Nephron. Clinical Practice

BACKGROUND/AIMS: S100A12 induces vascular inflammation contributing to the development of atherosclerosis. Serum S100A12 concentration is shown to be elevated in patients with chronic kidney disease (CKD), however the reason remains unclear. METHODS: Transcriptional levels of S100A12 and RAGE (receptor for advanced glycation end products) were measured in peripheral leukocytes by quantitative real-time RT-PCR. Subjects were 40 patients with CKD stage 4-5, 20 of whom were affected with cardiovascular disease (CVD), and 20 healthy subjects...

BACKGROUND/AIMS: The 'surprise question' (SQ) may aid timely identification of patients with end-of-life care needs. We assessed its prognostic value and variability among clinicians caring for a cohort of haemodialysis (HD) patients. METHODS: Clinicians (29 nurses and 6 nephrologists) in each of our 3 HD units were asked to pose the SQ concerning all patients dialysing in their unit. There were 344 patients, 116 in Unit 1, 132 in Unit 2 and 96 in Unit 3. RESULTS: An adverse SQ response: 'I would not be surprised if this patient were to die in the next 12 months' was reported by individual clinicians for between 6 and 43% of patients (mean 24 ± 9%)...

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity characterized by headache, visual disturbances, seizures, and the presence of edema on MRI scan, predominantly in the posterior white matter. Regarding end-stage renal disease (ESRD) and PRES, only a few cases of children on peritoneal dialysis (PD) and adults on hemodialysis have been described in the literature. CASES: We report 4 cases of adult patients on PD who presented with PRES, all of which were due to hypertension and inadequate management of fluid balance...

BACKGROUND: Native arteriovenous fistulae (AVF) are the vascular access of choice for haemodialysis. The consequences of AVF formation on microvascular function, locally or systemically, are unknown. METHODS: We recruited 43 predialysis patients undergoing AVF formation. Patients were studied 2 weeks prior to the planned AVF operation and 2 weeks postoperatively. Thirteen patients with failed AVF were subsequently utilised as sham controls. Laser Doppler perfusion imaging was used to measure subcutaneous microvascular blood flow...

BACKGROUND: The aim of the present study was to compare levels of fetuin-A, osteoprotegerin (OPG), and heat shock protein (HSP)70 according to the stage of chronic kidney disease (CKD), as well as to evaluate the association between serum fetuin-A, OPG, and HSP70 concentrations with respect to vascular stiffness and calcification in hemodialysis (HD) patients. METHODS: We measured fetuin-A, OPG, and HSP70 in 35 healthy controls, 35 patients with stage 3 CKD, 35 patients with stage 4 CKD, and 81 HD patients...

BACKGROUND/AIMS: Patients with autosomal dominant polycystic kidney disease (ADPKD) exhibit endothelial dysfunction (ED) despite normal levels of renal function. Hyperuricemia occurs in these patients and has been postulated to affect ED through the generation of oxidative stress. We therefore investigated the prevalence of ED and its association with serum uric acid levels in early-stage ADPKD. METHODS: A cross-sectional design was used for the assessment of prevalent patients with early-stage (normal renal function) ADPKD (n = 91) from two academic medical centers...

BACKGROUND: The incidence of infective endocarditis (IE) in dialysis patients is higher than the general population. Dialysis patients who develop endocarditis are thought to have a poorer prognosis than other patients with IE. AIM: To examine the risk profiles, clinical features, and outcomes of patients on dialysis who developed IE in a large cohort. DESIGN AND METHODS: A retrospective analysis of all patients developing IE on dialysis (using the modified Duke criteria) was undertaken between 1998 and 2011...

BACKGROUND: Acute kidney injury (AKI) in hospitalized patients has significant implications in terms of morbidity and mortality, length of hospital stay and associated costs. To date, no interventions are proven to prevent the development of AKI but this is hampered in part by the lack of early recognition of patients at risk. We aimed to determine whether a simple system could be devised from both physiological and demographic data in order to identify individuals at increased risk from the development of inpatient AKI...

BACKGROUND/AIMS: The aim of this controlled study was to investigate the effect of high-load strength training on glucose tolerance in patients undergoing dialysis. METHODS: 23 patients treated by dialysis underwent a 16-week control period followed by 16 weeks of strength training three times a week. Muscle fiber size, composition and capillary density were analyzed in biopsies obtained in the vastus lateralis muscle. Glucose tolerance and the insulin response were measured by a 2-hour oral glucose tolerance test...

AIM: The aim of this cross-sectional study was to assess the correlation between self-reported appetite and the time of recovery after the hemodialysis session (TIRD). METHODS: All patients on chronic hemodialysis at the Hemodialysis Service of the Catholic University of Rome underwent assessment of appetite through the first three questions of the Hemodialysis Study Appetite questionnaire, TIRD (through the question 'How long does it take you to recover from a dialysis session?'), number and severity of comorbidities according to the Charlson Comorbidity Index (CCI), and daily activities through the ADL (activities of daily living) and the IADL (instrumental activities of daily living)...

BACKGROUND: Haemodialysis (HD) is able to induce recurrent myocardial ischemia and segmental left-ventricular dysfunction (myocardial stunning). The association of N-terminal Pro-B-type natriuretic peptide (NTpro-BNP) with HD-induced myocardial stunning is unclear. METHODS: In 70 prevalent HD patients, HD-induced myocardial stunning was assessed echocardiographically at baseline and after 12 months. The extent to which pre-dialysis NTpro-BNP was associated with the occurrence of HD-induced myocardial stunning was assessed as the primary endpoint...

BACKGROUND: Continental Africa is facing an epidemic of chronic kidney disease (CKD). APOL1 risk variants have been shown to be strongly associated with an increased risk for non-diabetic kidney disease including HIV nephropathy, primary non-monogenic focal and segmental glomerulosclerosis, and hypertension-attributed nephropathy among African ancestry populations in the USA. The world's highest frequencies of APOL1 risk alleles have been reported in West African nations, overlapping regions with a high incidence of CKD and hypertension...

BACKGROUND/AIMS: Sudden cardiac death remains the leading cause of death in hemodialysis (HD) patients. Prolongation of QTc intervals (as measured by the tangent method) increases sudden cardiac death risk in populations without kidney disease. METHODS: We performed a retrospective electrocardiograph (ECG) and chart review of HD patients. Our objectives were (1) to establish the effect of one of four different dialysis modalities on interdialytic QTc intervals, (2) to determine the effect of dialysis frequency and time on QTc interval and on the prevalence of borderline or prolonged QTc intervals, and (3) to determine if changes in QTc interval were simultaneous to changes in electrocardiographic left ventricular mass...

UNLABELLED: Anemia is more prevalent in renal transplant recipients than in GFR-matched chronic kidney disease patients. Hepcidin is a small defensin-like peptide whose production by hepatocytes is modulated in response to anemia, hypoxia or inflammation. Growth differentiation factor 15 (GDF15) was recently identified as a hepcidin-suppression factor that is expressed at high levels in patients with ineffective erythropoiesis. The aim of the study was to assess GDF15 levels with relation to iron parameters in 62 stable kidney allograft recipients maintained on triple immunosuppressive therapy...

BACKGROUND/AIMS: Several formulas for glomerular filtration rate (GFR) estimation, based on serum creatinine or cystatin C, have been proposed. We assessed the impact of some of these equations on estimated GFR (eGFR) and chronic kidney disease (CKD) prevalence, and on the association with cardiovascular risk factors, in a general population sample characterized by a young mean age. METHODS: We studied 1,199 individuals from three Alpine villages enrolled into the MICROS study...

BACKGROUND/AIMS: Serum phosphate (P) has been linked to adverse events in patients with chronic kidney disease. Salivary phosphate (Psal) has been proposed as a potential target of therapy with a chitosan-containing chewing gum. METHODS: We conducted several pilot studies to characterize Psal and its relationship with kidney function and subsequently conducted two clinical efficacy studies: a double-blind placebo-controlled trial in patients with end-stage renal disease (ESRD) and an open-label trial in those with stage 3-4 CKD...

UNLABELLED: In adults, recurrent hemodialysis (HD)-induced cardiac injury results in ischemic myocardial dysfunction. Uremic children, like adults, share the full complement of uremia-related cardiovascular abnormalities but without significant atheromatous coronary artery disease. The aim of this study was, to assess the impact of HD on left ventricular (LV) myocardial function in children. METHOD: We assessed all single-center chronic HD patients (n = 15, range 1-17 years) excluding those with overt cardiac disease...

BACKGROUND: Tumor necrosis factor-alpha is a proinflammatory cytokine that has been implicated in the pathobiology of acute kidney injury (AKI). METHODS: We explored the association of a functional polymorphism in the promoter region (rs1800629) of the TNFA gene with severity of AKI, as defined by level of glomerular filtration (serum cystatin C and creatinine) and tubular injury (urinary NAG, KIM-1, α-GST, and π-GST) markers, in 262 hospitalized adults. RESULTS: In unadjusted analyses, compared with the GG genotype, the TNFA GA and AA genotype groups tended to have higher enrollment (p = 0...

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