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Early Outcomes of the New UK Deceased Donor Kidney Fast-track Offering Scheme.

Sat, 06/24/2017 - 12:45
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Early Outcomes of the New UK Deceased Donor Kidney Fast-track Offering Scheme.

Transplantation. 2017 Jun 21;:

Authors: Callaghan CJ, Mumford L, Pankhurst L, Baker RJ, Bradley JA, Watson CJE

Abstract
BACKGROUND: The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012 to identify kidneys at high risk of discard and to rapidly facilitate transplantation. A retrospective analysis of kidneys transplanted through the KFTS was undertaken.
METHODS: UK Transplant Registry data were collected on deceased donor kidneys implanted between 1 November 2012 and 30 April 2015 (DBD donors) and 1 March 2013 and 30 April 2015 (DCD donors). Posttransplant outcomes included 1-year eGFR and death-censored graft survival (DCGS).
RESULTS: Over the study period, 523 deceased donor kidneys were transplanted through the KFTS and 4,174 via the standard National Kidney Allocation Scheme (NKAS). Kidneys in the KFTS were more likely to be from older, diabetic donors, had a higher frequency of poor ex vivo perfusion, longer cold ischaemic times and were transplanted into older recipients. One-year DCGS of KFTS and NKAS DBD donor kidneys was similar (94% versus 95%; p=0.70), but for DCD donor kidneys DCGS was lower in those allocated via the KFTS (91% versus 95%; p=0.04). Median 1-year eGFR for DBD donor kidneys was lower in those allocated via the KFTS (49 versus 52 mL/min/1.73m; p=0.01), but for DCD kidneys there was no difference (45 versus 48 mL/min/1.73m; p=0.10).
CONCLUSIONS: Although KFTS kidneys have less favourable donor, graft, and recipient risk factors than NKAS kidneys, short-term graft and patient outcomes are acceptable. National schemes that identify and rapidly offer kidneys at high risk of discard may contribute to minimising the unnecessary discard of organs.

PMID: 28640070 [PubMed - as supplied by publisher]

Pharmacodynamic Monitoring of Tacrolimus-based Immunosuppression in CD14+ Monocytes after Kidney Transplantation.

Sat, 06/24/2017 - 12:45
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Pharmacodynamic Monitoring of Tacrolimus-based Immunosuppression in CD14+ Monocytes after Kidney Transplantation.

Ther Drug Monit. 2017 Jun 19;:

Authors: Kannegieter NM, Hesselink DA, Dieterich M, De Graav GN, Kraaijeveld R, Rowshani AT, Leenen PJ, Baan CC

Abstract
BACKGROUND: Monocytes significantly contribute to ischemia reperfusion injury and allograft rejection after kidney transplantation. However, the knowledge about the effects of immunosuppressive drugs on monocyte activation is limited. Conventional pharmacokinetic methods for immunosuppressive drug monitoring are not cell type-specific. In this study, phosphorylation of three signaling proteins was measured to determine the pharmacodynamic effects of immunosuppression on monocyte activation in kidney transplant patients.
METHODS: Blood samples from 20 kidney transplant recipients were monitored before and during the first year after transplantation. All patients received induction therapy with basiliximab, followed by tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisolone maintenance therapy. TAC whole-blood pre-dose concentrations were determined using an antibody-conjugated magnetic immunoassay. Samples were stimulated with PMA/ionomycin and phosphorylation of p38MAPK, ERK, and Akt in CD14 monocytes was quantified by phospho-specific flow cytometry.
RESULTS: Phosphorylation of p38MAPK and Akt in monocytes of immunosuppressed recipients was lower after 360 days compared with before transplantation in the unstimulated samples (mean median fluorescence intensity (MFI) reduction 36%; range -28% to 77% for p-p38MAPK and 20%; range -22% to 53% for p-Akt; p < 0.05). P-ERK was only decreased at day 4 after transplantation (mean inhibition 23%; range -52% to 73%; p < 0.05). At day 4, when the highest whole-blood pre-dose TAC concentrations were measured, p-p38MAPK and p-Akt, but not p-ERK, correlated inversely with TAC (rs = -0.65; p = 0.01 and rs = -0.58; p = 0.03, respectively).
CONCLUSIONS: Immunosuppressive drug combination therapy partially inhibits monocyte activation pathways after kidney transplantation. This inhibition can be determined by phospho-specific flow cytometry, which enables the assessment of the pharmacodynamic effects of immunosuppressive drugs in a cell-type-specific manner.

PMID: 28640063 [PubMed - as supplied by publisher]

Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure-A Retrospective Analysis.

Sat, 06/24/2017 - 12:45
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Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure-A Retrospective Analysis.

Crit Care Med. 2017 Jun 21;:

Authors: Gerth HU, Pohlen M, Thölking G, Pavenstädt H, Brand M, Hüsing-Kabar A, Wilms C, Maschmeier M, Kabar I, Torner J, Pavesi M, Arroyo V, Banares R, Schmidt HHJ

Abstract
OBJECTIVES: Acute-on-chronic liver failure is associated with numerous consecutive organ failures and a high short-term mortality rate. Molecular adsorbent recirculating system therapy has demonstrated beneficial effects on the distinct symptoms, but the associated mortality data remain controversial.
DESIGN: Retrospective analysis of acute-on-chronic liver failure patients receiving either standard medical treatment or standard medical treatment and molecular adsorbent recirculating system. Secondary analysis of data from the prospective randomized Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial by applying the recently introduced Chronic Liver Failure-criteria.
SETTING: Medical Departments of University Hospital Muenster (Germany).
PATIENTS: This analysis was conducted in two parts. First, 101 patients with acute-on-chronic liver failure grades 1-3 and Chronic Liver Failure-C-Organ Failure liver subscore equals to 3 but stable pulmonary function were identified and received either standard medical treatment (standard medical treatment, n = 54) or standard medical treatment and molecular adsorbent recirculating system (n = 47) at the University Hospital Muenster. Second, the results of this retrospective analysis were tested against the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial.
INTERVENTIONS: Standard medical treatment and molecular adsorbent recirculating system.
MEASUREMENTS AND MAIN RESULTS: Additionally to improved laboratory variables (bilirubin and creatinine), the short-term mortality (up to day 14) of the molecular adsorbent recirculating system group was significantly reduced compared with standard medical treatment. A reduced 14-day mortality rate was observed in the molecular adsorbent recirculating system group (9.5% vs 50.0% with standard medical treatment; p = 0.004), especially in patients with multiple organ failure (acute-on-chronic liver failure grade 2-3). Concerning the affected organ system, this effect of molecular adsorbent recirculating system on mortality was particularly evident among patients with increased kidney, brain, or coagulation Chronic Liver Failure-C-Organ Failure subscores. Subsequent reanalysis of the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure dataset with adoption of the Chronic Liver Failure-classification resulted in similar findings.
CONCLUSIONS: Molecular adsorbent recirculating system treatment was associated with an improved short-term survival of patients with acute-on-chronic liver failure and multiple organ failure. Among these high-risk patients, molecular adsorbent recirculating system treatment might bridge to liver recovery or liver transplantation.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PMID: 28640024 [PubMed - as supplied by publisher]

Potential Impact of Risk and Loss Aversion on the Process of Accepting Kidneys for Transplantation.

Sat, 06/24/2017 - 12:45
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Potential Impact of Risk and Loss Aversion on the Process of Accepting Kidneys for Transplantation.

Transplantation. 2017 Jul;101(7):1514-1517

Authors: Heilman RL, Green EP, Reddy KS, Moss A, Kaplan B

Abstract
Behavioral economic theory suggests that people make decisions based on maximizing perceived value; however, this may be influenced more by the risk of loss rather than of potential gain. Additionally, individuals may seek certainty over uncertainty. These are termed loss aversion and risk aversion, respectively. Loss aversion is particularly sensitive to how the decision is "framed." Thus, labeling a kidney as high Kidney Donor Profile Index results in higher discard rates because this creates a nonlinearity in perceived risk. There is also evidence that the perceived loss due to regulatory sanction results in increased organ discard rates. This may be due to the overuse of terminology that stresses regulatory sanctions and thus perpetuates fear of loss through a form of nudging. Our goal is to point out how these concepts of behavioral economics may negatively influence the decision process to accept these suboptimal organs. We hope to make the community more aware of these powerful psychological influences and thus potentially increase the utilization of these suboptimal organs. Further, we would urge regulatory bodies to avoid utilizing strategies that frame outcomes in terms of loss due to flagging and build models that are less prone to uncertain expected versus observed outcomes.

PMID: 28640014 [PubMed - in process]

Multiple socioeconomic deprivation and impact on survival in patients with primary glomerulonephritis.

Sat, 06/24/2017 - 12:45
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Multiple socioeconomic deprivation and impact on survival in patients with primary glomerulonephritis.

Clin Kidney J. 2017 Feb;10(1):49-54

Authors: McQuarrie EP, Mackinnon B, Bell S, Fleming S, McNeice V, Stewart G, Fox JG, Geddes CC, Scottish Renal Biopsy Registry

Abstract
Background: The impact of multiple socio-economic deprivation on patient outcomes in primary renal diseases is unknown. We aimed to assess whether risk of death or requiring renal replacement therapy (RRT) in patients with primary glomerulonephritis (GN) was higher in patients living in an area of multiple socio-economic deprivation. Methods: Patients undergoing native renal biopsy between 2000 and 2014 were identified. Baseline demographics, postcode at time of biopsy, follow-up blood pressure, proteinuria and time to death or RRT were recorded. The Scottish Index of Multiple Deprivation (SIMD) is a multidimensional model used to measure deprivation based on postcode. Using SIMD, patients were separated into tertiles of deprivation. Results: A total of 797 patients were included, 64.2% were male with mean age of 54.1 (standard deviation 17.0) years. Median follow-up was 6.3 (interquartile range 3.7-9.4) years during which 174 patients required RRT and 185 patients died. Patients in the most deprived tertile of deprivation were significantly more likely to die than those in the least deprived tertile [hazard ratio (HR) 2.2, P  <  0.001], independent of age, baseline serum creatinine and blood pressure. They were not more likely to require RRT (P  =  0.22). The increased mortality risk in the most deprived tertile was not uniform across primary renal diseases, with the association being most marked in focal segmental glomerulosclerosis (HR 7.4) and IgA nephropathy (HR 2.7) and absent in membranous nephropathy. Conclusion: We have demonstrated a significant independent 2-fold increased risk of death in patients with primary GN who live in an area of multiple socio-economic deprivation at the time of diagnosis as compared with those living in less deprived areas.

PMID: 28639628 [PubMed - in process]

Role of CT scan in diagnosis of renal lymphangiectasia: our single-center experience.

Sat, 06/24/2017 - 12:45
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Role of CT scan in diagnosis of renal lymphangiectasia: our single-center experience.

Ren Fail. 2017 Nov;39(1):533-539

Authors: Pandya VK, Sutariya HC, Gandhi SP, Khemchandani SI, Patel HV, Shah MK

Abstract
BACKGROUND: Renal lymphangiectasia is rarely reported benign renal disorder of lymphatic malformation. Though found incidentally; it presents with nonspecific symptoms and shows characteristic findings in radiological imaging studies.
AIM: Here, we report eight patients with symptoms, laboratory and imaging findings compatible with renal lymphangiectasia. This report describes clinical and laboratory characteristics, treatment, Imaging findings and outcome of a series of patients with renal lymphangiectasia and reviews the literature.
METHODS AND MATERIAL: Eight patients (mean age 45 years, male:female ratio 3:1) from 1st January 2011 to 30th June 2016; showing renal lymphangiectasia as incidental finding on CT IVP were included in the series. Imaging and laboratory findings were reviewed. Two out of eight patients (25%) underwent aspiration of collection and laboratory findings confirmed the diagnosis of renal lymphangiectasia. Four out of eight patients (50%) did not undergo aspiration of fluid and were offered conservative treatment. Two out of eight patients (25%) were donors for renal transplantation who were managed conservatively.
RESULTS: Renal lymphangiectasia was diagnosed on CT IVP. In each case, where aspiration of collection fluid was offered, the laboratory diagnosis of renal lymphangiectasia was confirmed and patients were managed conservatively. However, large collection in one patient was relieved by percutaneous aspiration.
CONCLUSIONS: Renal lymphangiectasia can be diagnosed with CT scan and confirmed by laboratory tests. As it may be confused with other cystic lesions of kidney; proper diagnosis and exclusion of other differentials can be effectively offered by CT scan IVP, which can avoid unnecessary invasive treatment options.

PMID: 28639460 [PubMed - in process]

Development of immune response to tissue-restricted self-antigens in simultaneous kidney-pancreas transplant recipients with acute rejection.

Sat, 06/24/2017 - 12:45
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Development of immune response to tissue-restricted self-antigens in simultaneous kidney-pancreas transplant recipients with acute rejection.

Clin Transplant. 2017 Jun 21;:

Authors: Gunasekaran M, Vachharajani N, Gaut JP, Maw TT, Delos Santos R, Shenoy S, Chapman WC, Wellen J, Mohanakumar T

Abstract
Simultaneous kidney-pancreas transplantation (SKP Tx) is a treatment for end-stage kidney disease secondary to diabetes mellitus. We investigated the role of immune responses to donor human leukocyte antigens (HLA) and tissue-restricted kidney and pancreas self-antigens (KSAgs and PSAgs, respectively) in SKP Tx recipients (SKP TxRs). Sera collected from 39 SKP TxRs were used to determine de novo Abs specific for KSAgs (collagen-IV, Col-IV; fibronectin, FN) and PSAgs (insulin, islet cells, glutamic acid decarboxylase, and pancreas-associated protein-1) by ELISA. KSAg-specific IFN-γ, IL-17, and IL-10 cytokines were enumerated by ELISpot. Abs to donor HLA classes I and II were determined by Luminex assay. Abs to KSAgs and PSAgs were detectable in recipients with rejection compared with stable recipients (P<.05). Kidney-only rejection recipients had increased Abs against KSAgs compared with stable (P<.05), with no increase in Abs against PSAgs. Pancreas-only rejection recipients showed increased Abs against PSAgs compared to stable (P<.05), with no Abs against KSAgs. SKP TxRs with rejection showed increased frequencies of KSAg-specific IFN-γ and IL-17 with reduction in IL-10-secreting cells. SKP TxRs with rejection developed Abs to KSAgs and PSAgs demonstrated increased frequencies of kidney or pancreas SAg-specific IFN-γ and IL-17-secreting cells with reduced IL-10, suggesting loss of peripheral tolerance to SAgs.

PMID: 28639386 [PubMed - as supplied by publisher]

Perfusion of isolated rat kidney with Mesenchymal Stromal Cells/Extracellular Vesicles prevents ischaemic injury.

Sat, 06/24/2017 - 12:45
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Perfusion of isolated rat kidney with Mesenchymal Stromal Cells/Extracellular Vesicles prevents ischaemic injury.

J Cell Mol Med. 2017 Jun 21;:

Authors: Gregorini M, Corradetti V, Pattonieri EF, Rocca C, Milanesi S, Peloso A, Canevari S, De Cecco L, Dugo M, Avanzini MA, Mantelli M, Maestri M, Esposito P, Bruno S, Libetta C, Dal Canton A, Rampino T

Abstract
Kidney donation after circulatory death (DCD) is a less than ideal option to meet organ shortages. Hypothermic machine perfusion (HMP) with Belzer solution (BS) improves the viability of DCD kidneys, although the graft clinical course remains critical. Mesenchymal stromal cells (MSC) promote tissue repair by releasing extracellular vesicles (EV). We evaluated whether delivering MSC-/MSC-derived EV during HMP protects rat DCD kidneys from ischaemic injury and investigated the underlying pathogenic mechanisms. Warm ischaemic isolated kidneys were cold-perfused (4 hrs) with BS, BS supplemented with MSC or EV. Renal damage was evaluated by histology and renal gene expression by microarray analysis, RT-PCR. Malondialdehyde, lactate, LDH, glucose and pyruvate were measured in the effluent fluid. MSC-/EV-treated kidneys showed significantly less global ischaemic damage. In the MSC/EV groups, there was up-regulation of three genes encoding enzymes known to improve cell energy metabolism and three genes encoding proteins involved in ion membrane transport. In the effluent fluid, lactate, LDH, MDA and glucose were significantly lower and pyruvate higher in MSC/EV kidneys as compared with BS, suggesting the larger use of energy substrates by MSC/EV kidneys. The addition of MSC/EV to BS during HMP protects the kidney from ischaemic injury by preserving the enzymatic machinery essential for cell viability and protects the kidney from reperfusion damage.

PMID: 28639291 [PubMed - as supplied by publisher]

Assessment of physical performance and quality of life in kidney-transplanted patients: a cross-sectional study.

Sat, 06/24/2017 - 12:45
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Assessment of physical performance and quality of life in kidney-transplanted patients: a cross-sectional study.

Clin Kidney J. 2017 Feb;10(1):124-130

Authors: Esposito P, Furini F, Rampino T, Gregorini M, Petrucci L, Klersy C, Dal Canton A, Dalla Toffola E

Abstract
BACKGROUND: Information on physical and mental wellness in renal transplantation is limited. Therefore, we performed a cross-sectional study to evaluate and describe the different components of physical performance and quality of life (QoL) in a cohort of kidney-transplanted patients.
METHODS: Physical performance and QoL were determined through the administration of validated tests and questionnaires [muscle strength, dynamometer handgrip, tactile sensitivity, visual analogue scale (VAS) for pain, Timed Up and Go (TUG) test, Fatigue Severity Scale (FSS) and the 36-item Short Form Health Survey]. The patients were divided into three groups based on time elapsed since transplantation: early (in the first 6 months), middle (from 7 to 60 months) and late (>60 months).
RESULTS: Of 132 enrolled patients, 11 patients (8.3%) presented a severe reduction of muscle strength, 63 patients (47%) had significant bilateral impaired handgrip and tactile sensitivity was altered in 23 patients (17.4%). TUG assessment showed significant mobility limitation in 29 patients (21.9%). The FSS presented a pathological value in 50 patients (37.3%), while the mean VAS was 1.8 ± 2.7. There were no significant differences in physical performance parameters among the three patient groups. There were inverse correlations among different components of physical performance and age, comorbidity and dialysis vintage, and there was a direct correlation with renal function. During the first months after transplantation there were limitations in physical, social and emotional activities. Overall, the self-perceived physical performance was significantly lower in transplanted patients with respect to the normal reference level.
CONCLUSION: Kidney-transplanted patients may present different degrees of impairment in physical performance and quality of life. Systematic functional assessment is essential to identify patients needing intensive and personalized rehabilitation programmes.

PMID: 28638612 [PubMed - in process]

Does size matter? Kidney transplant donor size determines kidney function among living donors.

Sat, 06/24/2017 - 12:45
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Does size matter? Kidney transplant donor size determines kidney function among living donors.

Clin Kidney J. 2017 Feb;10(1):116-123

Authors: Narasimhamurthy M, Smith LM, Machan JT, Reinert SE, Gohh RY, Dworkin LD, Merhi B, Patel N, Beland MD, Hu SL

Abstract
BACKGROUND: Kidney donor outcomes are gaining attention, particularly as donor eligibility criteria continue to expand. Kidney size, a useful predictor of recipient kidney function, also likely correlates with donor outcomes. Although donor evaluation includes donor kidney size measurements, the association between kidney size and outcomes are poorly defined.
METHODS: We examined the relationship between kidney size (body surface area-adjusted total volume, cortical volume and length) and renal outcomes (post-operative recovery and longer-term kidney function) among 85 kidney donors using general linear models and time-to-chronic kidney disease data.
RESULTS: Donors with the largest adjusted cortical volume were more likely to achieve an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) over a median 24-month follow-up than those with smaller cortical volumes (P <0.001), had a shorter duration of renal recovery (1.3-2.2 versus 32.5 days) and started with a higher eGFR at pre-donation (107-110 versus 91 mL/min/1.73 m(2)) and immediately post-nephrectomy (∼63 versus 50-51 mL/min/1.73 m(2)). Similar findings were seen with adjusted total volume and length.
CONCLUSIONS: Larger kidney donors were more likely to achieve an eGFR ≥60 mL/min/1.73 m(2) with renal recovery over a shorter duration due to higher pre-donation and initial post-nephrectomy eGFRs.

PMID: 28638611 [PubMed - in process]

Looking for the needle in the kidney transplantation haystack.

Sat, 06/24/2017 - 12:45
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Looking for the needle in the kidney transplantation haystack.

Clin Kidney J. 2017 Feb;10(1):95-96

Authors: Cruzado JM, Melilli E

Abstract
The diagnosis of acute rejection still relies on renal allograft biopsy. In fact, histological features including C4d staining can be useful to differentiate cellular and antibody-mediated acute rejection. However, the pathogenic mechanism to define the type of rejection is usually assessed by anti-HLA donor specific antibodies (DSA) monitoring. Suspicion of acute rejection is usually based on renal function deterioration. This method has low sensitivity. Moreover, creatinine increase follows graft injury and therefore the diagnosis is performed when there is an ongoing acute rejection. One strategy to overcome the limitation of serum creatinine as predictor of acute rejection is to perform surveillance protocol biopsies. However, the low incidence of subclinical acute rejection among patients treated with tacrolimus-based immunosuppression makes this procedure questionable in terms of cost-effectiveness. In this scenario new biomarkers predicting acute rejection are urgently needed. Ideally, such biomarkers should anticipate acute rejection, thus allowing preventive actions such as maintenance immunosupression intensification and/or modification. Alternatively, these new biomarkers should at least improve the predictive value of serum creatinine monitoring. Although many of the new biomarkers are promising, none have been translated to the clinic to date because of a lack of validation studies and the existence of major methodological concerns.

PMID: 28638610 [PubMed - in process]

Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making.

Sat, 06/24/2017 - 12:45
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Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making.

Clin Kidney J. 2017 Feb;10(1):89-94

Authors: Iyasere O, Okai D, Brown E

Abstract
Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD) patients. The relationship between cognitive impairment and decision-making capacity (DMC) was also assessed. Methods: Patients were recruited from three outpatient clinics. Cognitive function was assessed 4-monthly for up to 2 years, using the Montreal Cognitive Assessment (MoCA) tool. Cognitive trends were assessed using mixed model analysis. DMC was assessed using the Macarthur Competency Assessment tool (MacCAT-T). MacCAT-T scores were compared between patients with cognitive impairment (MoCA <26) and those without. Results: In total, 102 (41 HD, 25 PD and 36 CKD) patients were recruited into the prospective study. After multivariate analysis, the total MoCA scores declined faster in dialysis compared with CKD patients [coefficient = -0.03, 95% confidence interval (95% CI) = -0.056 to - 0.004; P = 0.025]. The MoCA executive scores declined faster in the HD compared with PD patients (coefficient = -0.12, 95% CI = -0.233 to - 0.007; P = 0.037). DMC was assessed in 10 patients. Those with cognitive impairment had lower MacCAT-T compared with those without [median (interquartile range) 19 (17.9-19.6) versus 17.4 (16.3-18.4); P = 0.049]. Conclusions: Cognition declines faster in dialysis patients compared with CKD patients and in HD patients compared with PD patients. Cognitive impairment affects DMC in patients with advanced kidney disease.

PMID: 28638609 [PubMed - in process]

The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review.

Sat, 06/24/2017 - 12:45
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The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review.

Clin Kidney J. 2017 Feb;10(1):79-88

Authors: Picariello F, Moss-Morris R, Macdougall IC, Chilcot AJ

Abstract
Fatigue is a common and debilitating symptom, affecting 42-89% of end-stage kidney disease patients, persisting even in pre-dialysis care and stable kidney transplantation, with huge repercussions on functioning, quality of life and patient outcomes. This paper presents a critical review of current evidence for the role of psychological factors in renal fatigue. To date, research has concentrated primarily on the contribution of depression, anxiety and subjective sleep quality to the experience of fatigue. These factors display consistent and strong associations with fatigue, above and beyond the role of demographic and clinical factors. Considerably less research is available on other psychological factors, such as social support, stress, self-efficacy, illness and fatigue-specific beliefs and behaviours, and among transplant recipients and patients in pre-dialysis care. Promising evidence is available on the contribution of illness beliefs and behaviours to the experience of fatigue and there is some indication that these factors may vary according to treatment modality, reflecting the differential burdens and coping necessities associated with each treatment modality. However, the use of generic fatigue scales casts doubt on what specifically is being measured among dialysis patients, illness-related fatigue or post-dialysis-specific fatigue. Therefore, it is important to corroborate the available evidence and further explore, qualitatively and quantitatively, the differences in fatigues and fatigue-specific beliefs and behaviours according to renal replacement therapy, to ensure that any model and subsequent intervention is relevant and grounded in the experiences of patients.

PMID: 28638608 [PubMed - in process]

Effect of ethnicity and socioeconomic status on vascular access provision and performance in an urban NHS hospital.

Sat, 06/24/2017 - 12:45
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Effect of ethnicity and socioeconomic status on vascular access provision and performance in an urban NHS hospital.

Clin Kidney J. 2017 Feb;10(1):62-67

Authors: Wilmink T, Wijewardane A, Lee K, Murley A, Hollingworth L, Powers S, Baharani J

Abstract
BACKGROUND: The aim of this study was to examine the effect of ethnicity, socioeconomic group (SEG) and comorbidities on provision of vascular access for haemodialysis (HD).
METHODS: This was a retrospective review of two databases of HD sessions and access operations from 2003-11. Access modality of first HD session and details of transplanted patients were derived from the renal database. Follow-up was until 1 January 2015. Primary failure (PF) was defined as an arteriovenous fistula (AVF) used for fewer than six consecutive dialysis sessions. AVF survival was defined as being until the date the AVF was abandoned. Ethnicity was coded from hospital records. SEG was calculated from postcodes and 2011 census data from the Office of National Statistics. Comorbidities were calculated with the Charlson Comorbidity Index.
RESULTS: Five hundred incident patients started chronic HD in the study period. Mode of starting HD was not associated with ethnicity (P = 0.27) or SEG (P = 0.45). Patients from ethnic minorities were younger when starting dialysis (P < 0.0001). Some 928 AVF patients' first AVF operations were analysed: 68% Caucasian, 26% Asian and 6% Afro-Caribbean. Half were in the most deprived SEG and 11% in the least deprived SEG. PF did not differ by ethnicity (P = 0.29), SEG (P = 0.75) or comorbidities (P = 0.54). AVF survival was not different according to ethnicity (P = 0.13) or SEG (P = 0.87). AVF survival was better for patients with a low comorbidity score (P = 0.04). The distribution of transplant recipients by ethnic group and SEG was similar to the distributions of all HD starters.
CONCLUSION: Ethnicity and socioeconomic group had no effect on mode of starting HD, primary AVF failure rate or AVF survival. Ethnic minorities were younger at start of dialysis and at their first AVF operation.

PMID: 28638605 [PubMed - in process]

Progressive Multifocal Leukoencephalopathy: Endemic Viruses and Lethal Brain Disease.

Sat, 06/24/2017 - 12:45
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Progressive Multifocal Leukoencephalopathy: Endemic Viruses and Lethal Brain Disease.

Annu Rev Virol. 2017 Jun 21;:

Authors: Haley SA, Atwood WJ

Abstract
In 1971, the first human polyomavirus was isolated from the brain of a patient who died from a rapidly progressing demyelinating disease known as progressive multifocal leukoencephalopathy. The virus was named JC virus after the initials of the patient. In that same year a second human polyomavirus was discovered in the urine of a kidney transplant patient and named BK virus. In the intervening years it became clear that both viruses were widespread in the human population but only rarely caused disease. The past decade has witnessed the discovery of eleven new human polyomaviruses, two of which cause unusual and rare cancers. We present an overview of the history of these viruses and the evolution of JC polyomavirus-induced progressive multifocal leukoencephalopathy over three different epochs.Wereview what is currently known about JC polyomavirus, what is suspected, and what remains to be done to understand the biology of how this mostly harmless endemic virus gives rise to lethal disease. Expected final online publication date for the Annual Review of Virology Volume 4 is September 29, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

PMID: 28637388 [PubMed - as supplied by publisher]

Bone Marrow-Derived Mononuclear Cell Therapy Accelerates Renal Ischemia-Reperfusion Injury Recovery by Modulating Inflammatory, Antioxidant and Apoptotic Related Molecules.

Sat, 06/24/2017 - 12:45
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Bone Marrow-Derived Mononuclear Cell Therapy Accelerates Renal Ischemia-Reperfusion Injury Recovery by Modulating Inflammatory, Antioxidant and Apoptotic Related Molecules.

Cell Physiol Biochem. 2017;41(5):1736-1752

Authors: Ornellas FM, Ornellas DS, Martini SV, Castiglione RC, Ventura GM, Rocco PR, Gutfilen B, de Souza SA, Takiya CM, Morales MM

Abstract
BACKGROUND/AIMS: We investigated the regenerative capacity of intravenous administration of bone marrow-derived mononuclear cells (BMMCs) in a rat model of bilateral renal ischemia/reperfusion (IR) injury and the involvement of inflammatory anti-inflammatory and other biological markers in this process.
METHODS: Rats were subjected to 1h bilateral renal pedicle clamping. BMMCs were injected i.v 1h after reperfusion and tracked by 99mTc and GFP+ BMMCs. Twenty-four hours after reperfusion, renal function and histological changes were evaluated. The mRNA (real time PCR) and protein (ELISA and immuno-staining) expression of biological markers were analyzed.
RESULTS: Renal function and structure improved after infusion of BMMCs in the IR group (IR-C). Labeled BMMCs were found in the kidneys after therapy. The expression of inflammatory and biological markers (TLR-2, TRL-4, RAGE, IL-17, HMGB-1, KIM-1) were reduced and the expression of anti-inflammatory and antioxidant markers (IL-10, Nrf2, and HO-1) were increased in IR-C animals compared with IR untreated animals (IR-S). The apoptotic index diminished and the proliferation index increased in IR-C compared with IR-S.
CONCLUSION: The results contribute to our understanding of the role of different biological players in morphofunctional renal improvement and cytoprotection in a post-ischemic reperfusion kidney injury model subjected to cellular therapy.

PMID: 28365681 [PubMed - indexed for MEDLINE]

[Acute myocardial infarction complicated pregnancy of patient after kindey transplantation and knee osteosarcoma].

Sat, 06/24/2017 - 12:45
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[Acute myocardial infarction complicated pregnancy of patient after kindey transplantation and knee osteosarcoma].

Ceska Gynekol. Fall 2016;81(5):389-393

Authors: Lehnertová K, Huml K, Pilka R

Abstract
OBJECTIVE: Case report describes a patient with acute ST elevation myocardial infarction with Q wave in 26 weeks gestation.
DESIGN: Case report.
SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc.
CASE REPORT: Medical history is complicated with a cadaveric transplantation of kindey, osteosarcoma of the left knee with a joint extraction and chemotherapy, serious hypothyreosis after spontaneous discontinuation of medication and missing fetal nasal bone at the ultrasound examination.
CONCLUSION: Myocardial infarction complicating pregnancy is an important cause of maternal morbidity and mortality. The coexistence of obesity, diabetes, chronic hypertension, and delayed age at pregnancy is expected to increase the prevalence of myocardial infarction during pregnancy. Timely treatment in the form of percutaneous coronary intervention has dramatically improved outcomes.

PMID: 27897026 [PubMed - indexed for MEDLINE]

Short- and Long-Term Mortality Rates of Elderly Acute Kidney Injury Patients Who Underwent Continuous Renal Replacement Therapy.

Sat, 06/24/2017 - 12:45
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Short- and Long-Term Mortality Rates of Elderly Acute Kidney Injury Patients Who Underwent Continuous Renal Replacement Therapy.

PLoS One. 2016;11(11):e0167067

Authors: Rhee H, Jang KS, Park JM, Kang JS, Hwang NK, Kim IY, Song SH, Seong EY, Lee DW, Lee SB, Kwak IS

Abstract
BACKGROUND: The world's population is aging faster and the incidence of acute kidney injury (AKI) needing continuous renal replacement therapy (CRRT) is increasing in elderly population. The outcome of AKI needing CRRT in elderly patients is known to be poor. However, the definitions of elderly used in the previous literatures were diverse and, there were few data that compared the long-term mortality rates of these patients with middle aged patients. This study was aimed to evaluate this issue.
METHODS: This study was a single-center, retrospective cohort study of patients who underwent CRRT from January 2013 to December 2015. The patients were divided into the following four age cohorts: middle-aged (55-64), young-old (65-74), middle-old (75-84), and old-old (≥85). The short- and long-term mortality rates for each age cohort were compared.
RESULTS: A total of 562 patients met the inclusion criteria. The short-term mortality rate was 57.3% in the entire cohort. Compared with the middle-aged cohort, the middle-old cohort (HR 1.48 (1.09-2.02), p = 0.012) and the old-old cohort (HR 2.33 (1.30-4.19), p = 0.005) showed an increased short-term mortality rate along with an increased SOFA score, acidemia and a prolonged prothrombin time. When we analyzed the long-term mortality rate of the 238 survived patients, the middle-old cohort (HR 3.76 (1.84-7.68), p<0.001), the old-old cohort (HR 4.40(1.20-16.10), p = 0.025), a lower BMI, the presence of liver cirrhosis, the presence of congestive heart failure and a history of sepsis were independent risk factors for the prediction of long-term mortality.
CONCLUSION: Compared with the middle-aged cohort, the middle-old and the old-old cohort showed an increased short-term and long-term mortality rate. However, in the young-old cohort, neither the short-term nor the long-term mortality rate was increased.

PMID: 27875571 [PubMed - indexed for MEDLINE]

Frailty and chronic kidney disease: A systematic review.

Sat, 06/24/2017 - 12:45
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Frailty and chronic kidney disease: A systematic review.

Arch Gerontol Geriatr. 2017 Jan - Feb;68:135-142

Authors: Chowdhury R, Peel NM, Krosch M, Hubbard RE

Abstract
OBJECTIVE: Frailty is associated with increased vulnerability to poor health. There is growing interest in understanding the association between frailty and chronic kidney disease (CKD). This systematic review explored how frailty is measured in patients with CKD and the association between frailty and adverse outcomes across different stages of renal impairment.
STUDY DESIGN: Systematic analysis of peer reviewed articles.
DATA SOURCES: Pubmed, Medline, Web of Science and Cochrane were used to identify the articles.
DATA SYNTHESIS: Articles published before the 17th of September 2016, that measured frailty in patients with CKD was eligible for the systematic review. Two independent researchers assessed the eligibility of the articles. Quality of the articles was assessed using the Epidemiological Appraisal Instrument.
RESULTS: The literature search yielded 540 articles, of which 32 met the study criteria and were included in the review (n=36,076, age range: 50-83 years). Twenty-three (72%) studies used or adapted the Fried phenotype to measure frailty. The prevalence of frailty ranged from 7% in community-dwellers (CKD Stages 1-4) to 73% in a cohort of patients on haemodialysis. The incidence of frailty increased with reduced glomerular filtration rate. Frailty was associated with an increased risk of mortality and hospitalization.
CONCLUSION: Frailty is prevalent in patients with CKD and it is associated with an increased risk of adverse health outcomes. There are differences in the methods used to assess frailty and this hinders comparisons between studies.

PMID: 27810661 [PubMed - indexed for MEDLINE]

Molecular patterns of diffuse and nodular parathyroid hyperplasia in long-term hemodialysis.

Sat, 06/24/2017 - 12:45
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Molecular patterns of diffuse and nodular parathyroid hyperplasia in long-term hemodialysis.

Am J Physiol Endocrinol Metab. 2016 Oct 01;311(4):E720-E729

Authors: Týcová I, Sulková SD, Štěpánková J, Krejčík Z, Merkerová MD, Stránecký V, Hrubá P, Girmanová E, Černoch M, Lipár K, Marada T, Povýšil C, Viklický O

Abstract
Secondary hyperparathyroidism is a well-known complication of end-stage renal disease (ESRD). Both nodular and diffuse parathyroid hyperplasia occur in ESRD patients. However, their distinct molecular mechanisms remain poorly understood. Parathyroid tissue obtained from ESRD patients who had undergone parathyroidectomy was used for Illumina transcriptome screening and subsequently for discriminatory gene analysis, pathway mapping, and gene annotation enrichment analysis. Results were further validated using quantitative RT-PCR on the independent larger cohort. Microarray screening proved homogeneity of gene transcripts in hemodialysis patients compared with the transplant cohort and primary hyperparathyroidism; therefore, further experiments were performed in hemodialysis patients only. Enrichment analysis conducted on 485 differentially expressed genes between nodular and diffuse parathyroid hyperplasia revealed highly significant differences in Gene Ontology terms and the Kyoto Encyclopedia of Genes and Genomes database in ribosome structure (P = 3.70 × 10(-18)). Next, quantitative RT-PCR validation of the top differently expressed genes from microarray analysis proved higher expression of RAN guanine nucleotide release factor (RANGRF; P < 0.001), calcyclin-binding protein (CACYBP; P < 0.05), and exocyst complex component 8 (EXOC8; P < 0.05) and lower expression of peptidylprolyl cis/trans-isomerase and NIMA-interacting 1 (PIN1; P < 0.01) mRNA in nodular hyperplasia. Multivariate analysis revealed higher RANGRF and lower PIN1 expression along with parathyroid weight to be associated with nodular hyperplasia. In conclusion, our study suggests the RANGRF transcript, which controls RNA metabolism, to be likely involved in pathways associated with the switch to nodular parathyroid growth. This transcript, along with PIN1 transcript, which influences parathyroid hormone secretion, may represent new therapeutical targets to cure secondary hyperparathyroidism.

PMID: 27600827 [PubMed - indexed for MEDLINE]

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