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Contributions to Nephrology

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https://www.readbyqxmd.com/read/27951581/micrornas-are-associated-with-uremic-toxicity-cardiovascular-calcification-and-disease
#1
Ziad A Massy, Valérie Metzinger-Le Meuth, Laurent Metzinger
BACKGROUND: Vascular calcification has been recognized to be a major risk factor in chronic kidney disease (CKD) and downstream cardiovascular complications. Micro-RNAs (miRNAs) are small noncoding RNAs comprising 20-25 nucleotides that regulate gene expression by inhibiting or degrading the target mRNA, and constitute potential new biomarkers and future therapeutic strategies. SUMMARY: We tested the relevance of several cardiovascular-specific miRNAs as new biomarkers for CKD, cardiovascular disease, and cardiovascular complications...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951580/the-evolution-of-home-hd-meeting-modern-patient-needs
#2
Mark Roger Marshall, Christopher T Chan
Patients with end-stage renal disease undergoing conventional renal replacement therapy face high morbidities and inappropriately high mortality rates globally. Intensive home hemodialysis has emerged as an alternate form of renal replacement therapy with superior clinical outcomes. In order to describe the international trends in conducting home hemodialysis, we performed a cross-sectional survey of 25 centers reporting the global trends and practices of intensive home hemodialysis. While the practice of home hemodialysis has continued to evolve, similar logistical barriers exist around the world...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951579/evidence-for-the-clinical-advantages-of-predilution-on-line-hemodiafiltration
#3
Ikuto Masakane, Kan Kikuchi, Hideki Kawanishi
BACKGROUND: On-line hemodiafiltration (OL-HDF) is a rapidly developing dialysis modality that is expected to ameliorate the quality of life and survival rate of chronic dialysis patients. There are generally 2 types of dilution methods in OL-HDF: postdilution and predilution. SUMMARY: Postdilution OL-HDF is widely performed worldwide, whereas predilution OL-HDF accounts for >90% of all OL-HDF sessions performed in Japan. The reasons for the preference for predilution are to increase the substitution volume at a lower blood flow rate and to remove larger low-molecular-weight proteins (LMWPs)...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951578/carbohydrate-counting-a-simple-method-of-dietary-management-for-glycemic-control-in-japanese-diabetic-hemodialysis-patients
#4
Yukie Kitajima, Noriko Mikami, Toru Hyodo, Miho Hida, Junko Kawakami
BACKGROUND: Carbohydrate counting used in dietary therapy for diabetes is based on the concept that the postprandial rise in blood glucose levels is primarily affected by ingested carbohydrates. This method has been widely accepted and used since 1993, when its usefulness was demonstrated in the United States, largely due to the ease with which patients can understand the method. However, in Japan, there is a common misunderstanding that energy intake determines postprandial blood glucose levels...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951577/the-economic-issues-of-hemodialysis-therapy-within-the-japanese-health-care-system
#5
Yoshiaki Takemoto, Toshihide Naganuma
BACKGROUND: Expenditure on hemodialysis therapy is high within the Japanese health care system, and cost reductions are desirable to maintain the system. Under these circumstances, both a macroeconomic analysis and a microeconomic analysis of the country's health care system are needed to elucidate its problems. SUMMARY: A macroeconomic analysis showed that Japan's sluggish GDP growth since the 1990s has been a major problem in the allocation of health care resources, and government policies have been put in place to reduce health care expenditure...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951576/future-trends-in-vascular-access-creation
#6
Surendra Shenoy
Delivery of a prescribed dialysis dose, which is critical for longevity on hemodialysis, is directly dependent on vascular access (VA). However, VA is fraught with high failure rates and has room for innovation. Arteriovenous fistula (AVF), considered the 'best choice', has a high 'failure to mature' rate. Arteriovenous grafts (AVGs) are considered when patients are poor candidates for or have failed AVF, but have a high incidence of infections and thrombosis. Due to associated morbidity and mortality from complications, central venous catheters are considered only as 'bridging short-term access' when there is an urgent need for dialysis...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951575/clearance-gap-does-it-really-matter-for-the-evaluation-of-vascular-access-function
#7
Jun-Ichi Ono, Yujiro Shiraga, Fumika Yoshikawa, Yoshisuke Haruna, Tamaki Sasaki, Seiichi Mochizuki
BACKGROUNDS: Vascular access (VA) stenosis increases the risk of VA obstruction due to the gradual progress of intimal thickening. Therefore, we should try to detect VA stenosis early. However, we do not have a cutoff for when a difference between prescribed Kt/V and delivered Kt/V reflects a clinical issue. Thus, we have devised a new index, the 'clearance gap' (CL-Gap), which quantifies the difference between the effective clearance (eCL) of a hemodialysis (HD) patient and the theoretical clearance (tCL) of a dialyzer to detect a decrease in dialysis efficiency due to VA dysfunction...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951574/clinical-performance-assessment-of-cordiax-filters-in-hemodialysis-and-hemodiafiltration
#8
Jacky Potier, Sudhir Bowry, Bernard Canaud
In this study, we evaluate the in vivo clinical performances of CorDiax FX 100 and CorDiax FX 1000 filters incorporating a high-flux membrane (Helixone Plus) designed for use in high-flux hemodialysis (HD) as well as in hemodiafiltration (HDF) in 6 stable end-stage kidney disease patients. In the HDF mode, various substitution modalities (post-, pre-, and mixed) were compared. In addition to conventional markers of efficacy of dialysis dose (urea, ionic dialysance, Kt/V), several additional middle- and large-size solute (β2-microglobulin, myoglobin, serum-free light-chain kappa and lambda, α1-microglobulin, and FGF23) compounds were explored in order to cover the spectrum of uremic toxins that are involved in uremia...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951573/a-new-poly-methyl-methacrylate-membrane-dialyzer-nf-with-adsorptive-and-antithrombotic-properties
#9
Wataru Oshihara, Hiroaki Fujieda, Yoshiyuki Ueno
BACKGROUND: Poly(methyl methacrylate) (PMMA) membranes adsorb several kinds of proteins and can remove high-molecular-weight proteins, including uremic toxins, which are not removed efficiently by hemodialysis or hemodiafiltration. However, the antithrombogenicity of PMMA membranes is insufficient due to their adsorptive properties. SUMMARY: Coagulation during hemodialysis occurs because proteins that are adsorbed to the PMMA membrane undergo structural changes and are recognized by platelets, which are then activated by adhesion to the membrane surface...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951572/a-new-polysulfone-membrane-dialyzer-nv-with-low-fouling-and-antithrombotic-properties
#10
Wataru Oshihara, Yoshiyuki Ueno, Hiroaki Fujieda
BACKGROUND: The biggest problem in routine hemodialysis therapy is possibly the blood pressure fall experienced by patients during dialysis. In contrast, in medium- and long-term hemodialysis therapy, the main problem might be deterioration of arteriosclerosis because of medial calcification associated with dialysis vintage. Both problems are caused by an autonomic imbalance or structural change in the blood vessels. Inflammation due to extracorporeal blood circulation is another possible cause...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951571/fundamental-characteristics-of-the-newly-developed-ata%C3%A2-membrane-dialyzer
#11
Takashi Sunohara, Toshiaki Masuda
BACKGROUND: Dialysis membranes are often made from synthetic polymers, such as polysulfone. However, membranes made from cellulose triacetate have superior biocompatibility and have been used since the 1980s. On-line hemodiafiltration treatment accompanied by massive fluid replacement is increasingly being used in Europe and Japan, but cellulose triacetate is not suitable for this treatment. SUMMARY: Our newly developed asymmetric triacetate membrane, the ATA™ membrane, substantially improved the filtration properties and blood compatibility because of the asymmetric structure and smooth surface of this cellulose acetate membrane...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951570/biocompatibility-of-hemodiafilters
#12
Tadashi Tomo
BACKGROUND: Biocompatibility and the efficiency of solute removal are important considerations in blood purification therapy. Improvement of biocompatibility is expected to lead to the prevention of dialysis-related complications (e.g. amyloidosis, arteriosclerosis, and malnutrition) and to the delay of disease progression by alleviating microinflammation. SUMMARY: The biocompatibility of dialyzers is greatly influenced by the interaction between blood and the treatment materials, in which the chemical and physical characteristics of membrane materials play important roles...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951569/optimal-design-of-dialyzers
#13
Michio Mineshima
BACKGROUND: Several types of synthetic dialysis membranes, including polysulfone, polyethersulfone, and polyester polymer alloy membranes, have asymmetrical structures. Dialyzers with these membranes show higher water and solute transport performance because the actual membrane thickness, which is related to the water and solute transfer resistance, is quite small compared with that in membranes with a homogeneous structure. SUMMARY: The performance of a dialyzer depends not only on membrane permeability to water and solutes, but also on flow conditions of the blood and dialysate, which are determined during dialyzer fabrication...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951568/the-clear-space-index
#14
Akihiro C Yamashita
BACKGROUND: Kt/V for urea (Kt/V) is a dimensionless clinical index of dialysis dose; however, it does not directly reflect the removal capacity of the solute. Since the total amount of solute removal, M, is directly proportional to the initial solute concentration CB(0), it is reasonable to introduce an index by dividing M by CB(0). This index was termed 'clear space' (CS) because it was later found that it reflects the body fluid volume, the concentration of which becomes zero by the treatment...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951567/evidence-for-targeting-low-molecular-weight-proteins-in-hemodialysis-and-hemodiafiltration
#15
Kenji Tsuchida, Kojiro Nagai, Narushi Yokota, Satoru Yamada, Hiroyuki Michiwaki, Jun Minakuchi
BACKGROUND: With the identification of β2-microglobulin (β2MG) as an active participant in dialysis-related amyloid fibril formation, low-molecular-weight proteins (LMWPs) are now recognized as a distinct class of uremic toxins, and numerous compounds in this category have been identified. The class of LMWPs, although not precisely defined, has a molecular weight range of approximately 1,000-50,000 Da. With this in mind, dialysis prescriptions have been modified to increase the efficiency of uremic solute removal...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951566/new-strategies-for-anaemia-management-in-chronic-kidney-disease
#16
Francesco Locatelli, Lucia Del Vecchio
Erythropoiesis-stimulating agents (ESAs) and iron therapy are the standard of care for normocytic normochromic anaemia, which is a frequent comorbidity of patients with chronic kidney disease. In a large percentage of patients, ESAs and iron increase haemoglobin levels, thus reducing the risk of blood transfusions and improving patient quality of life. However, randomised trials have raised some concerns about higher haemoglobin targets and/or high ESA dose use. These concerns include higher cardiovascular and thrombosis risk, cancer progression, and increased mortality...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951565/klotho-as-a-therapeutic-target-during-the-development-of-renal-fibrosis
#17
Shigehiro Doi, Takao Masaki
Systemic symptoms such as the ectopic calcification, atrophy of skin and muscle, and impaired sexual function observed in chronic kidney diseases (CKD) have been reported to coincide with those observed in geriatric symptoms. Regarding the kidney, clinical/pathological characteristics in CKD patients also coincide with those in the aging kidney. These findings suggest common mechanisms in the development of both CKD and aging. Our investigation of aging factors associated with renal fibrosis in IgA nephropathy patients revealed a significant correlation between accumulation of cells with an arrested cell cycle and decreased expression of Klotho protein...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951564/preventive-strategies-for-vascular-calcification-in-patients-with-chronic-kidney-disease
#18
Takashi Shigematsu, Tomohiro Sonou, Masaki Ohya, Keitaro Yokoyama, Hiraku Yoshida, Takashi Yokoo, Kouji Okuda, Asuka R Masumoto, Yuko Iwashita, Keiko Iseki, Satoko Kunimoto, Yukiko Yamano
BACKGROUND: Vascular calcification is significant because of the close association between the degree of vascular calcification and cardiovascular mortality in chronic kidney disease (CKD) patients. SUMMARY: There are 2 types of vascular calcification in CKD patients. One is endothelial vascular calcification, a common type of vascular calcification. Another is medial vascular calcification, a specific type that is common in CKD patients. The former is mainly associated with atherosclerosis due to hyperlipidemia, especially hypercholesterolemia...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951563/preparation-and-quality-management-of-fluids-for-hemodialysis
#19
Hideki Kawanishi, Misaki Moriishi, Naoko Takahashi, Shinichiro Tsuchiya
BACKGROUND: In 2008, the Japanese Society for Dialysis Therapy (JSDT) proposed a standard for the quality of fluids for hemodialysis. The standard was geared toward Japan, where the central dialysis fluid delivery system is routinely used. After establishment of the standard, dialysis fluid quality was markedly improved in facilities across the country. Moreover, the number of on-line hemodiafiltration patients dramatically increased. SUMMARY: However, the 2008 standard specifies only microbiological qualities and does not cover toxic chemicals...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951562/newly-developed-biocompatible-material-dispersible-titanium-doped-hydroxyapatite-nanoparticles-suitable-for-antibacterial-coating-on-intravascular-catheters
#20
Tsutomu Furuzono, Masatoshi Okazaki, Yoshinao Azuma, Mitsunobu Iwasaki, Yasumichi Kogai, Yoshiki Sawa
BACKGROUND: Thirteen patients with chlorhexidine-silver sulfadiazine-impregnated catheters have experienced serious anaphylactic shock in Japan. These adverse reactions highlight the lack of commercially available catheters impregnated with strong antibacterial chemical agents. A system should be developed that can control both biocompatibility and antibacterial activity. SUMMARY: Hydroxyapatite (HAp) is biocompatible with bone and skin tissues. To provide antibacterial activity by using an external physical stimulus, titanium (Ti) ions were doped into the HAp structure...
2017: Contributions to Nephrology
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