Influence of body mass index on the association of weight changes with mortality in hemodialysis patients.

Background And Objectives: A high body mass index (BMI) is associated with lower mortality in patients undergoing hemodialysis. Short-term weight gains and losses are also related to lower and higher mortality risk, respectively. The implications of weight gain or loss may, however, differ between obese individuals and their nonobese counterparts.

Use of phosphate-binding agents is associated with a lower risk of mortality.

Hyperphosphatemia has been associated with higher mortality risk in CKD 5 patients receiving dialysis. Here, we determined the association between the use of single and combined phosphate-binding agents and survival in 6797 patients of the COSMOS study: a 3-year follow-up, multicenter, open-cohort, observational prospective study carried out in 227 dialysis centers from 20 European countries. Patient phosphate-binding agent prescriptions (time-varying) and the case-mix-adjusted facility percentage of phosphate-binding agent prescriptions (instrumental variable) were used as predictors of the relative all-cause and cardiovascular mortality using Cox proportional hazard regression models.

COSMOS: the dialysis scenario of CKD-MBD in Europe.

Background: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are important complications of CKD5D patients that are associated with mortality.

Methods: COSMOS is a multicentre, open cohort, prospective, observational 3-year study carried out in haemodialysis patients from 20 European countries during 2005-07. The present article describes the main characteristics of the European dialysis population, the current practice for the prevention, diagnosis and treatment of secondary hyperparathyroidism and the differences across different European regions.

Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients.

Background: Geographical differences in disease prevalence and mortality have been described in the general population and in chronic kidney disease patients in Europe. In this secondary analysis of the Membrane Permeability Outcome (MPO) study, we addressed differences in patient and treatment patterns, and whether these affect patient outcomes.

Methods: Participating countries were grouped according to geographical location; thus study centers in France, Greece, Italy, Portugal and Spain were allocated to southern Europe (n=499), and those in all other countries (Belgium, Germany, Poland and Sweden) to northern Europe (n=148).

Valproic acid attenuates proteinuria and kidney injury.

Inhibitors of histone deacetylase (HDAC) have anti-inflammatory and antifibrotic effects in several organs and tissues, but their effect on the progression of renal disease is unknown. Here, we studied the effect of valproic acid in adriamycin-induced nephropathy in mice. Administration of valproic acid before kidney injury prevented the development of proteinuria and the onset of glomerulosclerosis.

Gender and hypertension management: a sub-analysis of the I-inSYST survey.

Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of death in women. Aim. To evaluate blood pressure control, prevalence of concomitant cardiovascular risk factors, subclinical and clinical organ damage, and treatment according to gender.

Age dependence of T1 perfusion MRI-based hemodynamic parameters in human kidneys.

Purpose: To determine the association between renal cortical perfusion parameters from T1-DCE magnetic resonance imaging (MRI) and age in human kidney.

Materials And Methods: Thirty-five patients (mean age: 53 years, SD = 15 years) were imaged using inversion recovery (IR)-prepared FLASH (pulse repetition time [TR] = 4.4 msec, echo time [TE] 2.

Fibrous intimal thickening at implantation adversely affects long-term kidney allograft function.

Background: Kidneys from marginal and older donors are increasingly used to respond to the increasing demand for kidney transplants. This study evaluated the predictive value of intimal hyperplasia, as a marker of vasculopathy, in the renal allograft at the time of transplantation (transplantation) on the subsequent graft function (7 years).

Methods: The intima/media ratio of the arterial walls (I/M) was morphometrically determined by the sectorial elliptic method, in 51 implantation biopsies.

Lanthanum carbonate possibly responsible for acute liver failure in a patient with Child-Pugh stage A liver cirrhosis.

The majority of patients with end-stage renal disease have hyperphosphataemia, which is associated with significant morbidity and mortality. Lanthanum carbonate has been introduced as a new treatment modality to lower serum phosphorus. But there has been ongoing concern about lanthanum accumulation in tissues, especially in liver.

Two-tier approach for the detection of alpha-galactosidase A deficiency in kidney transplant recipients.

Background: Anderson-Fabry disease (AFD) is an X-linked condition originating from a deficiency in alpha-galactosidase, a lysosomal enzyme. Multi-organ involvement ensues in early adulthood and vital organs are affected: the kidneys, brain, heart. Several reports however suggest that AFD is underdiagnosed.

Current management of secondary hyperparathyroidism: a multicenter observational study (COSMOS).

Study Aims: To survey bone mineral disturbances in the hemodialysis (HD) population in Europe and current clinical practice in Europe for the prevention, diagnosis and treatment of secondary hyperparathyroidism (SHPT) in HD patients.

Primary Objectives: First, to estimate the prevalence of Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline achievement in a representative sample of European hemodialysis subjects. As part of this objective, we will investigate the prevalence of achievement by type of dialysis, type of center and time on dialysis (less than or greater than 1 year).

CRBP-I in the renal tubulointerstitial compartment of healthy rats and rats with renal fibrosis.

Background: Cellular retinol-binding protein I (CRBP-I), a member of the intracellular lipid-binding protein (iLBP) superfamily, is a specific marker of quiescent stellate cells in the healthy human liver. In the diseased fibrotic/cirrhotic liver, portal and septal myofibroblasts acquire CRBP-I expression, while activated hepatic stellate cells maintain their CRBP-I expression. Here, we investigate the distribution of CRBP-I in the renal cortex of healthy rats and rats with renal fibrosis.

Vasculopathy in the kidney allograft at time of transplantation: impact on later function of the graft.

Background: Older and marginal donors, increasingly used to overcome organ shortness, often have a cerebrovascular accident as cause of death and could have vascular lesions in their kidneys.

Methods: In this literature study, we evaluated the predictive value of vasculopathy in the renal allograft at the time of transplantation, on the subsequent graft function.

Results: Short-term graft survival rates do not seem to be diminished by suboptimal donor histology.

The neurotoxicity and safety of treatment with cefepime in patients with renal failure.

Background: Cases of cefepime neurotoxicity have been sporadically reported in patients with renal failure. The neurotoxicity of cefepime might be underestimated and the frequency of its neurotoxic effects may be insufficiently recognized.

Methods: We retrospectively reviewed the files of patients with renal failure who were treated with cefepime and who developed neurological complications.

Combined T1-based perfusion MRI and MR angiography in kidney: first experience in normals and pathology.

Objectives: To investigate the feasibility of implementing quantitative T1-perfusion in the routine MRA-protocol and to obtain a first experience in normals and pathology.

Materials And Methods: For perfusion imaging, IR-prepared FLASH (one 4 mm slice at mid-renal level, TR 4.4 ms, TE 2.

Aristolochic acid induces proximal tubule apoptosis and epithelial to mesenchymal transformation.

Aristolochic acid contamination in herbal remedies leads to interstitial fibrosis, tubular atrophy, and renal failure in humans. To study the cellular mechanisms contributing to the pathophysiology of this renal disease, we studied Wistar rats treated with aristolochic acid and measured tubular and interstitial cell proliferation, epithelial/mesenchymal cell marker expression, tubular membrane integrity, myofibroblast accumulation, oxidative stress, mitochondrial damage, tubular apoptosis, and fibrosis. Oxidative stress, a loss of cadherin concomitant with vimentin expression, basement membrane denudation with active caspase-3 expression, and mitochondrial injury within tubular cells were evident within 5 days of administration of the toxin.

Two-tier approach for the detection of alpha-galactosidase A deficiency in a predominantly female haemodialysis population.

Introduction: Fabry's disease (AFD) is an X-linked lysosomal storage disease, resulting from a deficiency in alpha-galactosidase A (AGALA). Untreated, this leads to precocious failure of vital organ function and death. As enzyme replacement therapy is available, it is of vital importance that affected individuals can be traced.

Methotrexate should not be used for patients with end-stage kidney disease.

Methotrexate is a widely used disease-modifying anti-rheumatic drug. Its effectiveness has been proven in placebo-controlled trials and in comparison with other disease-modifying anti-rheumatic drugs. The pharmacokinetics of methotrexate are highly variable and unpredictable.

Acute interstitial nephritis associated with salmonellosis.

Acute interstitial nephritis (AIN) is a common cause of acute renal failure. We report a case of AIN, confirmed by renal biopsy, that developed in a patient with typhoid fever due to a Salmonella hadar infection. AIN secondary to Salmonella infection is a rare complication that has only been described twice in the literature.

Conversion from cyclosporine to sirolimus in stable renal transplant recipients.

Background: Conversion from cyclosporine (CsA) to sirolimus (SRL) has mainly been done in clinical conditions warranting calcineurin inhibitor discontinuation. Little is known about the clinical outcome of conversion in renal transplant recipients without transplant dysfunction.

Methods: This prospective, open-label, multicentric pilot study evaluates the safety and efficacy of converting patients with stable renal function from CsA to SRL.

Quantification of renal perfusion and function on a voxel-by-voxel basis: a feasibility study.

The feasibility of a voxel-by-voxel deconvolution analysis of T(1)-weighted DCE data in the human kidney and its potential for obtaining quantification of perfusion and filtration was investigated. Measurements were performed on 14 normal humans and 1 transplant at 1.5 T using a Turboflash sequence.

Evaluation of functional and mental state and quality of life in chronic haemodialysis patients.

Progressive increase of old patients with end stage renal disease (ESRD) with a high mortality and morbidity rate, receiving haemodialysis, increases the impact of psychosocial factors on the outcome. Depression is the most prevalent psychological problem in patients in haemodialysis and is associated with a high mortality. The purpose of this study was to evaluate the functional (ADL, IADL), mental (MMSE, SDS) state and the Quality of Life (KDQOL) in the chronic haemodialysis patients.