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Kotanko Peter

Paik Seong Lim, Chang Hsu Chen, Fansan Zhu, Peter Kotanko, Yachung Jeng, Chun Yu Hu, Li Shu Chiu, Hui-Chen Chang
OBJECTIVE: Obesity is becoming increasingly common in hemodialysis (HD) patients and is associated with inflammation and increased mortality. The primary aim of the present study was to evaluate the accuracy and variability of the bioimpedance device in measuring body fat in Taiwanese dialysis patients. DESIGN: Cross-sectional study. SUBJECTS: One hundred twenty-two adult patients receiving HD in a single hospital in Taiwan. SETTING: We compared the results of fat mass (FM) measured by dual-energy x-ray absorptiometry (DEXA) and bioelectrical impedance spectroscopy device (Body composition monitor, BCM)...
September 22, 2016: Journal of Renal Nutrition
Eric Seibert, Anja Richter, Martin K Kuhlmann, Suxin Wang, Nathan W Levin, Peter Kotanko, Garry J Handelman
Introduction The achievement of erythropoiesis in hemodialysis (HD) patients is typically managed with erythropoiesis-stimulating-agents (ESA's) and intravenous iron (IV-iron). Using this treatment strategy, HD patients frequently show an elevated fraction of red blood cells (RBC) with hemoglobin (Hb) content per cell that is below the normal range, called hypochromic RBC. The low Hb content per RBC is the result of the clinical challenge of providing sufficient iron content to the bone marrow during erythropoiesis...
September 12, 2016: Hemodialysis International
Fansan Zhu, Laura Rosales, Peter Kotanko
PURPOSE OF REVIEW: The aim of this article is to present current information on techniques for fluid status assessment in patients with kidney disease. The methods can be broadly categorized into biomarkers, ultrasound, blood volume monitoring, and bioimpedance. RECENT FINDINGS: Biomarkers including atrial natriuretic peptide and B-type natriuretic peptide have been shown to provide information about relative changes in fluid status. Ultrasound is applied to measure inferior vena cava indices, pulmonary indicators, and vascular indicators of fluid overload...
November 2016: Current Opinion in Nephrology and Hypertension
Cécile Couchoud, Brenda Hemmelgarn, Peter Kotanko, Michael J Germain, Olivier Moranne, Sara N Davison
In using a patient-centered approach, neither a clinician nor a prognostic score can predict with absolute certainty how well a patient will do or how long he will live; however, validated prognostic scores may improve accuracy of prognostic estimates, thereby enhancing the ability of the clinicians to appreciate the individual burden of disease and the prognosis of their patients and inform them accordingly. They may also facilitate nephrologist's recommendation of dialysis services to those who may benefit and proposal of alternative care pathways that might better respect patients' values and goals to those who are unlikely to benefit...
August 10, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Jochen G Raimann, Viviane Calice-Silva, Stephan Thijssen, Fabiana Baggio Nerbass, Marcos A Vieira, Pascal Dabel, Rhys Evans, John Callegari, Mary Carter, Nathan W Levin, James F Winchester, Peter Kotanko, Roberto Pecoits-Filho
BACKGROUND: Acute kidney injury (AKI) is a growing global concern and often reversible. Saliva urea nitrogen (SUN) measured by a dipstick may allow rapid diagnosis. We studied longitudinal agreement between SUN and blood urea nitrogen (BUN) and the diagnostic performance of both. METHODS: Agreement between SUN and BUN and diagnostic performance to diagnose AKI severity in AKI patients in the United States and Brazil were studied. Bland-Altman analysis and linear mixed effects models were employed to test the agreement between SUN and BUN...
April 22, 2016: Blood Purification
Xia Tao, Stephan Thijssen, Peter Kotanko, Chih-Hu Ho, Michael Henrie, Eric Stroup, Garry Handelman
Protein-bound uraemic toxins (PBUTs) cause various deleterious effects in end-stage kidney disease patients, because their removal by conventional haemodialysis (HD) is severely limited by their low free fraction in plasma. Here we provide an experimental validation of the concept that the HD dialytic removal of PBUTs can be significantly increased by extracorporeal infusion of PBUT binding competitors. The binding properties of indoxyl sulfate (IS), indole-3-acetic acid (IAA) and hippuric acid (HIPA) and their binding competitors, ibuprofen (IBU), furosemide (FUR) and tryptophan (TRP) were studied in uraemic plasma...
2016: Scientific Reports
Maria Ferris, Keisha Gibson, Brett Plattner, Debbie S Gipson, Peter Kotanko, Daniele Marcelli, Cristina Marelli, Michael Etter, Paola Carioni, Gero von Gersdorff, Xiaoqi Xu, Jeroen P Kooman, Qingqing Xiao, Frank M van der Sande, Albert Power, Roberto Picoits-Filho, Lucimary Sylvestre, Katherine Westreich, Len Usvyat
BACKGROUND: The aim of this study was to describe the experience of pediatric and young adult hemodialysis (HD) patients from a global cohort. METHODS: The Pediatric Investigation and Close Collaborative Consortium for Ongoing Life Outcomes for MONitoring Dialysis Outcomes (PICCOLO MONDO) study provided de-identified electronic information of 3244 patients, ages 0-30 years from 2000 to 2012 in four regions: Asia, Europe, North America and South America. The study sample was categorized into pediatric (≤18 years old) and young adult (19-30 years old) groups based on the age at dialysis initiation...
April 2016: Clinical Kidney Journal
Andreja Marn Pernat, Vanja Peršič, Len Usvyat, Lynn Saunders, John Rogus, Franklin W Maddux, Eduardo Lacson, Peter Kotanko
OBJECTIVE: Patients with diabetes are at increased risk of foot ulcers, which may result in limb amputations. While regular foot care prevents ulcerations and amputation in those patients with diabetes not on dialysis, evidence is limited in diabetic hemodialysis patients. We investigated the association between the implementation of a routine foot check program in diabetic incident hemodialysis patients, and major lower limb amputations. METHODS: In 1/2008, monthly intradialytic foot checks were implemented as part of standard clinic care in all Fresenius Medical Care North America hemodialysis facilities...
2016: BMJ Open Diabetes Research & Care
Georges Ouellet, Rakesh Malhotra, E Lars Penne, Len Usvya, Nathan W Levin, Peter Kotanko
BACKGROUND: Increased mortality rate in chronic hemodialysis (HD) patients is partly attributed to a chronic inflammatory state. Neutrophil-lymphocyte ratio (NLR), defined as the neutrophil count divided by lymphocyte count, is increasingly recognized as a marker of systemic inflammation, but its prognostic value in HD patients is unknown. The aim of this study was to assess NLR as a predictor of survival in this patient population. METHODS: In this study incident chronic HD patients were stratified in tertiles of NLR based on measurements obtained 3 months after initiation of dialysis...
April 2016: Clinical Nephrology
Anna Meyring-Wösten, Hanjie Zhang, Xiaoling Ye, Doris H Fuertinger, Lili Chan, Franz Kappel, Mikhail Artemyev, Nancy Ginsberg, Yuedong Wang, Stephan Thijssen, Peter Kotanko
BACKGROUND AND OBJECTIVES: Intradialytic hypoxemia has been recognized for decades, but its associations with outcomes have not yet been assessed in a large patient cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our retrospective cohort study was conducted between January of 2012 and January of 2015. We recorded blood oxygen saturation every minute during hemodialysis in patients with arteriovenous access. A 6-month baseline period with at least 10 treatments with oxygen saturation measurements preceded a 12-month follow-up...
April 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Natalia Borges Bonan, Thiago M Steiner, Viktoriya Kuntsevich, Grazia Maria Virzì, Marina Azevedo, Lia Sumie Nakao, Fellype Carvalho Barreto, Claudio Ronco, Stephan Thijssen, Peter Kotanko, Roberto Pecoits-Filho, Andréa N Moreno-Amaral
BACKGROUND: We tested the effect of uremia on red blood cell (RBC) eryptosis, CD14++/CD16+ monocytes and erythrophagocytosis. DESIGN: RBC and monocytes from chronic kidney disease (CKD) stages 3/4 (P-CKD3/4) or hemodialysis (HD) patients and healthy controls (HCs) cells incubated with sera pools from patients with CKD stages 2/3 (S-CKD2/3) or 4/5 (S-CKD4/5) were evaluated to assess eryptosis, monocyte phenotypes and reactive oxygen species (ROS) by cytometer. Erythrophagocytosis was evaluated by subsequent co-incubation of preincubated HC-monocytes and autologous-RBC...
2016: Blood Purification
Dugan W Maddux, Len A Usvyat, Daniel DeFalco, Peter Kotanko, Jeroen P Kooman, Frank M van der Sande, Franklin W Maddux
BACKGROUND: Pre-dialysis chronic kidney disease (CKD) care impacts dialysis start and incident dialysis outcomes. We describe the use of late stage CKD population data coupled with CKD case management to improve dialysis start. METHODS: The Renal Care Coordinator (RCC) program is a nephrology practice and Fresenius Medical Care North America (FMCNA) partnership involving a case manager resource and data analytics. We studied patients starting dialysis between August 1, 2009 and February 28, 2013 in 9 nephrology practices partnering in the RCC program...
March 2016: Clinical Nephrology
Jochen G Raimann, Christopher T Chan, John T Daugirdas, Tom Depner, Frank A Gotch, Tom Greene, George A Kaysen, Alan S Kliger, Peter Kotanko, Brett Larive, Robert Lindsay, Michael V Rocco, Glenn M Chertow, Nathan W Levin
In previous reports of the Frequent Hemodialysis Network trials, frequent hemodialysis (HD) reduced extracellular fluid (ECF) and left ventricular mass (LVM), with more pronounced effects observed among patients with low urine volume (UVol). We analyzed the effect of frequent HD on interdialytic weight gain (IDWG) and a time-integrated estimate of ECF load (TIFL). We also explored whether volume and sodium loading contributed to the change in LVM over the study period. Treatment effects on volume parameters were analyzed for modification by UVol and the dialysate-to-serum sodium gradient...
2016: Blood Purification
Peter Kotanko, Claudio Ronco
No abstract text is available yet for this article.
2016: Blood Purification
Maggie Han, Schantel Williams, Melissa Mendoza, Xiaoling Ye, Hanjie Zhang, Viviane Calice-Silva, Stephan Thijssen, Peter Kotanko, Anna Meyring-Wösten
BACKGROUND/AIMS: Hemodialysis (HD) patients are less active than their healthy counterparts and frequently experience poor sleep. Our aims were to objectively quantify activity and sleep quality in HD patients of an urban population and to determine the effect of providing feedback on activity. METHODS: Activity parameters and sleep parameters were collected by a commercially available activity tracker in 29 chronic HD patients. Patients in the feedback group were provided with their activity and sleep data during each HD treatment...
2016: Blood Purification
Israel Campos, Lili Chan, Hanjie Zhang, Sheila Deziel, Cheryl Vaughn, Anna Meyring-Wösten, Peter Kotanko
When kidney failure occurs, patients are at risk for fluid overload states, which can cause pulmonary edema, pleural effusions, and upper airway obstruction. Kidney disease is also associated with impaired respiratory function, as in central sleep apnea or chronic obstructive pulmonary disease. Hence, respiratory and renal diseases are frequently coexisting. Hypoxemia is the terminal pathway of a multitude of respiratory pathologies. The measurement of oxygen saturation (SO2) is a basic and commonly used tool in clinical practice...
2016: Blood Purification
Mostafa Bachar, Jochen G Raimann, Peter Kotanko
In this work, we develop an impulsive mathematical model of Vitamin C (ascorbic acid) metabolism in healthy subjects for daily intake over a long period of time. The model includes the dynamics of ascorbic acid plasma concentration, the ascorbic acid absorption in the intestines and a novel approach to quantify the glomerular excretion of ascorbic acid. We investigate qualitative and quantitative dynamics. We show the existence and uniqueness of the global asymptotic stability of the periodic solution. We also perform a numerical simulation for the entire time period based on published data reporting parameters reflecting ascorbic acid metabolism at different oral doses of ascorbic acid...
March 7, 2016: Journal of Theoretical Biology
Aurelio A de los Reyes V, Doris H Fuertinger, Franz Kappel, Anna Meyring-Wösten, Stephan Thijssen, Peter Kotanko
An assessment of fluid status can be obtained by monitoring relative blood volume (RBV) during hemodialysis (HD) treatment. The dynamics of RBV is determined by fluid removal from the intravascular compartment by ultrafiltration (UF) and vascular refill from the interstitium. To characterize this dynamics, a two-compartment model describing the short-term dynamics of vascular refilling and UF is developed. Fluid movement between the compartments is governed by lymphatic and microvascular fluid shifts. Further, protein flux is described by convection, diffusion and the lymphatic protein flux...
February 7, 2016: Journal of Theoretical Biology
Adrian M Guinsburg, Len A Usvyat, Michael Etter, Xiaoqi Xu, Stephan Thijssen, Daniele Marcelli, Bernard Canaud, Cristina Marelli, Claudia Barth, Yuedong Wang, Paola Carioni, Frank M van der Sande, Peter Kotanko, Jeroen P Kooman
BACKGROUND: Seasonal mortality differences have been reported in US hemodialysis (HD) patients. Here we examine the effect of seasons on mortality, clinical and laboratory parameters on a global scale. METHODS: Databases from the international Monitoring Dialysis Outcomes (MONDO) consortium were queried to identify patients who received in-center HD for at least 1 year. Clinics were stratified by hemisphere and climate zone (tropical or temperate). We recorded mortality and computed averages of pre-dialysis systolic blood pressure (pre-SBP), interdialytic weight gain (IDWG), serum albumin, and log C-reactive protein (CRP)...
2015: BMC Nephrology
Stephan Thijssen, Michelle M Y Wong, Len A Usvyat, Qingqing Xiao, Peter Kotanko, Franklin W Maddux
BACKGROUND AND OBJECTIVES: Dialysis patients have a high risk for inadequate nutrition. Their nutritional status is particularly susceptible to deterioration when faced with intercurrent events such as hospitalization. This study was conducted to improve the understanding of the temporal evolution of nutritional parameters as a foundation for rational and proactive nutritional intervention. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective cohort study was performed to investigate the temporal evolution of nutritional parameters (serum albumin, serum phosphate, serum creatinine, equilibrated normalized protein catabolic rate, and interdialytic weight gain) and a composite nutritional score derived from these parameters, in two populations: (1) incident hemodialysis (HD) patients who started HD between January 2006 and December 2011 and were followed for up to 54 months (median 16...
September 4, 2015: Clinical Journal of the American Society of Nephrology: CJASN
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