and treatment time average values. <i>Methods:</i> A review and critical analysis of the recent studies was performed. <i>Results:</i> The indices are mathematically interrelated and depend on kinetic parameters of the treatment, as device clearance, treatment time, solute distribution volume, dialysis frequency. In particular, KT/V and KT can be directly translated to FSR and ECC using the treatment time average reference method. <i>Conclusion:</i> The diverse family of dialysis adequacy indices can be understood as one integrated system and be useful when assessing both standard treatment modalities and newer schedules and modalities (frequent dialysis, hybrid dialysis, dialysis in acute renal failure) of renal replacement therapies.
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