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Dalia E Yousif, Alice R Topping, Maha F Osman, Jochen G Raimann, Elfadil M Osman, Peter Kotanko, Omar I Abboud
BACKGROUND: The burden of acute kidney injury (AKI) is high in Africa. While there are no reliable statistics about AKI in Africa, the Global Snapshot Study of the 0by25 initiative of the International Society of Nephrology has determined dehydration, infections, animal envenomation, and complications during pregnancy as the main causes. METHODS: This study was conducted at the Soba University Hospital (SUH), Khartoum, Sudan, a tertiary referral center. We included all hemodialysis patients treated for AKI at SUH between -January 1, 2013 and December 31, 2014 in the study...
January 26, 2018: Blood Purification
Samir Patel, Alice Topping, Xiaoling Ye, Hanjie Zhang, Bernard Canaud, Paola Carioni, Cristina Marelli, Adrian Guinsburg, Albert Power, Neill Duncan, Jeroen Kooman, Frank van der Sande, Len A Usvyat, Yuedong Wang, Xiaoqi Xu, Peter Kotanko, Jochen G Raimann
BACKGROUND: Tall people have improved metabolic profiles and better cardiovascular outcomes, a relationship inverted in dialysis patients. We investigated the relationship between height and outcomes in incident hemodialysis (HD) patients commencing treatment in an analysis of the international Monitoring Dialysis Outcomes (MONDO) database. METHODS: In this retrospective cohort study, we included incident HD patients commencing treatment between -January 1, 2006 and December 31, 2010 and investigated the association between height and mortality using the MONDO database...
January 26, 2018: Blood Purification
Maggie Han, Xiaoling Ye, Priscila Preciado, Schantel Williams, Israel Campos, Marcee Bonner, Candace Young, Daniel Marsh, John W Larkin, Len A Usvyat, Franklin W Maddux, Roberto Pecoits-Filho, Peter Kotanko
BACKGROUND/AIMS: Neighborhood walkability is associated with indicators of health in the general population. We explored the association between neighborhood walkability and daily steps in hemodialysis (HD) patients. METHODS: We measured daily steps over 5 weeks using Fitbit Flex (Fitbit, San Francisco, CA, USA) and retrieved Walk Score® (WS) data by patient's home ZIP code (; 0 = poorest walkability; 100 = greatest walkability). RESULTS: HD patients took a mean of 6,393 ± 3,550 steps/day (n = 46)...
January 26, 2018: Blood Purification
Dugan Maddux, Len A Usvyat, Danqing Xu, Yuedong Wang, Peter Kotanko, Frank M van der Sande, Jeroen P Kooman, Franklin W Maddux
BACKGROUND/AIMS: Few studies examine the impact of systolic blood pressure (SBP) on mortality in the incident hemodialysis (HD) period, and throughout the first HD year. This large retrospective observational study analyzes the impact of "current" and cumulative low preSBP <110 mmHg (L), and variations in preSBP on short-term (1 week) mortality over the first HD year. METHODS: Weekly mean preSBP for HD weeks 1 to 51 was categorized into L or high preSBP>=110 mmHg (H) for each patient...
January 31, 2018: Kidney & Blood Pressure Research
Doris H Fuertinger, Alice Topping, Franz Kappel, Stephan Thijssen, Peter Kotanko
In silico approaches have been proposed as a novel strategy to increase the repertoire of clinical trial designs. Realistic simulations of clinical trials can provide valuable information regarding safety and limitations of treatment protocols and have been shown to assist in the cost-effective planning of clinical studies. In this report, we present a blueprint for the stepwise integration of internal, external, and ecological validity considerations in virtual clinical trials (VCTs). We exemplify this approach in the context of a model-based in silico clinical trial aimed at anemia treatment in patients undergoing hemodialysis (HD)...
January 25, 2018: CPT: Pharmacometrics & Systems Pharmacology
Anna Meyring-Wösten, Ya Luo, Hanjie Zhang, Priscila Preciado, Stephan Thijssen, Yuedong Wang, Peter Kotanko
Background: The pathophysiology of a paradoxical systolic blood pressure (SBP) rise during hemodialysis (HD) is not yet fully understood. Recent research indicated that 10% of chronic HD patients suffer from prolonged intradialytic hypoxemia. Since hypoxemia induces a sympathetic response we entertained the hypothesis that peridialytic SBP change is associated with arterial oxygen saturation (SaO 2 ). Methods: We retrospectively analyzed intradialytic SaO 2 and peridialytic SBP change in chronic HD patients with arteriovenous vascular access...
November 24, 2017: Nephrology, Dialysis, Transplantation
Samer R Abbas, Stephan Thijssen, Erik L Penne, Jochen G Raimann, Li Liu, Murat H Sipahioglu, Eric Seibert, Yuedong Wang, Yuqi Chen, Qingqing Xiao, Nathan W Levin, Peter Kotanko, Fansan Zhu
OBJECTIVE: This prospective study uses calf bioimpedance spectroscopy (cBIS) to guide the attainment of dry weight (DWcBIS) in chronic hemodialysis (HD) patients. The primary aim of this study was to evaluate whether body composition is altered when fluid status is reduced to DWcBIS. METHODS: Target post-HD weight was gradually reduced from baseline (BL) until DWcBIS was achieved. DWcBIS was defined as the presence of both flattening of the curve of extracellular resistance and the attainment calf normalized resistivity in the normal range during the dialysis treatment...
November 18, 2017: Journal of Renal Nutrition
Dugan W Maddux, Len A Usvyat, Terry Ketchersid, Yue Jiao, Tommy C Blanchard, Peter Kotanko, Frank M van der Sande, Jeroen P Kooman, Franklin W Maddux
INTRODUCTION: The transition from pre-dialysis chronic kidney disease (CKD) to post-dialysis start is a critical period associated with high patient mortality and increased hospital admissions. Little is known about the trends of key clinical and laboratory parameters through this time of transition to start dialysis. METHODS: De-identified data including demographics, vital signs, lab results, and eGFR from the Fresenius Medical Care-CKD Registry were analyzed to determine trends in clinical and laboratory parameters through the time of transition from 12 months pre-dialysis start to 12 months post-dialysis start...
November 17, 2017: Hemodialysis International
Rhys Evans, Viviane Calice-Silva, Jochen G Raimann, Ulla Hemmila, Alison Craik, Mwayi Mtekateka, Fergus Hamilton, Zuze Kawale, Hamish Dobbie, Gavin Dreyer, Nathan Levin, Peter Kotanko, Roberto Pecoits-Filho
Introduction: Kidney disease (KD), including acute kidney injury, is common, severe and leads to significant mortality in the developing world. However, simple tools to facilitate diagnosis and guide treatment are lacking. We studied the diagnostic performance of saliva urea nitrogen (SUN) measured by dipstick to diagnose KD in a low-resource setting. Methods: Medical admissions to a tertiary hospital in Malawi had serum creatinine tested at presentation; SUN was measured using a dipstick...
March 2017: KI Reports
Rakesh Malhotra, Xia Tao, Yuedong Wang, Yuqi Chen, Rebecca H Apruzzese, Paul Balter, Qingqing Xiao, Len A Usvyat, Peter Kotanko, Stephan Thijssen
BACKGROUND: The surprise question (SQ) ("Would you be surprised if this patient were still alive in 6 or 12 months?") is used as a mortality prognostication tool in hemodialysis (HD) patients. We compared the performance of the SQ with that of prediction models (PMs) for 6- and 12-month mortality prediction. METHODS: Demographic, clinical, laboratory, and dialysis treatment indicators were used to model 6- and 12-month mortality probability in a HD patients training cohort (n = 6,633) using generalized linear models (GLMs)...
2017: American Journal of Nephrology
Vaibhav Maheshwari, Alhaji Cherif, Doris Fuertinger, Gudrun Schappacher-Tilp, Priscila Preciado, Stephan Thijssen, David A Bushinsky, Peter Kotanko
International guidelines for chronic hemodialysis patients suggest a dialysate calcium concentration between 1.25 and 1.5 mmol/L. However, it is not certain if these dialysate calcium levels result in net calcium transfer into the patient. With ubiquitous prevalence of vascular calcification in hemodialysis patients, it is pertinent to model the mass balance of calcium during dialysis. To this end, we developed a two compartmental patient model and spatiotemporal representation of dialyzer model to investigate and quantify the calcium mass balance during dialysis...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Fansan Zhu, Peter Kotanko, Nathan W Levin
This paper describes a method to estimate interstitial fluid volume and peripheral blood volume (BVP) in hemodialysis (HD) patients using whole body (wBIS) and calf (cBIS) bioimpedance spectroscopy techniques. The aim of this study was to evaluate the usefulness of the technique. Thirty five HD patients were studied pre and post HD. Extracellular volume (ECV) and total body water (TBW) were measured using wBIS and cBIS. The calf resistances at 5 kHz (R5) and at 1000 kHz (R1000) respectively reflect ECV and TBW in the calf...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Xiaoling Ye, Marijke J E Dekker, Franklin W Maddux, Peter Kotanko, Constantijn J A M Konings, Jochen G Raimann, Frank M van der Sande, Len A Usvyat, Jeroen P Kooman, Stephan Thijssen
OBJECTIVES: Recently, a new Nutritional Competence Score (NCS) has been shown to associate with hospitalization and outcome in hemodialysis patients. The aim of this study was to investigate the dynamics, the individual components, and the impact of hospitalizations of this score's trajectory in the year before death. In addition, we investigated whether dynamics in the NCS add additional independent prognostic value over a single cross-sectional assessment. DESIGN: We included all Fresenius Medical Care North America patients who initiated hemodialysis between January 1, 2006, and December 31, 2011 with data on all 5 NCS components (serum albumin, creatinine, phosphate, equilibrated normalized protein catabolic rate, and interdialytic weight gain) in at least 1 month...
November 2017: Journal of Renal Nutrition
Hanjie Zhang, Lili Chan, Anna Meyring-Wösten, Israel Campos, Priscila Preciado, Jeroen P Kooman, Frank M van der Sande, Doris Fuertinger, Stephan Thijssen, Peter Kotanko
Background: Cardiac disease is highly prevalent in hemodialysis (HD) patients. Decreased tissue perfusion, including cardiac, due to high ultrafiltration volumes (UFVs) is considered to be one of the drivers of cardiac dysfunction. While central venous oxygen saturation (ScvO 2 ) is frequently used as an indicator of cardiac output in non-uremic populations, the relationship of ScvO 2 and UFV in HD patients remains unclear. Our aim was to determine how intradialytic ScvO 2 changes associate with UFV...
September 12, 2017: Nephrology, Dialysis, Transplantation
Vaibhav Maheshwari, Stephan Thijssen, Xia Tao, Doris Fuertinger, Franz Kappel, Peter Kotanko
Protein-bound uremic toxins (PBUTs) are difficult to remove by conventional hemodialysis; a high degree of protein binding reduces the free fraction of toxins and decreases their diffusion across dialyzer membranes. Mechanistic understanding of PBUT kinetics can open new avenues to improve their dialytic removal. We developed a comprehensive model of PBUT kinetics that comprises: (1) a three-compartment patient model, (2) a dialyzer model. The model accounts for dynamic equilibrium between protein, toxin, and the protein-toxin complex...
September 4, 2017: Scientific Reports
Lili Chan, Hanjie Zhang, Anna Meyring-Wösten, Israel Campos, Doris Fuertinger, Stephan Thijssen, Peter Kotanko
Central venous oxygen saturation (ScvO2) in the superior vena cava is predominantly determined by cardiac output, arterial oxygen content, and oxygen consumption by the upper body. While abnormal ScvO2 levels are associated with morbidity and mortality in non-uremic populations, ScvO2 has received little attention in hemodialysis patients. From 1/2012 to 8/2015, 232 chronic hemodialysis patients with central venous catheters as vascular access had their ScvO2 monitored during a 6-month baseline period and followed for up to 36 months...
August 17, 2017: Scientific Reports
Ana P Modesto, Len Usvyat, Viviane Calice-Silva, Dandara N Spigolon, Ana E Figueiredo, Thyago P de Moraes, Marcia Olandoski, Silvia E Shimakura, Pasqual Barretti, Peter Kotanko, Roberto Pecoits-Filho
BACKGROUND: Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at high risk of complications and mortality are scarce. One of the tools available to monitor the variation in vitality and dependence levels is the Karnofsky performance status (KPS). This study analyzed the average trends and variation of KPS during the 12 months before death and its independent value in predicting patients' survival. METHODS: The data were compiled from the BRAZPD II multi-center study, performed in Brazil between 2004 and 2011...
August 1, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Samir Patel, Jochen G Raimann, Peter Kotanko
The risk of intradialytic hypotension (IDH) is determined by various factors, among them dialysis modality and dialyzer membrane. We conducted a literature search in PubMed on November 1, 2016 and selected relevant randomized controlled and cross-over trials, and prospective and retrospective cohort studies published in English that investigated the association between IDH and dialysis modality and membrane, respectively. This literature search revealed 669 publications on dialysis modality, 64 on dialysis membrane, and 24 on acetate/bicarbonate dialysate...
July 13, 2017: Seminars in Dialysis
Jeroen P Kooman, Marijke J Dekker, Len A Usvyat, Peter Kotanko, Frank M van der Sande, Casper G Schalkwijk, Paul G Shiels, Peter Stenvinkel
Systemic inflammation in end-stage renal disease is an established risk factor for mortality and a catalyst for other complications, which are related to a premature aging phenotype, including muscle wasting, vascular calcification, and other forms of premature vascular disease, depression, osteoporosis, and frailty. Uremic inflammation is also mechanistically related to mechanisms involved in the aging process, such as telomere shortening, mitochondrial dysfunction, and altered nutrient sensing, which can have a direct effect on cellular and tissue function...
October 1, 2017: American Journal of Physiology. Renal Physiology
John W Larkin, Marta M Reviriego-Mendoza, Len A Usvyat, Peter Kotanko, Franklin W Maddux
Abnormal decreases in blood pressure during hemodialysis are frequent in end stage renal disease (ESRD) patients treated with hemodialysis, and thought to be largely due to an inadequate cardiovascular response to the rapid blood volume decline. Intradialytic hypotension (IDH) and cardiac instability during dialysis can increase risks for negative health consequences and is possibly preventable though several types of interventions. One intervention that holds promise for prevention of IDH in hemodialysis patients is to reduce the temperature of the dialysate to or below the patient's core temperature...
November 2017: Seminars in Dialysis
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