Abstract
BACKGROUND AND AIMS
Inflammation is an important process in the pathogenesis of atherosclerosis, and chronic kidney disease (CKD) is recognized as a proinflammatory state. Interleukin-6 ...(IL-6) is associated with cardiovascular events and also predicts mortality in individuals with CKD patients.
The subendocardial viability ratio (SEVR) is one of the pulse wave analysis parameters and represents a non-invasive measure of coronary perfusion. In a non-dialysis CKD population, we previously reported about the prognostic value of SEVR for cardiovascular outcome in these patients.
The aim of this study was to investigate the association between inflammatory markers IL-6, tumour necrosis factor-α (TNF-α), high-sensitive C-reactive protein (hsCRP) and SEVR in CKD patients undergoing maintenance hemodialysis (HD).
METHOD
In a cross-sectional study, we enrolled only HD patients. SEVR was assessed using a generalized transfer function applied to the radial artery pressure wave form (Sphygmocor, Atcor Medical, Sydney, Australia). Plasma IL-6, TNF-α and hsCRP were measured by an enzyme-linked immunosorbent assay.
RESULTS
A total of 40 HD patients (mean age 65.2 ± 11.8 years, 72.5% male) were included. Other descriptive parameters are presented in Table 1. A statistically significant correlation was found between SEVR and IL-6 (r = 0.379; P = 0.016), but not between SEVR and TNF-α (P = 0.195), nor between SEVR and hsCRP (P = 0.686).
In a multivariate adjusted model with SEVR as dependent variable and IL-6, TNF-α and hsCRP as independent variables we found a statistically significant association only between SEVR and IL-6 (β = 0.393; P = 0.017).
CONCLUSION
This study suggests an association between IL-6 and SEVR in HD patients.
Abstract
BACKGROUND AND AIMS
Several methods have been developed to assess hydration status in chronic haemodialysis (HD) patients. The aim of this study was to compare multifrequency body ...bioimpedance spectroscopy (MBIS) with ultrasound lung comet scores (ULCs) and inferior vena cava diameters (IVCD) using ultrasound to estimate dry weight on the non-dialysis day.
METHOD
We evaluated MBIS, ULCs at 28 typical sites and IVCD during expiration in 40 HD patients. All measurements were performed on a non-dialysis day. For MBIS measurement, we used the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany), and for ULCs and IVCD, we used an ultrasound device (Esaote MyLabOmega, Genoa, Italy). Overhydration was defined as > 2L with MBIS, > 15 ULCs, and > 11.5 mm/m2 IVCD.
RESULTS
Mean age of patients was 65 (40–89) years, and 29 (72.5%) were men. Other descriptive data are in Table 1. We found a significant correlation between MBIS and ULCs (r = 0.464, P <0.003) and between MBIS and IVCD (r = 0.589, P <0.001). Multiple regression analysis with the MBIS as the dependent variable and ULCs, IVCD, albumin and haemoglobin as independent variables confirmed a statistically significant relationship between MBIS and IVCD (β = 0.436; P < 0.001). According to the overhydration criteria, 14 (35%) patients were overhydrated by MBIS, 8 (20%) patients by ULCs and 9 (22.5%) patients by IVCD. Only 4 (10%) patients met overhydration criteria simultaneously by all three methods (MBIS, ULCs and IVCD).
CONCLUSION
All methods were able to describe overhydration in HD patients on a non-dialysis day. The MBIS was associated with the IVCD.
Chronic kidney disease (CKD) is a risk factor for cardiovascular and all-cause mortality. Recognition of high-risk patients is important and could lead to a different approach and better treatment. ...The CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF), but it is also a useful predictor of outcome in other cardiovascular conditions, independent of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in predicting cardiovascular and all-cause mortality in CKD patients.
Stable nondialysis CKD patients were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed till the same end date, until kidney transplantation or until their death.
Eighty-seven CKD patients were included (60.3 ± 12.8 years, 66% male). Mean follow-up time was 1,696.5 ± 564.6 days. During the follow-up, 21 patients died and 11 because of cardiovascular reasons. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular and all-cause mortality. In multivariate Cox regression analysis, in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, hemoglobin, high-sensitivity C-reactive protein, and intact parathyroid hormone were included, CHA2DS2-VASc score was an independent predictor of cardiovascular (HR: 2.04, CI: 1.20-3.45, p = 0.008) and all-cause mortality (HR: 2.06, CI: 1.43-2.97, p = 0.001). The same was true after adding total cholesterol, triglycerides, and smoking status to both the analyses.
The CHA2DS2-VASc score is a simple, practical, and quick way to identify the risk for cardiovascular and all-cause mortality in CKD patients.
Polyneuropathy (PNP) is a common complication in hemodialysis (HD) patients. Electrophysiological parameters are quantitative indices of its severity. The aim of our study was to find the prevalence ...of pathologic electrophysiological parameters, to assess their prevalence in relation to duration of HD treatment and age, to establish which parameters are the most sensitive in demonstrating PNP and to find an association between them and HD adequacy.
We included 84 (50 men, 34 women) HD patients (average age 47.32 years; average dialysis duration 62.56 months) and divided them into three groups according to the duration of HD treatment. Each group was further divided into two subgroups according to age. We included electrophysiological parameters for evaluation of motor and sensory nerve functions (Medelec Sapphire Premiere device). HD adequacy was measured with urea kinetic modeling (Kt/V).
PNP was found in 77 (91.6%) HD patients and was more common in men (P < 0.016). The association between the number of pathologic electrophysiological parameters and age (P < 0.0001), duration of HD treatment (P < 0.009) and HD adequacy (P < 0.0001) was statistically significant. The most sensitive electrophysiological parameter was the latency of the F wave (pathologic values of F wave latency in the lower limbs in 86% patients and in the upper limbs in 49%). Sensory conduction velocities and the amplitudes of the orthodromic sensory action potentials and the M wave were also sensitive parameters. The F wave latency of different nerves was associated with dialysis adequacy.
PNP is frequent in HD patients and is associated with age and duration of dialysis treatment. The most sensitive electrophysiological parameter of PNP is F wave latency, which may also be used as a parameter of dialysis adequacy.
Abstract
Background and Aims
Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a substantial ...proportion of critically ill patients. The aim of our single centre retrospective observational study was to analyse the outcomes of patients admitted to a non-surgical ICU and treated with RRT and with/without continuous hemoperfusion with Cytosorb.
Method
One hundred critically ill patients (mean age, 64.3 years; 69 men) admitted to the ICU and requiring RRT for AKI were analysed. Patient demographics, concomitant diseases, type of RRT, and survival were obtained from the medical record. APACHE II and Sofa Scores on admission were calculated. 30-day mortality was assessed using Kaplan-Meyer or Cox proportional hazards models.
Results
Reasons for ICU admission were acute respiratory failure (39%), cardiopulmonary resuscitation (14%), shock (13%), acute coronary syndrome (9%), sepsis (3%), acute pancreatitis (3%), and other (19%). Prior comorbidities were hypertension (70%), diabetes (43%), heart failure (32%), chronic kidney disease (CKD) (30%), coronary artery disease (CAD) (27%), chronic obstructive pulmonary disease (COPD) (15%), malignancies (12%). Eighty-six patients were treated with continuous RRT (CRRT) and 14 with intermittent hemodialysis (IHD). Twenty-four (24%) of patients treated with CRRT were also treated with hemoperfusion with Cytosorb. Using an independent-samples T test, we compared the two groups of patients with respect to the use of Cytosorb (Table 1). 30-day mortality was 82% in all patients and 87.5% in patients treated with CRRT and Cytosorb. Among concomitant diseases, only patients with previous heart failure had worse survival (p = 0.032), previous CKD, CAD, COPD, malignancy had no statistically significant impact. We found no statistically significant differences in 30-day mortality between patients treated with CRRT+Cytosorb and patients treated with CRRT or IHD alone. Multivariate Cox proportional hazard regression showed that of all the variables in the statistical model (age, sex, body mass index, previous diabetes, C-reactive protein, lactate, procalcitonin, serum creatinine, mean arterial pressure, APACHE II, ultrafiltration between CRRT), only lactate levels on admission (p = 0.002; 95%CI 1.08-1.38) were significant predictor of survival.
Conclusion
The use of hemoperfusion with Cytosorb in ICU patients with AKI did not reduce 30-day mortality. Patients with prior heart failure had a worse outcome. Serum lactate levels at ICU admission were an independent highly prognostic factor for death within 30 days of admission.
Abstract
Background and Aims
Albuminuria signifies subclinical vascular damage in the kidneys and other organs and is associated with systemic endothelial dysfunction and increased future ...cardiovascular risk.
Subendocardial viability ratio (SEVR) is defined as diastolic to systolic pressure-time integral ratio and is a marker of subendocardial perfusion. Reduced SEVR has been uncovered in patients with chronic kidney disease (CKD) and simultaneous albuminuria. Albuminuria is also considered a risk factor for peripheral artery disease, especially in patients with additional atherosclerosis risk factors or diabetes mellitus. The aim of our study was to determine the impact of albuminuria on SEVR and ankle-brachial index (ABI) in patients without known CKD.
Method
We included 111 patients (73% male, mean age 64.2±9.3 years) that were hospitalized at our Cardiology department between 2016-2020 due to elective cardiac catheterization. Albuminuria was determined by urine albumin to creatinine ratio (UACR) from a random urine specimen. SEVR was determined by using applanation tonometry on radial artery (Sphygmocor, Atcor Medical, Australia). Ankle-brachial index (ABI) was measured by using an automated, non-invasive waveform analysis device (MESIÒ, Slovenia), mean ABI between the left and right side was used. Glomerular filtration rate was estimated (eGFR) by using the CKD-EPI 2009 creatinine equation. All the data were obtained prior to cardiac catheterization and only patients with eGFR ³60 ml/min/1.73 m2 were included. Statistical analysis was performed with the Statistical Package for Social Sciences version 22.0 (SPSS Inc, USA).
Results
Basic descriptive statistics, comorbidities, and medications are presented in Tables 1 and 2. Spearmann's correlation test showed significant correlation between UACR and SEVR (r = - 0.238; p = 0.017) and UACR and ABI (r = - 0.304; p = 0.003). Multiple regression analysis with SEVR as the dependent variable and waist-to-hip ratio, body mass index (BMI), arterial hypertension, diabetes, dyslipidemia, eGFR and UACR as independent variables, showed a significant association between UACR and SEVR (b = - 0.232; p = 0.029). The same model was used for ABI as the dependent variable, and a significant association was found only between UACR and ABI (b = - 0.232; p = 0.029).
Conclusion
Albuminuria is independently associated with decreased SEVR and ABI even in the absence of CKD.
Abstract
Background and Aims
Human kidneys have a role in water homeostasis, acid-base control, reabsorption of compounds, and secretion of xenobiotics and endogenous metabolites, exposing them to ...substances that could cause harm. This results in an alarming number of acute kidney injuries (AKI) worldwide, estimated at 13%. Furthermore, one-quarter of hospitalised cases are due to drug-induced AKI 1. Current methods for nephrotoxicity assays are based on animal testing and/or the use of simple human cell lines. Meta-analyses show that we can correctly predict human drug responses in only 10–50% 2. Our work aimed to develop a novel and optimised protocol for isolating proximal tubular epithelial cells (PTEC) from human kidney biopsy to aid future research regarding AKI and nephrotoxicity studies.
Method
Isolation and cultivation of primary human adult PTEC obtained with biopsy during the regular diagnostic procedure was performed. We used a protocol consisting of micro-dissection of a tissue sample to get ∼1 mm3 fragments, enzymatic dissociation with 0.2% collagenase type 1, and use of selective culture media (Advanced DMEM/F12 with added insulin, transferrin, and selenite (all three together termed ITS), epidermal growth factor (EGF), and hydrocortisone). Light microscopy was used for morphologic characterisation. Some cells were cultured on Transwell inserts, and the transepithelial electric resistance (TEER) was measured in mature cells that formed a confluent culture. For phenotypic characterisation, several markers characteristic of PTEC were chosen 3, and immunocytochemical staining was performed using a fluorescent microscope to evaluate the PTEC phenotype.
Results
Following the described protocol resulted in isolating cells that formed first colonies after 24 h. Using light microscopy, the cells exhibited a cobblestone appearance, reached confluence after eight days, and showed dome (hemicysts) formation after 13 days. TEER reached 169 Ω/cm2 after 14 days. The isolated cells were marked positive using immunocytochemistry for sodium-glucose cotransporter 2 (SGLT2), multidrug-resistant protein 4 (MRP4), organic anionic transporter 1 and 3 (OAT1 and OAT3), organic cationic transporter 2 (OCT2), p-glycoprotein (p-gp), multidrug and toxin extrusion protein 1 (MATE1), and N-cadherin.
Conclusion
In this study, we developed a protocol for isolating and cultivating primary human PTEC from biopsy samples. To the best of our knowledge, we have performed the most extensive systematic characterisation following the isolation of PTEC from kidney biopsy reported to date.
Abstract Introduction This retrospective study aimed to evaluate the 30 and 60‐day survival of critically ill patients with COVID‐19 and AKI. Methods Inflammatory and biochemical biomarkers, length ...of intensive care unit (ICU) stay and mortality at Day 30 and Day 60 after ICU admission were analyzed. A total of 44 patients treated with continuous renal replacement therapy (CRRT) with cytokine adsorber (CA group) were compared to 58 patients treated with CRRT alone (non‐CA group). Results Patients in CA group were younger, had better preserved kidney function prior to the beginning of CRRT and had higher levels of interleukin‐6. There were no statistically significant differences in their comorbidities and in other measured biomarkers between the two groups. The number of patients who died 60 days after ICU admission was statistically significantly higher in non‐CA group ( p = 0.029). Conclusion Treatment with CRRT and cytokine adsorber may have positively influenced 60‐day survival in our COVID‐19 ICU patients with AKI.
Abstract
Chronic kidney disease (CKD) in patients with diabetes mellitus (DM) is a major problem of public health. Currently, many of these patients experience progression of cardiovascular and renal ...disease, even when receiving optimal treatment. In previous years, several new drug classes for the treatment of type 2 DM have emerged, including inhibitors of renal sodium–glucose co-transporter-2 (SGLT-2) and glucagon-like peptide-1 (GLP-1) receptor agonists. Apart from reducing glycaemia, these classes were reported to have other beneficial effects for the cardiovascular and renal systems, such as weight loss and blood pressure reduction. Most importantly, in contrast to all previous studies with anti-diabetic agents, a series of recent randomized, placebo-controlled outcome trials showed that SGLT-2 inhibitors and GLP-1 receptor agonists are able to reduce cardiovascular events and all-cause mortality, as well as progression of renal disease, in patients with type 2 DM. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of SGLT-2 inhibitors and GLP-1 analogues, analyses the potential mechanisms involved in these actions and discusses their place in the treatment of patients with CKD and DM.
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