Chronic Kidney Disease Hemodialysis Patients Research Articles

COVID-19 is more lethal in hemodialysis chronic kidney disease patients with low physical capacity.

The mortality rate in patients on maintenance hemodialysis (HD) is high and is associated with low functional capacity (FC). We analyzed the association of FC and COVID-19 lethality among HD patients. A cohort study that included evaluations of FC in patients on HD was underway, and the association between FC and lethality was included as an ad-hoc outcome. One hundred and twelve patients were submitted to a physical, 31 patients contracted symptomatic COVID-19, 20 recovered and 11 died (lethality rate of 35.5%). There was a difference between survivors and non-survivors on six-minutes-walking-test (6MWT) 386.1 ± 112.8 versus 296.9 ± 103.3 meters (p = 0.04), 30 s sit-to-stand test (30CST) score 11.7 ± 3.1 versus 7.7 ± 4.1 (p = 0.006), and timed up and go test (TUG) 9.4 versus 13.6 s (p = 0.009). There was also an association between percentages of predicted 6MWT, 30CST, and TUG with COVID-19 lethality. Patients on maintenance HD with poorer physical performance presented the worst prognosis from COVID-19 pandemic.

Changes of Gut Microbiota in Maintenance Hemodialysis Patients and Their Impact on Patient's Microinflammation Status.

This study was to investigate the changes in gut microbiota in maintenance hemodialysis patients and analyze their impact on patient's microinflammation status. For this purpose, thirty-nine chronic kidney disease (CKD) maintenance hemodialysis patients admitted to our hospital from March 2019 to March 2022 were selected as the experimental group, and 40 healthy individuals with examination results during the same period were selected as the control group. The levels of gut microbiota (Lactobacillus, Bifidobacterium, Escherichia coli, and Enterococcus faecalis) and microinflammation indicators [interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP)] were measured in both groups. The relationship between changes in gut microbiota and microinflammation in maintenance hemodialysis CKD patients was analyzed. Results showed that the levels of Lactobacillus and Bifidobacterium in the experimental group were significantly lower than those in the control group (all, P<0.05), while the levels of Escherichia coli and Enterococcus faecalis in the experimental group were significantly higher than those in the control group (all, P<0.05). The IL-6, TNF-α, and hs-CRP levels in the experimental group were significantly higher than those in the control group (all, P<0.05). Using microinflammation indicators as dependent variables and microbiota indicators as independent variables for stepwise regression analysis, the results showed that the levels of Lactobacillus were negatively correlated with IL-6 and TNF-α levels in patients (r=-0.358, -0.942, P<0.05); the levels of Bifidobacterium were negatively correlated with IL-6, TNF-α, and hs-CRP levels in patients (r=-0.394, -0.211, -0.547, P<0.05); the levels of Escherichia coli were positively correlated with IL-6 and TNF-α levels in patients (r=0.221, 0.268, P<0.05); the levels of Enterococcus faecalis were positively correlated with IL-6 and hs-CRP levels in patients (r=0.253, 0.378, P<0.05). In conclusion, patients with maintenance hemodialysis for CKD commonly exhibit gut microbiota dysbiosis and varying degrees of low-grade inflammation. Compared to healthy individuals, maintenance hemodialysis patients with CKD have lower levels of Bifidobacterium and Lactobacillus and higher levels of Escherichia coli and Enterococcus in their gut. Bifidobacterium, Lactobacillus, Escherichia coli, and Enterococcus all have a certain impact on the low-grade inflammation status of patients with maintenance hemodialysis for CKD.

The Correlation of Interleukin-6, Malnutrition Inflammation Score and Asymmetric Dimethylarginine in Chronic Kidney Disease Patients Undergoing Routine Hemodialysis

Introduction: Chronic kidney disease (CKD) patients undergoing routine hemodialysis (HD) have a high prevalence of protein-energy malnutrition (PEM) and inflammation. The combination of inflammation and PEM is associated with cardiovascular disease and poor outcomes. Interleukin-6 (IL-6) is an inflammatory factor that runs parallel to endothelial damage and is closely related to the nutritional status of CKD HD patients. The tool to assess nutrition status is Malnutrition Inflammation Score (MIS) and to assess endothelial damage is Asymmetric Dimethylarginine (ADMA). It is currently unclear whether there is a correlation between inflammation, malnutrition, and endothelial dysfunction. Therefore the aim of this study is to determine the correlation between IL-6, MIS and ADMA in CKD HD patients. Methods: A cross-sectional design with analytic observational study was conducted on end stage renal disease patient who undergo routine hemodialysis for at least 2 years with the duration of hemodialysis is 4-5 hours and at least twice per week. IL-6 was examined by kit (ELISA) and ADMA using LC-MS/MS at a certified laboratory in Manado city. History taking and physical examination were used to calculate MIS. Data analysis was done using SPSS version 22. Results: There were 30 participants consisting of 22 men (72%) and 8 women (28%). The median age of the subjects was 56.50 years. There was a statistically significant positive correlation between IL-6 and ADMA (r = 0.440, p = 0.015), MIS and ADMA (r = 0.378, p = 0.039), and IL-6 and MIS (r = 0.682, p = 0.0001). Conclusion: There was a significant correlation between IL-6, MIS and ADMA.

High C-Terminal Fibroblast Growth Factor-23, Intact Parathyroid Hormone, and Interleukin-6 as Determinants of Valvular Calcification in Regular Hemodialysis Patients.

PurposeBiggest cause of death in chronic kidney disease-hemodialysis (CKD-HD) patients is cardiovascular disease (CVD). Cardiovascular disease is often associated with mineral bone disorders (MBD), especially vascular and valvular calcification. Biomarkers such as C-terminal-fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) were investigated. Only few studies have focused on valvular calcification in CKD-HD patients, with controversial results. The present study aimed to investigate whether high C-terminal-FGF-23, iPTH, and IL-6 can be used as determinants of valvular calcification in CKD-MBD patients undergoing regular HD.Patients and MethodsThis was an analytical cross-sectional study which involved CKD-HD patients aged 18–60 years with no history of CVD, malignancy, and diabetes mellitus. C-terminal FGF-23 was measured using enzyme-linked immunosorbent assay (ELISA) kit, iPTH using chemiluminescent immunometric method, and IL-6 using sandwich enzyme immunoassay technique. Valvular calcification on aortic and mitral valves was examined with echocardiography. Data analysis was done using Chi-squared test or Fisher’s exact test as appropriate and multivariate logistic regression analysis.ResultsBivariate analysis with Fisher’s exact test showed significant association of prevalence ratio (PR) of C-terminal FGF-23 (PR = 1.33; p = 0.003; CI (1.017–1.748)), iPTH (PR = 1.361; p = 0.002; CI (1.02–1.816)), and IL-6 (PR = 1.2; p = 0.019; CI (1.000–1.446)) with valvular calcification. Multivariate analysis with logistic regression showed high C-terminal FGF-23 (exp (B) value of 16.44; p = 0.045; CI (1.07–252.75)), iPTH (exp (B) value of 33.312; p = 0.016; CI (1.94–571.71)), and IL-6 (exp (B) value of 21.58; p = 0.0381; CI (1.18–394.87)) were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.ConclusionThis study demonstrated that high C-terminal FGF-23, iPTH, and IL-6 were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.

Hepatocyte Growth Factor in Predialysis and Hemodialysis Chronic Kidney Disease Patients.

Chronic kidney disease (CKD) which is characterized by progressive loss of renal function and renal fibrosis is a worldwide public health problem. Hepatocyte growth factor (HGF) is a polypeptide that exhibits multiple functions including antifibrotic effects on kidneys. The present study was aimed at evaluating HGF levels and studying its association with markers of inflammation and oxidative stress in patients of predialysis and dialysis CKD. A total of 80 subjects including 20 healthy controls, 40 patients of CKD stage 1 to stage 5 (predialysis), and 20 CKD patients with end-stage renal disease on hemodialysis were recruited. HGF, high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA), and ferric reducing ability of plasma (FRAP) were measured in all the subjects. HGF levels were significantly higher in all patients with CKD compared to controls. The levels were found to be lower in patients on dialysis than in the predialysis group; however, the difference was not statistically significant. hsCRP, MDA, and FRAP were significantly higher in all patients with CKD than in controls. HGF levels did not show a significant correlation with the markers studied. HGF levels were increased in response to renal injury in CKD patients. The levels were higher in predialysis patients of CKD than in CKD patients on dialysis. HGF levels may be used as an indicator of renal fibrosis in patients with CKD.

The Relationship between Haemodialysis Procedures and Interleukin-6 Levels in Regular Hemodialysis Patients in Haji Adam Malik Central General Hospital

Introduction: Chronic kidney disease (CKD) is kidney damage characterized by the presence of protein in the urine or a decrease in the glomerular filtration rate (GFR). CKD is a global problem throughout the world, including Indonesia, which requires special attention. IL-6 is known to play a role in regulating hemostatic functions, including glucose metabolism, the hypothalamus-pituitary-adrenal (HPA) axis, influencing mood, fatigue, depression, and hematopoiesis. As an inflammatory cytokine, IL-6 is an inflammatory mediator that most plays a role in various conditions, such as infection, autoimmune disease, and cancer. In CKD patients undergoing dialysis (HD), elevated serum IL-6 levels beginning from the start of the treatment is a strong predictor of mortality. The study aimed to determine the association between hemodialysis procedures and interleukin-6 levels in regular hemodialysis CKD patients in Haji Adam Malik Central General Hospital. Methods: This is an analytical study with a cross-sectional design. A total of 20 study subjects met the inclusion criteria and exclusion criteria, underwent history taking, physical examination, anthropometry, and laboratory examination to measure hemoglobin, creatinine, albumin, and IL-6 levels. Data analysis was performed using SPSS. Results: The median level of IL-6 before hemodialysis was 10.39 pg/mL with the lowest level and the highest level being 1.50 – 74.79 pg/mL, the median level of IL-6 after hemodialysis was 29.13 pg/mL with the lowest level and the lowest level. the highest is 2.11 – 316.20 pg/mL. Based on the results of the analysis, the levels of IL-6 after hemodialysis were higher than the levels of IL-6 before hemodialysis, there was a statistically significant relationship between regular hemodialysis and interleukin-6 levels before and after in patients with kidney disease. Conclusion: Regular hemodialysis and interleukin-6 levels have a statistically significant relationship before and after hemodialysis in CKD patients. Keywords: Chronic kidney disease; haemodialysis; interleukin-6.

Hemoglobin, Hematocrit, Leukocyte, and Platelet Changes Due To Ultrafiltrationhemodialysis in Chronic Kidney Disease Patients

Managing anemia in Chronic Kidney Disease (CKD) patients with hemodialysis (HD) is a challenge to physicians. The present consensus does not address the proper time of blood sampling in HD patients, but higher ultrafiltration (UF) volume (a process of removing fluid excess during HD) may alter hematologic parameters. The objective of this study was to compare some parameters of the Complete Blood Count (CBC); hemoglobin (Hb), hematocrit (Hct), leukocyte (WBC), and platelet counts (Plt) before and after HD. This method was a cross-sectional study performed in the HD Unit, Dr.Soetomo Hospital, including 51 CKD patients selected consecutively, divided into two groups based on the UF volume (2 L and &gt;2 L). Complete blood count pre- and post-HD were measured using Sysmex XN 1000. The results were 25 males and 26 females in this study, age ranged from 20 to 74-year-old, and 36 patients with UF volume &gt;2 L. Only HD with UF &gt;2 L showed significant increases for Hb (9.35g/dL to 10.00 g/dL), Hct (29.80% to 31.15 %), and Plt (209.00x103/µL to 213.00x103/µL) but WBC did not change significantly. These changes were believed to be caused by ultrafiltration. The conclusion was Hb, Hct, and Plt increased significantly with UF ≥2 L in HD CKD patients.

COMPARISON OF TOTAL ANTIOXIDANT CAPACITY (TAC)’S PATIENTS OF CHRONIC KIDNEY DISEASE UNDERGOING HEMODIALYSIS AND NON-HEMODIALYSIS

Background: Total antioxidant capacity (TAC) is one of the biomarkers to determine a person's health condition through antioxidant and oxidant activity or oxidative stress so that it can help in determining the therapy needed. However, currently, TAC levels in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and non-hemodialysis (non-HD) are still controversial, so further research is needed. Objective: To analyze the comparison of TAC in HD and non-HD CKD patient. Materials and Methods: This was an analytical cross-sectional study with clinical observation in CKD patient. A total of 71 CKD patients consisting of 28 CKD HD patients and 43 non-HD CKD patients were enrolled in this study. Data about the characteristics of the subjects were taken using the anamnesis method, while data about TAC were taken using the colorimetric method with COBAS C-501 0837-19 series and 0835-13 series to measure TAC levels in the serum of CKD patients. The data that has been obtained were analyzed using independent sample t-tests. Results: TAC levels were significantly higher in CKD patients undergoing HD compared to non-HD CKD patients (p &lt;0.05). There are data on albumin as an antioxidant and MDA as an oxidative stress biomarker that affects TAC levels. Conclusion: TAC levels found to be higher in hemodialysis CKD patient compared to non-hemodialysis CKD patient.

COMPARISON OF TOTAL ANTIOXIDANT CAPACITY (TAC)’S PATIENTS OF CHRONIC KIDNEY DISEASE UNDERGOING HEMODIALYSIS AND NON-HEMODIALYSIS

Background: Total antioxidant capacity (TAC) is one of the biomarkers to determine a person's health condition through antioxidant and oxidant activity or oxidative stress so that it can help in determining the therapy needed. However, currently, TAC levels in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and non-hemodialysis (non-HD) are still controversial, so further research is needed. Objective: To analyze the comparison of TAC in HD and non-HD CKD patient. Material and Method: This was an analytical cross-sectional study with clinical observation in CKD patient. A total of 71 CKD patients consisting of 28 CKD HD patients and 43 non-HD CKD patients were enrolled in this study. Data about the characteristics of the subjects were taken using the anamnesis method, while data about TAC were taken using the colorimetric method with COBAS C-501 0837-19 series and 0835-13 series to measure TAC levels in the serum of CKD patients. The data that has been obtained were analyzed using independent sample t-tests. Result: TAC levels were significantly higher in CKD patients undergoing HD compared to non-HD CKD patients (p &lt;0.05). There are data on albumin as an antioxidant and MDA as an oxidative stress biomarker that affects TAC levels. Conclusion: TAC levels found to be higher in hemodialysis CKD patient compared to non-hemodialysis CKD patient.

The Association of ACE Gene polymorphism and Some Biomarkers in Hemodialysis Patients

The Aim: Chronic kidney disease (CKD) is clarified by constant structural abnormalities, urine abnormalities or damaged excretory renal function indicative of a failure of functional nephrons. One of the treatments for renal fail¬ure is hemodialysis. The aim was assessing the potential association between Angiotensin Converting Enzyme (ACE) gene I/D polymorphism with renal failure and their correlation with some biochemical parameter as Insulin-like Growth Factor 1 (IGF-1) and Symmetric Dimethyl Arginine (SDMA) and kidney function test "urea" and "creatinine" in Iraqi hemodialysis patients. Materials and Methods: The study was contained 60 hemodialysis patients (30 Male and 30 Female).The control group was 30 healthy subjects (15 Male and 15 Female). The ages of hemodialysis patients and control groups ranged between (11-75 years). The information was taken from a questionnaire which included age, sex, smoking, duration of disease, duration of dialysis, number of dialyses, other disease and family history. Also, BMI, urea, creatinine, IGF-1, and SDMA were measured. After extraction of DNA from white blood cells and carrying out of PCR, characterizing ACE I/D polymorphism by applying an amplification refractory mutation system (ARMS) technique. Results: The demographic study showed that there were more hemodialysis patients had age ≥ 50 years old (40%)when compared with the control group. The most hemodialysis patients had body mass index (BMI) were 18-24.9 (48.33%)in comparison with control group which was18-24.9 (100 %). The smoking percentage was (16,67%) in hemodialysis patients compared to control group (10%). The presence of another disease in the hemodialysis patients were hypertension (70 %) followed by diabetes mellitus (25 %), arthritis (23.33%), and cardiovascular disease (20 %). With respect to family history of CKD, (25%) of hemodialysis patients have a family history while the family history of the control group was (6.67%). In the hemodialysis patients, the genotype I/I, I/D, and D/D distribution percentage were 18.33 %, 65 %, and 16.67% respectively compared with the control group which was 33.33 %, 36.67%, and 30 % respectively. Conclusion: There was a high association between heterozygous genotype (I/D) with the occurrence of CKD. Serum urea level increased in hemodialysis patients had ID genotypes in comparison with II and DD genotypes. Also, of IGF-1 and SADMA has importance as a risk factor or prognosis indicator in adult CKD hemodialysis patients.

Intraoperative Arterial Biopsy in Incident Hemodialysis Patients: Differences Observed

Introduction: Arterial calcification (AC) is a common complication in chronic kidney disease (CKD) patients that starts to develop before these patients need renal replacement therapy. In these patients, calcification can involve tunica intima or tunica media. This study has looked for the prevalence, severity, and distribution of arterial wall calcification in incident hemodialysis patients through intraoperative arterial biopsy obtained during creation of arteriovenous vascular access for hemodialysis. Methodology: One hundred and seventy-two stage 5 CKD adults (98 male and 74 female) were included. Beside histopathology of the obtained arterial samples, all these cases were tested for serum calcium (Ca), phosphorus (P), alkaline phosphatase, uric acid, parathormone (PTH), fibroblast growth factor 23 (FGF23), and 25 hydroxy vitamin D. Results: Eighty six (50%) of the cases had AC (group I); 29 (17%) as intimal (subgroup Ii), 36 (21%) as medial (subgroup Im), while 21 (12%) had both intimal and medial calcification (subgroup Iim). Eighty-six patients (50%) were devoid of calcification (group II). Apart from the significantly higher serum level of PTH in group I, statistical analysis failed to disclose significant difference in any of the other studied parameters between the 2 groups. On the other hand, there were significant differences in serum P, Ca × P product, serum PTH, and FGF23 between patients according to intensity of calcification. Conclusion: Half of incident hemodialysis CKD patients have developed AC mainly in tunica media. Discrepancy in serum P can have an impact on calcification intensity.

Evaluation of Bone Metabolism Biomarkers in Hemodialysis Chronic Kidney Disease

Metabolic bone disease (MBD) is a common complication of chronic kidney disease (CKD) and is a part of a broad spectrum of disorders of mineral metabolism that occur in this clinical setting and result in both skeletal and extraskletal consequences. This study was a cross sectional which conducted in Dialysis Unit in Tikrit Teaching Hospital in Tikrit city. The study started from January 2018 to August 2018 on study population age ranged from (18 – 68) years old The total of 60 subjects were separated to two groups as following: Control: This group consist of 30 healthy individuals (15 females and 15 males), and Hemodialysis (HD) (CKD) patients: This group consist of CKD 30 patients (15 females and 15 males). The results referred to the increased levels of Transforming growth factor- ? (TGF-?), Osteoprogestrin (OPG), Sclerostin (SOST), Osteocalcin (OC) and C-reactive protein (CRP) in CKD with HD with highly significant differences (P?0.01) when compared with control group. The bone metabolism biomarkers are increased in HD CKD patients who complicated to MBD.

Anthropometry-based Body Fat Percentage Predicts High hs-CRP in Chronic Kidney Disease Patients

BACKGROUND: Obesity is an important cardiovascular risk factor and associated with low grade inflammation in chronic kidney disease (CKD) patients. This study aims to assess the association between body fat with serum high sensitivity C-reactive protein (hs-CRP) level in CKD patients.METHODS: A cross-sectional study was performed in 71 CKD patients. Anthropometric measurements included body weight, height, body mass index (BMI), body fat percentage (BFP), skinfold thickness (SKF) of triceps and biceps were performed by trained physician. BFP was calculated using Kwok’s Formula and hs-CRP was measured by Particle enhanced Turbidimetry.RESULTS: The averaged BMI of our subjects was 25.8±4.4. There was no significant difference in BMI between pre-dialysis and hemodialysis CKD patients. Positive correlation was found between BFP and hs-CRP (r=0.266; p&lt;0.05), while there was no significant correlation between BMI and hs-CRP.CONCLUSION: Body fat percentage was associated with hs-CRP. Hence, it will be more beneficial to assess nutritional status in CKD using BFP rather than BMI alone since it was demonstrated to correlate with hs-CRP in our studyKEYWORDS: CKD, obesity, inflammation, body fat, hs-CRP

Prophylactic hepatitis B immunization in chronic kidney disease patients, Oran, Algeria

Background It is estimated that > 2 billion people worldwide have been infected with HBV. Of these, approximately 360 million individuals are chronically infected and at-risk of serious illness and death, mainly from liver cirrhosis and hepatocellular carcinoma (HCC). Algeria is situated in areas of intermediate endemicity (prevalences of endemicity of HBsAg 2–7%). Patients suffering from chronic kidney disease (CKD) are at particular risk of infection with HBV, they are associated with reduced immunogenicity following vaccine administration. Because of that, these patients have been offered schedules containing more than 3 doses and larger doses of the vaccine (schedule containing 4 double doses of standard hepatitis B vaccine). Those found to have anti-HBs concentrations Aim Determine the efficacy of the four double doses schedule of hepatitis B vaccine in preventing infection up postvaccination of chronic renal failure patients. Patients and methods It is a retrospective descriptive study including 209 chronic kidney disease patients. All patients had received hepatitis B vaccine with follow-up at epidemiology service of Oran university hospital (EHUO), during a period 2011–2012. Patients have been offered immunization schedule containing double doses (40 μg) of monovalant recombinant hepatitis B vaccine. The primary immunization series consists of 4 doses of vaccine (at 0, 1, 2, 6 month) followed by anti-HBs testing. People who do not respond (anti-HBs antibody titres Results The average age of patients is 61.2 ± 1.1 years old with a sex ratio of 1.1. Non-dialyzed CKD patients accounted for 78.9%. Vaccine seroprotection was obtained in 82% of non-hemodialysis CKD patients and in 76% of CKD hemodialysis patients after primary vaccination. Nevertheless, 12% of non-hemodialysis CKD patients and 12.5% of CKD hemodialysis patients are low responders (10 ≤ AC-HBS Conclusion The four doses of 40 μg vaccine schedule has proven its effectiveness with good seroprotection in chronic kidney disease patients. The vaccination against hepatitis B represents a considerable advance in the prophylaxis of this disease but unfortunately no regulatory text governs this vaccination in CKD patients in our country. Early vaccination (before dialysis) is recommended.

Peripheral Blood Regulatory T Cells Are Diminished in Kidney Transplant Patients With Chronic Allograft Nephropathy

BackgroundOur aim in this study was to assess peripheral blood CD4+CD25+FOXP3+ regulatory T cell (Treg) levels in patients with chronic allograft nephropathy (CAN) 1 year after kidney transplantation. MethodsTwelve renal transplant patients with an initial onset of CAN, 12 patients with chronic kidney disease (CKD) stage G5 on dialysis, and 13 healthy control individuals were evaluated regarding the proportion of Tregs in their peripheral blood via flow cytometry. ResultsThe renal transplant patients with CAN had a significantly lower proportion of Tregs than the hemodialysis CKD patients and healthy controls (P < .0001). In contrast, the hemodialysis CKD patients showed higher levels of Tregs than the renal transplant patients with CAN and the healthy controls (P < .0001). ConclusionThe high level of peripheral blood Tregs in the hemodialysis CKD patients suggests a chronic inflammatory state. However, the low frequency of Tregs in the peripheral blood from the renal transplant patients with CAN suggests an unfavorable prognosis for allograft immune tolerance.

Biomarkers of Endothelial, Renal, and Platelet Dysfunction in Stage 5 Chronic Kidney Disease Hemodialysis Patients With Heart Failure.

The aim of this study was to determine the role of endothelial, renal, and inflammatory biomarkers in the pathogenesis of heart failure (HF) in patients with stage 5 chronic kidney disease (CKD5) undergoing maintenance hemodialysis (HD). Plasma levels of biomarkers-kidney injury molecule 1 (KIM-1), N-terminal pro brain natriuretic peptide (NT-proBNP), glycated hemoglobin, neutrophil gelatinase-associated lipocalin, interleukin-18,platelet-derived growth factor, platelet factor 4 (PF4), 25-OH vitamin D, parathyroid hormone (PTH), endothelin, and endocan-were measured in CKD5-HD patients at the Loyola University Ambulatory Dialysis facility. The HF (+) CKD5-HD patients, as compared to HF (-) CKD5-HD patients, exhibited significantly elevated NT-proBNP ( P = .0194) and KIM-1 ( P = .0485). The NT-proBNP in HF (+) CKD5-HD patients was found to correlate with the levels of serum potassium ( P = .023, R = -.39), calcium ( P = .029, R = -.38), and PF4 ( P = .045, R = -.35). The KIM-1 in HF (+) CKD5-HD patients was found to correlate with PTH ( P = .043, R = -.36) and 25-OH vitamin D ( P = .037, R = .36). Elevated plasma NT-proBNP and KIM-1 in CKD5-HD and HF (+) CKD5-HD patients suggest that natriuretic peptides and KIM-1 may contribute to the pathogenesis of HF in CKD5-HD patients.

Abstract 11276: Differentiating Cardiac Fibrosis From Hypertrophy in Chronic Kidney Disease Hemodialysis Patients Using Gadolinium-Free Imaging and Biomarkers of Extracellular Matrix Turnover

Purpose: Cardiac stress blood biomarkers are typically correlated to hypertrophy or diastolic dysfunction but not fibrosis in chronic kidney disease (CKD). Cardiac fibrosis can be measured without gadolinium as elevated normalized signal difference (ΔS/S o ) between pairs of magnetization transfer (MT) weighted magnetic resonance (MRI) images. We used MT-MRI to compare blood biomarkers to fibrosis, hypertrophy and diastolic strain rate in CKD patients on hemodialysis (CKD5). Hypothesis: Biomarkers of cardiac stress correlate with left ventricular (LV) hypertrophy, not fibrosis, in CKD5 patients. Methods: MT-MRI generated maps of ΔS/S o in 23 CKD5 patients and 21 controls (Fig 1A, B). Fibrotic burden was defined as divergence in ΔS/S o compared to a standard distribution (Fig 1C). In a subset of 12-15 per group, serum troponin T (TnT), fibroblast growth factor 23 (FGF23), matrix metalloproteases (MMP) 2 and 9 and tissue inhibitor of MMP (TIMP) 1 and 2 were measured by ELISA and analyzed with Spearman correlations. Feature tracking measured strain. Results: CKD5 patients had higher ΔS/S o (146.2 ± 18.7%), divergence (10.0 ± 9.2%) and LV mass index (81.6 ± 28.9 g/m 2 ) than controls (133.5 ± 11.5%, 5.4 ± 3.7%, 57.9 ± 15.5 g/m 2 , all p &lt;0.05). Ejection fraction, diastolic strain rate and longitudinal strain were similar. While TnT, FGF23 and TIMP1/2 correlated with mass, only TIMP1 correlated with fibrotic burden (Table 1). Conclusions: Most stress biomarkers correlate with hypertrophy but not fibrosis in CKD5 patients. Activation of cardiac fibroblasts by TIMP1 and correlation of TIMP1 with degree of fibrosis suggest TIMP1 as an alternative target to attenuate cardiac fibrosis in CKD5 patients.

EFFICACY AND SAFETY OF IRON (III)–HYDROXIDE SUCROSE COMPLEX IN CORRECTION OF ANEMIA STAGE 5D CHRONIC KIDNEYDISEASE HEMODIALYSIS PATIENTS NOT TREATED BY ERYTHROPOIESIS–STIMULATING AGENTS (PROSPECTIVEANALYSIS)

The aim of study was to evaluat the efficacy and safety ofSUFER® (iron (III) sucrose complex) in correction of anemia stage 5D chronic kidney disease hemodialysis patients.&#x0D; Methods. This study included thirty patients undergoing regular hemodialysis (mean age 48,81±3,24 years, mean duration of dialysis 30,43±9,25 months) with renal anemia and iron deficiency. All patients were treated with SUFER® intravenously 200 mg three times a week. Correction dose was determined according to the manufacturer’s recommendations.&#x0D; Results. Mean level offerritin was significantly increased from 125,15 ± 21,46 ng / ml to 375,56 ± 64,12 ng / ml (p &lt;0,001), transferrin saturation – from 17,48 ± 2,71% to 38,21 ± 4,90 ng / ml (p &lt;0,001). 23 (76.67%) patients achieved target levels offerritin and transferrin, 12 (40% ) adverse events.&#x0D; Conclusions. SUFER® is effective and safety drug in dialysis patients.

Influence of Four Different PTH Methods on the Classification of Chronic Kidney Disease PatientS According to the New KDIGO Guideline

Secondary hyperparathyroidism develops frequently with chronic kidney disease (CKD) and is associated with poor outcome. The new CKD-MBD guideline, Kidney Disease: Improving Global Outcomes (KDIGO), recommends a target range for PTH which is based on the locally used, upper reference range limit (URL). We examined the impact of the KDIGO guideline on the classification of dialysis patients in two different hospitals using 4 different intact-PTH assays. Blood samples from 76 consecutive hemodialysis CKD patients were measured for PTH concentration. Classification of the patients was performed according to the previous KDOQI and the KDIGO guideline using the manufacturers' and laboratory determined URLs. Classification of patients based on 3 different PTH methods (Siemens ADVIA Centaur, Siemens Immulite 2000, and Beckman Coulter Unicel DxI) was compared with the classification found in another hospital using the Roche Modular E170 PTH assay. Depending on the PTH assay used, between 9 (12%) to 14 (18%) of the patients were classified differently in the two hospitals if the KDOQI guideline was followed. Application of the KDIGO-PTH target range resulted in a similar or decreased number of differently classified patients if the PTH concentration was measured using the Advia Centaur and Immulite assays. With the Beckman Coulter PTH assay, however, the number of differently KDIGO-classified patients increased if the manufacturers' URL (9.3 pmol/L) was used to calculate the PTH-target range. Application of the laboratory determined URL (7.0 pmol/L) improved concordance in classification, although the number of differently classified patients was still higher than with the other PTH assays. The best concordance in classification for the Beckman Coulter assay was found at a PTH value of 6.0 pmol/L. Regarding the Roche and Siemens assays, no significant difference was found in the classification using the URL either determined by the laboratory or the manufacturers. Compared with the KDOQI guideline, the new KDIGO guideline may increase the number of discrepancies in the classification of CKD patients if the Access Beckman Coulter PTH assay is used in conjunction with the calculated target range based on the manufacturers' URL. The best concordance in the classification for the Beckman Coulter assay was found at a PTH value below the manufacturers' and laboratory determined URL.

Biochemical markers of vascular calcification in elderly hemodialysis patients

The increased vascular calcification, cardiovascular morbidity, and mortality in chronic kidney disease (CKD) patients has been associated with disturbances in mineral-bone metabolism. In order to determine markers of the vascular calcification frequently observed in these patients, blood samples of elderly male and female hemodialysis CKD patients were used to measure serum levels of: osteoprotegerin (OPG), total soluble receptor activator of nuclear factor-κB ligand (sRANKL), and fetuin-A by enzyme immunoassay; tartrate-resistant acid phosphatase (TRACP-5b), and bone-specific alkaline phosphatase (BAP) by immunoenzymometric assay; osteocalcin (OC) by ELISA; iPTH by immunoradiometric assay; 25(OH)D(3) and 1,25(OH)(2)D(3), by I(125) radioimmunoassay; and calcium and phosphorus by photometric assay. Serum OPG, BAP, iPTH, phosphorus, and OC levels were higher and serum 25(OH)D(3), 1,25(OH)(2)D(3), and fetuin-A levels lower in both male and female CKD patients than in their respective controls. Our results indicate that the bone formation and resorption parameters are altered in elderly male and female hemodialysis CKD patients. These changes may lead to vascular calcifications and cardiovascular complications, given that elevated OPG and OC levels and reduced fetuin-A levels are associated with cardiovascular events.