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  • 11
    Online Resource
    Online Resource
    High‐permeability alternatives to current dialyzers performing both high‐flux hemodialysis and postdilution online hemodiafiltration
    Wiley ; 2019
    In:  Artificial Organs Vol. 43, No. 10 ( 2019-10), p. 1014-1021
    Details
    In: Artificial Organs, Wiley, Vol. 43, No. 10 ( 2019-10), p. 1014-1021
    Abstract: Most high‐flux dialyzers can be used in both hemodialysis (HD) and online hemodiafiltration (OL‐HDF). However, some of these dialyzers have higher permeability and should not be prescribed for OL‐HDF to avoid high albumin losses. The aim of this study was to compare the safety and efficacy of a currently used dialyzer in HD and OL‐HDF with those of several other high permeability dialyzers which should only be used in HD. A prospective, single‐center study was carried out in 21 patients. Each patient underwent 5 dialysis sessions with routine dialysis parameters: 2 sessions with Helixone (HD and postdilution OL‐HDF) and 1 session each with steam sterilized polyphenylene, polymethylmethacrylate (PMMA), and medium cut‐off (MCO) dialyzers in HD treatment. The removal ratios (RR) of urea, creatinine, ß 2 ‐microglobulin, myoglobin, prolactin, α 1 ‐microglobulin, α 1 ‐acid glycoprotein, and albumin were compared intraindividually. A proportional part of the dialysate was collected to quantify the loss of various solutes, including albumin. Urea and creatinine RRs with the Helixone‐HDF and MCO dialyzers were higher than with the other 3 dialyzers in HD. The β 2 ‐microglobulin, myoglobin and prolactin RRs with Helixone‐HDF treatment were significantly higher than those obtained with all 4 dialyzers in HD treatment. The β 2 ‐microglobulin value obtained with the MCO dialyzer was also higher than that obtained with the other 3 dialyzers in HD treatment. The myoglobin RR with MCO was higher than those obtained with Helixone and PMMA in HD treatment. The prolactin RR with Helixone‐HD was significantly lower than those obtained in the other 4 study sessions. The α 1 ‐microglobulin and α 1 ‐ acid glycoprotein RRs with Helixone‐HDF were significantly higher than those obtained with Helixone and PMMA in HD treatment. The albumin loss varied from 0.54 g with Helixone‐HD to 3.3 g with polyphenylene. The global removal score values ((Urea RR + β 2 ‐microglobulin RR + myoglobin RR + prolactin RR + α 1 ‐microglobulin RR + α 1 ‐acid glycoprotein RR – albumin RR )/6) were 43.7% with Helixone‐HD, 47.7% with PMMA, 54% with polyphenylene, 54.8% with MCO and 59.6% with Helixone‐HDF, with significant differences. In conclusion, this study confirms the superiority of OL‐HDF over HD with the high‐flux dialyzers that allow both treatments. Although new dialyzers with high permeability can only be used in HD, they are in an intermediate position and some are very close to OL‐HDF.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v43.10
    DOI: 10.1111/aor.13480
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2003825-2
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  • 12
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    Abstract 357: Antioxidant and Anti-inflammatory Strategies Prevent Endothelial Dysfunction in Chronic Kidney Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Arteriosclerosis, Thrombosis, and Vascular Biology Vol. 36, No. suppl_1 ( 2016-05)
    Details
    In: Arteriosclerosis, Thrombosis, and Vascular Biology, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. suppl_1 ( 2016-05)
    Abstract: Accelerated atherosclerosis in chronic kidney disease (CKD) is preceded by the development of endothelial dysfunction (ED), with development of a proinflammatory and prothrombotic phenotype and enhanced oxidative stress. The effect of anti-inflammatory and antioxidant strategies on the endothelium has been evaluated in an in vitro model of ED in uremia. Endothelial cells (ECs) were pretreated with the antioxidant enzyme mimetics ebselen, EUK-134 and EUK-118; the flavonoids apigenin, genistein and quercetin, with both antioxidant and anti-inflammatory potential; and two commercially available compounds: N-acetylcysteine (NAC) and defibrotide (DF). There is increasing evidence demonstrating that both NAC and DF exhibit both properties. ECs were exposed to medium containing serum from patients on dialysis (n=10) or from healthy donors (n=15). Changes in the expression of the adhesion receptor ICAM-1 and the production of intracellular reactive oxygen species (ROS) were assessed. Activation of inflammation-related proteins p38 MAPK and NFkappaB (NFκB) were also evaluated. Exposure of ECs to uremic media resulted in a significantly increased expression of ICAM-1, overproduction of ROS and activation of p38MAPK and NFκB compared to control ECs (p 〈 0.05). Ebselen, EUK 134, and EUK118 inhibited ICAM-1 expression and ROS generation in the uremic condition (p 〈 0.01). Regarding flavonoids, only quercetin showed a moderated but significant inhibitory effect on both parameters (p 〈 0.05). NAC and DF exhibited a protective effect on ECs exposed to the uremic insult (p 〈 0.05 for ICAM-1 expression and ROS generation). All the compounds reduced p38MAPK activation (p 〈 0.05). The antioxidant-enzyme mimetics and NAC were able to inhibit the activation of NFκB induced by the uremic media (p 〈 0.05). Endothelial dysfunction associated with CKD is considered to be the first step in the progression of atherosclerosis. Our results indicate that the antioxidant enzyme mimetics, NAC and DF exhibit not only antioxidant but also anti-inflammatory effects on the endothelium. Therefore, further research on the protective effects of these compounds may provide new strategies for the prevention of the cardiovascular complications in uremia.
    Type of Medium: Online Resource
    ISSN: 1079-5642 , 1524-4636
    URL: Article
    DOI: 10.1161/atvb.36.suppl_1.357
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1494427-3
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  • 13
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    Antioxidant and Anti-Inflammatory Strategies Based on the Potentiation of Glutathione Peroxidase Activity Prevent Endothelial Dysfunction in Chronic Kidney Disease
    S. Karger AG ; 2018
    In:  Cellular Physiology and Biochemistry Vol. 51, No. 3 ( 2018), p. 1287-1300
    Details
    In: Cellular Physiology and Biochemistry, S. Karger AG, Vol. 51, No. 3 ( 2018), p. 1287-1300
    Abstract: Background/Aims: Accelerated atherosclerosis in chronic kidney disease (CKD) is preceded by endothelial dysfunction (ED), which exhibits a proinflammatory and prothrombotic phenotype and enhanced oxidative stress. In this study, the effect of several compounds with anti-inflammatory and/or antioxidant properties on uremia-induced endothelial dysfunction has been evaluated in an in vitro model. Methods: Endothelial cells (ECs) were exposed to sera from uremic patients in the absence and presence of the flavonoids apigenin, genistein and quercetin, the antioxidant enzyme mimetics (AEM) ebselen (glutathione peroxidase mimetic), EUK-134 and EUK-118 (both superoxide dismutase mimetics), and the pharmacological drug N-acetylcysteine (NAC). We explored changes in the expression of adhesion receptors on the cell surface, by immunofluorescence, the production of radical oxygen species (ROS), by fluorescence detection, and the activation of signaling proteins related to inflammation, by both a phosphospecific antibody cell-based ELISA and immunoblotting techniques. Results: Uremic media induced a significantly increased expression of ICAM-1, overproduction of radical oxygen species (ROS) and activation of p38 mitogen activated protein kinase (p38MAPK) and Nuclear Factor kB (NFkB) in ECs. Quercetin, the AEM and NAC showed a significant inhibitory effect on both ICAM-1 expression and ROS generation (p 〈 0.05). All the compounds reduced p38MAPK activation, but only the AEM, especially ebselen, and NAC, both potentiating the glutathione peroxidase pathway, also inhibited NFkB activation. These two compounds were capable of increasing endothelial glutathione levels, especially in response to uremia. Conclusion: Our results indicate that the potentiation of the antioxidant pathways can be an effective strategy to improve endothelial dysfunction in uremia and a potential target to reduce the cardiovascular risk in this population.
    Type of Medium: Online Resource
    ISSN: 1015-8987 , 1421-9778
    URL: Article
    DOI: 10.1159/000495540
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1482056-0
    SSG: 12
    SSG: 15,3
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  • 14
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    Diálisis peritoneal automática adaptada: un método de prescripción eficaz, eficiente y seguro
    Sociedad Espanola de Enfermeria Nefrologica ; 2014
    In:  Enfermería Nefrológica Vol. 17, No. 3 ( 2014-10-23), p. 202-208
    Details
    In: Enfermería Nefrológica, Sociedad Espanola de Enfermeria Nefrologica, Vol. 17, No. 3 ( 2014-10-23), p. 202-208
    Abstract: El objetivo del trabajo es analizar los resultados obtenidos tras la introducción de la modalidad de diálisis peritoneal automática adaptada, usando bicarbonato puro como agente tampón, en un grupo de pacientes en programa de diálisis peritoneal automática convencional. Estudio de diseño cuasi experimental, que se realizó entre los meses de febrero y diciembre de 2013, en la unidad de diálisis peritoneal del Hospital Clínic de Barcelona. Los sujetos de estudio fueron 12 pacientes, 7 mujeres y 5 hombres, de dicha unidad en modalidad de diálisis peritoneal automática convencional. Edad media 58±12 años (rango: 34-71). El estudio consistió en comparar dos modalidades de diálisis peritoneal automática. Se inició el estudio con prescripción de diálisis convencional, durante tres meses, para cambiar a modalidad de diálisis adaptada durante el mismo intervalo de tiempo. Y finalizarlo, con tres meses de pauta de diálisis convencional. Se prescribió el mismo volumen total de líquido de diálisis y tiempo de sesión, para cada paciente en ambas modalidades, variando los volúmenes y tiempos de permanencia en función de la modalidad. Se utilizó solución de diálisis con bicarbonato puro y glucosa 1,5%. Todos los pacientes, con día seco. Se monitorizaron las variables al inicio del estudio, y en cada cambio de prescripción. Los resultados obtenidos en diálisis convencional: Kt/v=2,3±0,2, aclaramiento de creatinina=63±8litros/s mana, y ultrafiltración=842±110ml. En diálisis adaptada, Kt/v=2,8±0,2, aclaramiento de creatinina=74±9litros/semana, y ultrafiltración=982±123ml. La diálisis adaptada permite obtener una adecuada eficacia de tratamiento, mejora los parámetros de adecuación de diálisis y ultrafiltración; siendo segura y cómoda.
    Type of Medium: Online Resource
    ISSN: 2255-3517 , 2254-2884
    URL: Article
    DOI: 10.4321/S2254-28842014000300007
    Language: Unknown
    Publisher: Sociedad Espanola de Enfermeria Nefrologica
    Publication Date: 2014
    detail.hit.zdb_id: 2739231-4
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  • 15
    Online Resource
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    Opportunities to improve the management of anemia in peritoneal dialysis patients: lessons from a national study in routine clinical practice
    Oxford University Press (OUP) ; 2023
    In:  Clinical Kidney Journal ( 2023-06-29)
    Details
    In: Clinical Kidney Journal, Oxford University Press (OUP), ( 2023-06-29)
    Abstract: Current guidelines establish the same hemoglobin (Hb) and iron biomarkers targets for hemodialysis (HD) and peritoneal dialysis (PD) in patients receiving erythropoiesis-stimulating agents (ESAs) even though patients having PD are usually younger, more active and less comorbid. Unfortunately, specific renal anemia [anemia in chronic kidney disease (aCKD)] trials or observational studies on PD are scanty. The aims of this study were to describe current aCKD management, goals and adherence to clinical guidelines, identifying opportunities for healthcare improvement in PD patients. Methods This was a retrospective, nationwide, multicentre study including patients from 19 PD units. The nephrologists collected baseline data, demographics, comorbidities and data related to anemia management (laboratory values, previously prescribed treatments and subsequent adjustments) from electronic medical records. The European adaptation of KDIGO guidelines was the reference for definitions, drug prescriptions and targets. Results A total of 343 patients (mean age 62.9 years, 61.2% male) were included; 72.9% were receiving ESAs and 33.2% iron therapy [20.7% intravenously (IV)]. Eighty-two patients were receiving ESA without iron therapy, despite 53 of them having an indication according to the European Renal Best Practice guidelines. After laboratory results, iron therapy was only started in 15% of patients. Among ESA-treated patients, 51.9% had an optimal control [hemoglobin (Hb) 10–12 g/dL] and 28.3% between 12–12.9 g/dL. Seventeen patients achieved Hb & gt;13 g/dL, and 12 of them remained on ESA after overshooting. Only three patients had Hb & lt;10 g/dL without ESAs. Seven patients (2%) met criteria for ESA resistance (epoetin dose & gt;300 IU/kg/week). The highest tertile of erythropoietin resistance index ( & gt;6.3 UI/kg/week/g/dL) was associated with iron deficiency and low albumin corrected by renal replacement therapy vintage and hospital admissions in the previous 3 months. Conclusion Iron therapy continues to be underused (especially IV). Low albumin, iron deficiency and prior events explain most of the ESA hyporesponsiveness. Hb targets are titrated to/above the upper limits. Thus, several missed opportunities for adequate prescriptions and adherence to guidelines were identified.
    Type of Medium: Online Resource
    ISSN: 2048-8505 , 2048-8513
    URL: Article
    DOI: 10.1093/ckj/sfad152
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2656786-6
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  • 16
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    Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial
    American Diabetes Association ; 2019
    In:  Diabetes Care Vol. 42, No. 5 ( 2019-05-01), p. 777-788
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 42, No. 5 ( 2019-05-01), p. 777-788
    Abstract: The long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention. RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively. RESULTS Diet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P & lt; 0.001), a mean difference of −2.5 kg (95% CI −3.1 to −1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P & lt; 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P & lt; 0.002). Reductions in insulin resistance, HbA1c, and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P & lt; 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts. CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc18-0836
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
    detail.hit.zdb_id: 1490520-6
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