A descriptive analysis of non-human leukocyte antigens present in renal transplant donor-recipient pairs.

Introduction: End stage renal disease (ESRD) is the irreversible deterioration of renal function requiring renal replacement therapy by dialysis or transplant. Human leucocyte antigens (HLA) have been well examined however research still is required into the non-HLA antibodies. Antibody mediated rejection (AMR) can be seen in the absence of HLA antibodies on biopsies of patients who have received identical transplants; anti-endothelial cell antibodies may explain this.

Ascorbic acid lowers central blood pressure and asymmetric dimethylarginine in chronic kidney disease.

Background: Premature cardiovascular disease in patients with chronic kidney disease (CKD) is not explained by traditional risk factors and oxidative stress may contribute via endothelial and vascular dysfunction. We investigated the effect of ascorbic acid on oxidative stress and vascular function in CKD patients compared with controls with hypertension (HTN).

Methods: A crossover study of intravenous saline and ascorbic acid was conducted.

Deleterious effects of phosphate on vascular and endothelial function via disruption to the nitric oxide pathway.

Background: Hyperphosphataemia is an independent risk factor for accelerated cardiovascular disease in chronic kidney disease (CKD), although the mechanism for this is poorly understood. We investigated the effects of sustained exposure to a high-phosphate environment on endothelial function in cellular and preclinical models, as well as in human subjects.

Methods: Resistance vessels from rats and humans (± CKD) were incubated in a normal (1.

Non-Contrast Renal Magnetic Resonance Imaging to Assess Perfusion and Corticomedullary Differentiation in Health and Chronic Kidney Disease.

Aims: Arterial spin labelling (ASL) MRI measures perfusion without administration of contrast agent. While ASL has been validated in animals and healthy volunteers (HVs), application to chronic kidney disease (CKD) has been limited. We investigated the utility of ASL MRI in patients with CKD.

Risk factors and outcome of stroke in renal transplant recipients.

Stroke incidence is high in end-stage renal disease, and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analyzed all adult patients with a functioning renal transplant from 01/01/2007 to 12/31/2012.

Serum phosphate and social deprivation independently predict all-cause mortality in chronic kidney disease.

Background: Hyperphosphataemia is linked to cardiovascular disease and mortality in chronic kidney disease (CKD). Outcome in CKD is also affected by socioeconomic status. The objective of this study was to assess the associations between serum phosphate, multiple deprivation and outcome in CKD patients.

Association between serum phosphate and calcium, long-term blood pressure, and mortality in treated hypertensive adults.

Objectives: Abnormalities of bone mineral parameters are associated with cardiovascular morbidity and mortality in patients with chronic kidney disease and the general population.

Methods: We assessed the impact of baseline serum phosphate and calcium on longitudinal blood pressure (BP) control and survival in hypertensive adults. We studied 9260 hypertensive adults followed for 40 years (151 789 person-years).

Phosphate as a cardiovascular risk factor: effects on vascular and endothelial function.

Background: Hyperphosphataemia is a risk factor for accelerated cardiovascular disease in chronic kidney disease. The mechanism is poorly understood; it is unclear whether phosphate has direct effects or effects mediated via calcification or FGF23. We investigated direct effects of phosphate on endothelial function using myography to study rat and human blood vessels.

Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome-a single-center study.

Background: Premature cardiovascular (CV) death is the commonest cause of death in renal transplant recipients. Abnormalities of left ventricular (LV) structure (collectively termed uremic cardiomyopathy) and left atrial (LA) dilation, a marker of fluid status and diastolic function, are risk factors for reduced survival in patients with end stage renal disease (ESRD). In the present analysis, we studied the impact of pre-transplant LA and LV abnormalities on survival after successful renal transplantation (RT).

Predictors of sustained arteriovenous access use for haemodialysis.

Background: Guidelines encourage early arteriovenous (AV) fistula (AVF) planning for haemodialysis (HD). The aim of this study was to estimate the likelihood of sustained AV access use taking into account age, sex, comorbidity, anatomical site of first AVF and, for pre-dialysis patients, eGFR and proteinuria.

Methods: 1,092 patients attending our centre who had AVF as their first AV access procedure between January 1, 2000 and August 23, 2012 were identified from the electronic patient record.

Proteinuria and outcome after renal transplantation: ratios or fractions?

Background: Proteinuria is associated with poorer outcomes in renal transplant recipients. Fractional excretion of total protein (FEPR) may better reflect kidney damage than urine protein-to-creatinine ratio (PCR).

Methods: We assessed FEPR (FEPR = [serum creatinine × urine protein] / [serum protein × urine creatinine], %) and PCR ([urinary protein/urinary creatinine] × 1000, mg/mM) 1 year after first renal transplantation as predictors of transplant failure.

How to identify and manage diabetes mellitus after renal transplantation.

New-onset diabetes after transplantation (NODAT) has serious consequences for the patient in terms of overall survival, graft function and graft survival. The incidence of NODAT and impaired glucose tolerance has probably been underestimated previously because of lack of a universal diagnostic definition. Many risk factors have been identified, a proportion of which are modifiable.

Altered relative concentrations of high-energy phosphates in patients with uraemic cardiomyopathy measured by magnetic resonance spectroscopy.

Background: Premature sudden cardiovascular death is the commonest cause of death in end-stage renal disease (ESRD) patients and is associated with uraemic cardiomyopathy [left ventricular hypertrophy (LVH), systolic dysfunction (LVSD) or LV dilation]. High-energy phosphates (HEP), quantified using phosphorus-31 magnetic resonance spectroscopy, are reduced in patients with diabetes, heart failure and uraemia. Phosphocreatine:β adenosine triphosphate (PCr:ATP) ratio is an index of metabolic activity.

Fibroblast growth factor 23 predicts left ventricular mass and induces cell adhesion molecule formation.

Elevated FGF-23 is a predictor of mortality and is associated with LVH in CKD. It may be a biomarker or a direct toxin. We assessed the relationship between FGF-23 and LVH in CKD using CMRI.

Deceased donor transplantation in the elderly--are we creating false hope?

Background: Increasing numbers of older patients are developing established renal failure and considering kidney transplant as a renal replacement therapy (RRT) option. The probability of older patients actually receiving a deceased donor kidney transplant is unclear, preventing informed choice about pursuing the option of transplantation. We sought to analyse our RRT population to determine the probability of receiving a deceased donor kidney transplant in patients commencing RRT categorized by age and for whom there was no suitable living kidney donor.

Association of left atrial volume with mortality among ESRD patients with left ventricular hypertrophy referred for kidney transplantation.

Background: Left ventricular hypertrophy (LVH) is common in patients with end-stage renal disease (ESRD) and an independent risk factor for premature cardiovascular death. Left atrial volume (LAV), measured using echocardiography, predicts death in patients with ESRD. Cardiovascular magnetic resonance (CMR) imaging is a volume-independent method of accurately assessing cardiac structure and function in patients with ESRD.

Angiotensin blockade is associated with early graft dysfunction after live donor renal transplantation.

Background: Activation of the renin angiotensin system may contribute to the development of delayed graft function after renal transplantation. We, therefore, examined the impact of pretransplant treatment with blockers of the renin angiotensin system on early graft function after renal transplantation.

Method: The case records of all patients who received a live donor transplant between January 2001 and August 2008 were reviewed.