http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 06 Jun 2013 19:26:55 +0000 http://www.hindawi.com/journals/ijn/2013/515796/ The prevalence of atherosclerotic complications (myocardial infarction, stroke, and sudden death) is increased in end-stage renal disease (ESRD) patients, especially in haemodialysis patients. Increasing evidence suggests that both in general population and in dialysis patients, systemic inflammation plays a dominant role in the pathogenesis of atherosclerotic complications. In general population, also, evidence shows that moderate to severe periodontitis can contribute to inflammatory burden by increasing serum CRP levels and may increase the prevalence of atherosclerotic events. Moreover, the results of some new interventional studies reveal that effective phase I periodontal therapy may decrease serum CRP levels, the most important acute phase protein, monitored as a systemic marker of inflammation and endothelial dysfunction as well, used as an initial predictor of atherosclerotic events. Considering that moderate to severe periodontal diseases have a higher prevalence in CKD and in dialysis population and that periodontal examination is not part of the standard medical assessment, destructive periodontitis might be an ignored source of systemic inflammation in end-stage renal disease patients and may add to the chronic inflammatory status in CKD. Gener Ismail, Horia Traian Dumitriu, Anca Silvia Dumitriu, and Fidan Bahtiar Ismail Copyright © 2013 Gener Ismail et al. All rights reserved. Sun, 02 Jun 2013 13:40:49 +0000 http://www.hindawi.com/journals/ijn/2013/519130/ Objective. Although angiotensin II-mediated inflammation and extracellular matrix accumulation are considered to be associated with the progression of diabetic nephropathy, these processes have not yet been sufficiently clarified. The objective of this study was to determine whether the correction of the abnormal renal expression of MMPs and its inhibitors (MMPs/TIMPs) and cytokines following the administration of aliskiren to KK- mice results in a renoprotective effect. Methods. KK- mice were divided into two groups, that is, untreated (saline) and treated (aliskiren) groups. Systolic BP, HbA1c levels, and the albumin-creatinine ratio (ACR) were measured. The renal expression of MMPs/TIMPs, fibronectin, type IV collagen, MCP-1, and (pro)renin receptor ((P)RR) was examined using real-time PCR and/or immunohistochemical staining. Renal MAPK and NF-κB activity were also examined by Western blot analyses and ELISA, respectively. Results. Significant decreases in systolic BP and ACR levels were observed in treated KK- mice compared with the findings in untreated KK- mice. Furthermore, increases in MMPs/TIMPs, fibronectin, type IV collagen, MCP-1, and (P)RR expression, in addition to MAPK and NF-κB activity, were significantly attenuated by aliskiren administration. Conclusions. It appears that aliskiren improves albuminuria and renal fibrosis by regulating inflammation and the alteration of collagen synthesis and degradation. Masako Furukawa, Tomohito Gohda, Shinji Hagiwara, Mitsuo Tanimoto, Satoshi Horikoshi, Kazuhiko Funabiki, and Yasuhiko Tomino Copyright © 2013 Masako Furukawa et al. All rights reserved. Thu, 16 May 2013 12:16:59 +0000 http://www.hindawi.com/journals/ijn/2013/949357/ Randomized controlled trials involving natriuretic peptide administration in solid organ transplantation setting have shown inconsistent effects for renal endpoints. We conducted a systematic review and meta-analysis of these trials to ascertain the role of natriuretic peptides in the management of solid organ transplantation associated acute kidney injury (AKI). MEDLINE, EMBASE, and Google scholar were searched independently by two authors for randomized trials evaluating renal effects of natriuretic peptides in solid organ transplantation settings. Two reviewers independently assessed the studies for eligibility and extracted the relevant data. The pooled estimate showed that natriuretic peptide administration is associated with a reduction in AKI requiring dialysis (odds ratio = 0.50 [0.26–0.97]), a statistically nonsignificant trend toward improvement in posttransplant creatinine clearance (weighted mean difference = 5.5 mL/min, [−1.3 to 12.2 mL/min]), and reduction in renal replacement requirement duration (weighted mean difference −44.0 hours, [−60.5 to −27.5 hours]). There were no mortality events and no adverse events related to natriuretic peptides. In conclusion, administration of natriuretic peptides in solid organ transplantation may be associated with significant improvements in renal outcomes. These observations need to be confirmed in an adequately powered, prospective multicenter study. Sagar U. Nigwekar, Hrishikesh Kulkarni, and Charuhas V. Thakar Copyright © 2013 Sagar U. Nigwekar et al. All rights reserved. Sat, 27 Apr 2013 14:44:55 +0000 http://www.hindawi.com/journals/ijn/2013/980923/ Aim. The objective of this study was to characterize coordinated molecular changes in the structure and composition of the walls of venous segments of arteriovenous (AV) fistulas evoked by overflow. Methods. Venous tissue samples were collected from 6 hemodialysis patients with AV fistulas exposed to overflow and from the normal cephalic veins of 4 other hemodialysis patients. Total RNA was extracted from the venous tissue samples, and gene expression between the 2 groups was compared using Whole Human Genome DNA microarray 44 K. Microarray data were analyzed by GeneSpring GX software and Ingenuity Pathway Analysis. Results. The cDNA microarray analysis identified 397 upregulated genes and 456 downregulated genes. Gene ontology analysis with GeneSpring GX software revealed that biological developmental processes and glycosaminoglycan binding were the most upregulated. In addition, most upregulation occurred extracellularly. In the pathway analysis, the TGF beta signaling pathway, cytokines and inflammatory response pathway, hypertrophy model, and the myometrial relaxation and contraction pathway were significantly upregulated compared with the control cephalic vein. Conclusion. Combining microarray results and pathway information available via the Internet provided biological insight into the structure and composition of the venous wall of overflow AV fistulas. Yasuhiro Hashimoto, Akiko Okamoto, Hisao Saitoh, Shingo Hatakeyama, Takahiro Yoneyama, Takuya Koie, and Chikara Ohyama Copyright © 2013 Yasuhiro Hashimoto et al. All rights reserved. Mon, 18 Mar 2013 17:29:39 +0000 http://www.hindawi.com/journals/ijn/2013/703038/ Objective. We aimed to demonstrate safety and efficacy of intravenous (IV) low molecular weight iron dextran (LMWID) during treatment of anemic stage 3 and 4 chronic kidney disease (CKD) patients. Methods. Efficacy data was obtained by retrospective chart review of 150 consecutively enrolled patients. Patients were assigned per protocol to oral or IV iron, with IV iron given to those with lower iron stores and/or hemoglobin. Iron and darbepoetin were administered to achieve and maintain hemoglobin at 10–12 g/dL. Efficacy endpoints were mean hemoglobin and change in iron indices approximately 30 and 60 days after enrollment. Safety data was obtained by retrospective review of reported adverse drug events (ADEs) following 1699 infusions of LMWID (0.5–1.0 g). Results. Mean hemoglobin, iron saturation, and ferritin increased significantly from baseline to 60 days in patients assigned to LMWID (hemoglobin: 11.3 versus 9.4 g/dL; iron saturation: 24% versus 12.9%; ferritin: 294.7 versus 134.7 ng/mL; all ). Iron stores and hemoglobin were maintained in the group assigned to oral iron. Of 1699 iron dextran infusions, three ADEs occurred. Conclusions. Treatment of anemia in CKD stages 3 and 4 with LMWID and darbepoetin is efficacious. The serious ADE rate was 0.06% per infusion. Lenar Yessayan, Ankur Sandhu, Anatole Besarab, Alexy Yessayan, Stan Frinak, Gerard Zasuwa, and Jerry Yee Copyright © 2013 Lenar Yessayan et al. All rights reserved. Sat, 16 Mar 2013 13:41:11 +0000 http://www.hindawi.com/journals/ijn/2013/650847/ Sudden cardiac death and atherosclerosis have a major impact on cardiovascular mortality in chronic kidney disease (CKD). Inflammation with elevated high-sensitive C-reactive protein (hs-CRP) is involved in both sudden cardiac death and atherosclerosis, and decreased heart rate variability (HRV) is a predictor of both sudden cardiac death and atherosclerosis. Haptoglobin (Hp) is characterised by three genotypes (1-1, 2-1, and 2-2) with different antioxidant abilities. The aim was to examine whether HRV and hs-CRP were associated with Hp genotype in CKD patients. Fifty-six patients with CKD stage 2–5 were included. Hp genotype was determined by high-performance liquid chromatography. HRV was analysed from the 24 h Holter recordings. Hs-CRP was measured using an immunoturbidimetric assay. The results show that the HRV indices SDNN and SDANN were significantly lower in the Hp 2-2 patients ( and 0.04, resp.). In an adjusted linear regression model, Hp 2-2 was associated with both SDNN () and SDANN (). Hs-CRP was higher in the Hp 2-2 patients (). In an adjusted linear regression model, the association between Hp 2-2 and hs-CRP remained significant (). In conclusion, a negative association was observed between Hp 2-2 and HRV, and Hp 2-2 was positively associated with hs-CRP in CKD patients. Charlotte Strandhave, My Svensson, Henrik Krarup, and Jeppe Hagstrup Christensen Copyright © 2013 Charlotte Strandhave et al. All rights reserved. Wed, 27 Feb 2013 15:47:19 +0000 http://www.hindawi.com/journals/ijn/2013/818537/ Background. The natural history of idiopathic membranous nephropathy and recurrent disease in transplants is variable. We performed a retrospective cohort study of renal transplant recipients with a primary diagnosis of idiopathic membranous nephropathy. We aimed to establish patterns of disease recurrence and to identify factors associated with disease recurrence. Methods. We accessed the Irish renal transplant database to identify patients with biopsy-proven idiopathic membranous nephropathy in receipt of a renal transplant between 1982 and 2010. A detailed medical chart review was performed in all cases, and a senior renal histopathologist reviewed all histology specimens. Results. The outcomes of 32 patients, in receipt of 36 grafts, are reported. There was a male preponderance (). Significant graft dysfunction, directly attributable to recurrent disease, was evident in 31% of cases at 10 years. There was no significant association between time on dialysis, HLA mismatch, occurrence of rejection, and the development of recurrent membranous disease. One patient was retransplanted twice; all three grafts were lost to aggressive recurrent membranous disease. Conclusions. It remains difficult to identify those that will develop recurrent membranous nephropathy. Almost one third of patients in this cohort developed clinically significant recurrent disease at 10 years. Claire Kennedy, Carol Traynor, Patrick O'Kelly, Anthony Dorman, and Peter J. Conlon Copyright © 2013 Claire Kennedy et al. All rights reserved. Tue, 12 Feb 2013 11:43:54 +0000 http://www.hindawi.com/journals/ijn/2013/878041/ Purpose. We sought to investigate the effect of IV iron repletion on platelet (PLT) counts in CKD patients with iron deficiency anemia (IDA). Methods. We conducted a retrospective chart review, including all patients with CKD and IDA who were treated with iron dextran total dose infusion (TDI) between 2002 and 2007. Patient demographics were noted, and laboratory values for creatinine, hemoglobin (Hgb), iron stores and PLT were recorded pre- and post-dose. Results. 153 patients received a total of 251 doses of TDI (mean ± SD = 971 ± 175 mg); age years and Creatinine  mg/dL. All CKD stages were represented (stage 4 commonest). Hgb and Fe stores improved post-TDI (). There was a very mild decrease in PLT (pre-TDI 255 versus post-TDI 244, ). The mild reduction in PLT after TDI remained non-significant () when data was stratified by molecular weight (MW) of iron dextran used (low versus high), as well as by dose administered (<1000 versus ≥1000 mg). Linear regression analysis between pre-dose PLT and Tsat and Fe showed R2 of 0.01 and 0.04, respectively. Conclusion. Correction of iron deficiency did not significantly lower PLT in CKD patients, regardless of MW or dose used. Correlation of PLT to severity of iron deficiency was very weak. Neville R. Dossabhoy, Rebecca Gascoyne, and Steven Turley Copyright © 2013 Neville R. Dossabhoy et al. All rights reserved. Sun, 10 Feb 2013 10:38:28 +0000 http://www.hindawi.com/journals/ijn/2013/263285/ Mesothelial-to-mesenchymal transition (MMT) is an autoregulated physiological process of tissue repair that in uncontrolled conditions, such as peritoneal dialysis (PD), can lead to peritoneal fibrosis. The maximum expression of sclerotic peritoneal syndromes (SPS) is the encapsulating peritoneal sclerosis (EPS) for which no specific treatment exists. The SPS includes a wide range of peritoneal fibrosis that appears progressively and is considered as a reversible process, while EPS does not. EPS is a serious complication of PD characterized by a progressive intra-abdominal inflammatory process that results in bridles and severe fibrous tissue formation which cover and constrict the viscera. Recent studies show that transdifferentiated mesothelial cells isolated from the PD effluent correlate very well with the clinical events such as the number of hemoperitoneum and peritonitis, as well as with PD function (lower ultrafiltration and high Cr-MTC). In addition, in peritoneal biopsies from PD patients, the MMT correlates very well with anatomical changes (fibrosis and angiogenesis). However, the pathway to reach EPS from SPS has not been fully and completely established. Herein, we present important evidence pointing to the MMT that is present in the initial peritoneal fibrosis stages and it is perpetual over time, with at least theoretical possibility that MMT initiated the fibrosing process to reach EPS. Jesús Loureiro, Guadalupe Gónzalez-Mateo, José Jimenez-Heffernan, Rafael Selgas, Manuel López-Cabrera, and Abelardo Aguilera Peralta Copyright © 2013 Jesús Loureiro et al. All rights reserved. Tue, 29 Jan 2013 10:34:02 +0000 http://www.hindawi.com/journals/ijn/2013/841518/ There are limited data on the application of the RIFLE criteria among patients with severe malaria. This retrospective study was conducted by reviewing 257 medical records of adult hospitalized patients with severe falciparum malaria at the Mae Sot General Hospital, Tak province in the northern part of Thailand. The aims of this study were to determine the incidence of acute renal failure (ARF) in patients with severe falciparum malaria and its association with RRT as well as in-hospital mortality. Using the WHO 2006 criteria, ARF was the second most common complication with incidence of 44.7% (115 patients). The requirement for RRT was 45.2% (52 patients) and the in-hospital mortality was 31.9% (36 patients). Using the RIFLE criteria, 73.9% (190 patients) had acute kidney injury (AKI). The requirement for RRT was 11.6% (5 patients) in patients with RIFLE-I and 44.9% (48 patients) in patients with RIFLE-F. The in-hospital mortality gradually increased with the severity of AKI. The requirement for RRT () and the in-hospital mortality () were significantly higher in ARF patients with severe falciparum malaria using both criteria. In conclusion, the RIFLE criteria could be used for diagnosing AKI and predicting outcomes in patients with severe malaria similar to the WHO 2006 criteria. Vipa Thanachartwet, Varunee Desakorn, Duangjai Sahassananda, Ko Ko Yazar Kyaw Win, and Thanom Supaporn Copyright © 2013 Vipa Thanachartwet et al. All rights reserved. Mon, 28 Jan 2013 15:27:34 +0000 http://www.hindawi.com/journals/ijn/2013/940106/ Peritoneal dialysis catheter (PDC) is the lifeline of peritoneal dialysis (PD) patients. One of the critical issues for successful PD is a well-functioning PDC which is timely inserted. It is the implantation technique rather than the catheter design that determines the outcome of the catheter. Dedication in acquiring the appropriate technique is vital to the success of a PD program. In this paper, we discuss the pros and cons of various techniques used for PDC implantation. A detailed description of PDC implantation by using the minilaparotomy method is presented. We strongly recommend mini-laparotomy as the method of choice for PDC implantation by nephrologists. T. Yip, S. L. Lui, and W. K. Lo Copyright © 2013 T. Yip et al. All rights reserved. Thu, 17 Jan 2013 17:29:02 +0000 http://www.hindawi.com/journals/ijn/2013/954956/ Patients on hemodialysis (HD) have a high burden of chronic inflammation induced associated with multiple comorbidities including poor nutritional status. Endotoxin (ET) is a Gram-negative bacterial cell wall component and a potent stimulus for innate immune system activation leading to the transcription of proinflammatory cytokines (e.g., IL-1, IL-6, and TNFα) that adversely affect protein metabolism and nutrition. Several cross-sectional observational studies have found that elevated serum ET concentrations in hemodialysis patients are associated with lower serum albumin, higher proinflammatory cytokine, and C-reactive protein concentrations. Possible sources of ET in the systemic circulation are bacterial translocation from the gastrointestinal tract and iron supplementation, potentially leading to intestinal bacterial overgrowth. Sevelamer is a nonabsorbable hydrogel approved for use as a phosphate binder in HD patients. Reductions in serum ET concentrations in hemodialysis patients have been observed with sevelamer therapy in observational studies and the few published interventional studies. Reduction of ET concentrations was associated with concomitant reductions in TNFα, IL-6, and CRP and improvement in serum albumin in the majority of these small studies. Additional studies are needed to evaluate the potential effects of sevelamer treatment on nutritional status in chronic kidney disease (CKD) patients with elevated ET. Natsuki Kubotera, Alexander J. Prokopienko, Adinoyi O. Garba, and Amy Barton Pai Copyright © 2013 Natsuki Kubotera et al. All rights reserved. Tue, 08 Jan 2013 10:30:24 +0000 http://www.hindawi.com/journals/ijn/2013/424915/ The efficacy and safety of icodextrin has been well established. In this paper, we will discuss the pharmacokinetics and biocompatibility of icodextrin and its clinical effect on fluid management in peritoneal dialysis patients. Novel strategies for its prescription for peritoneal dialysis patients with inadequate ultrafiltration are reviewed. Periklis Dousdampanis, Konstantina Trigka, and Joanne M. Bargman Copyright © 2013 Periklis Dousdampanis et al. All rights reserved. Tue, 08 Jan 2013 09:06:26 +0000 http://www.hindawi.com/journals/ijn/2013/827459/ In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I  > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3 mg/dl increase. Standardized mortality rates (SMR) were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI). 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29–1.42), 1.84 (1.66–2.04), and 2.25 (2.07–2.45)) and was 0.98 (0.78–1.20) in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances. Charuhas V. Thakar, Annette Christianson, Peter Almenoff, Ron Freyberg, and Marta L. Render Copyright © 2013 Charuhas V. Thakar et al. All rights reserved. Mon, 31 Dec 2012 00:00:00 +0000 http://www.hindawi.com/journals/ijn/2012/427589/ Rudolph A. Rodriguez, Li-Li Hsiao, J. Kevin Tucker, and David Pugsley Copyright © 2012 Rudolph A. Rodriguez et al. All rights reserved. Thu, 27 Dec 2012 17:10:16 +0000 http://www.hindawi.com/journals/ijn/2012/940320/ Background. The use of sodium polystyrene sulfonate in decreasing serum potassium has recently been questioned due to the lack of documented effectiveness. Methods. A retrospective cohort analysis of all hospitalized patients who received sodium polystyrene sulfonate over four months was performed. The change in serum potassium was noted over a period of 24 hours. Patients who received any other form of potassium-altering drug or treatment were excluded. Results. The administration of sodium polystyrene sulfonate reduced serum potassium by 16.7% () as compared to the baseline serum potassium over a period of 24 hours. During this same time, no change in serum creatinine was identified (). In addition, there was no correlation between potassium and creatinine change (r2 = 0.0004 and ). Patients with higher initial serum potassium (≥5.6 mEq/L) reduced their potassium concentration 4% more than those with initial serum potassium of <5.6 mEq/L; however, this reduction did not reach statistical significance (). There was no significant difference in the effectiveness of 15 gm and 30 gm resin preparation (). Thirteen deaths were noted in our cohort, of which one death was due to ischemic colitis. Conclusion. We conclude that sodium polystyrene sulfonate is effective in lowering serum potassium. Shaifali Sandal, Hatim Karachiwala, John Noviasky, Dongliang Wang, William C. Elliott, and David F. Lehmann Copyright © 2012 Shaifali Sandal et al. All rights reserved. Wed, 26 Dec 2012 15:18:10 +0000 http://www.hindawi.com/journals/ijn/2012/483748/ Background. Transcatheter aortic valve implantation (TAVI) is widely used in high risk patients (pts) with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI). We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age years; logistic EuroSCORE ). AKI definition was a creatinine rise of mol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%). Baseline creatinine was higher in AKI pts (126.4  59.2 mol/L versus 108.7  45.1 mol/L, ). Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, ) and long-term mortality (43% versus 18%, ) were higher; hospital stay was longer in AKI pts (20  12 versus 15  10 days, ). Predicted renal failure calculated STS Score was similar (8.0  5.0% [AKI] versus 7.1  4.0% [non-AKI], ) and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential. Katrin Gebauer, Gerhard-Paul Diller, Gerrit Kaleschke, Gregor Kerckhoff, Nasser Malyar, Matthias Meyborg, Holger Reinecke, and Helmut Baumgartner Copyright © 2012 Katrin Gebauer et al. All rights reserved. Sun, 23 Dec 2012 09:14:42 +0000 http://www.hindawi.com/journals/ijn/2012/720429/ There is consistent evidence linking excessive dietary sodium intake to risk factors for cardiovascular disease and chronic kidney disease (CKD) progression in CKD patients; however, additional research is needed. In research trials and clinical practice, implementing and monitoring sodium intake present significant challenges. Epidemiological studies have shown that sodium intake remains high, and intervention studies have reported varied success with participant adherence to a sodium-restricted diet. Examining barriers to sodium restriction, as well as factors that predict adherence to a low sodium diet, can aid researchers and clinicians in implementing a sodium-restricted diet. In this paper, we critically review methods for measuring sodium intake with a specific focus on CKD patients, appraise dietary adherence, and factors that have optimized sodium restriction in key research trials and discuss barriers to sodium restriction and factors that must be considered when recommending a sodium-restricted diet. Emma J. McMahon, Katrina L. Campbell, David W. Mudge, and Judith D. Bauer Copyright © 2012 Emma J. McMahon et al. All rights reserved. Thu, 20 Dec 2012 18:15:34 +0000 http://www.hindawi.com/journals/ijn/2012/483250/ Background. Peritonitis represents a major complication of peritoneal dialysis (PD). The aim of this paper was to systematically collect data on patient-related risk factors for PD-associated peritonitis, to analyze the methodological quality of these studies, and to summarize published evidence on the particular risk factors. Methods. Studies were identified by searches of Pubmed (1990–2012) and assessed for methodological quality by using a modified form of the STROBE criteria. Results. Thirty-five methodologically acceptable studies were identified. The following nonmodifiable risk factors were considered valid and were associated with an increased risk of peritonitis: ethnicity, female gender, chronic lung disease, coronary artery disease, congestive heart failure, cardiovascular disease, hypertension, antihepatitis C virus antibody positivity, diabetes mellitus, lupus nephritis or glomerulonephritis as underlying renal disease, and no residual renal function. We also identified the following modifiable, valid risk factors for peritonitis: malnutrition, overweight, smoking, immunosuppression, no use of oral active vitamin D, psychosocial factors, low socioeconomic status, PD against patient’s choice, and haemodialysis as former modality. Discussion. Modifiable and nonmodifiable risk factors analyzed in this paper might serve as a basis to improve patient care in peritoneal dialysis. Julia Kerschbaum, Paul König, and Michael Rudnicki Copyright © 2012 Julia Kerschbaum et al. All rights reserved. Wed, 19 Dec 2012 14:36:21 +0000 http://www.hindawi.com/journals/ijn/2012/673631/ Objective. This paper assessed the effectiveness of pre-, pro-, and synbiotics on reducing two protein-bound uremic toxins, p-cresyl sulphate (PCS) and indoxyl sulphate (IS). Methods. English language studies reporting serum, urinary, or fecal PCS and/or IS (or their precursors) following pre-, pro-, or synbiotic interventions (>1 day) in human adults were included. Population estimates of differences in the outcomes between the pre- and the postintervention were estimated for subgroups of studies using four meta-analyses. Quality was determined using the GRADE approach. Results. 19 studies met the inclusion criteria, 14 in healthy adults and five in haemodialysis patients. Eight studies investigated prebiotics, six probiotics, one synbiotics, one both pre- and probiotics, and three studies trialled all three interventions. The quality of the studies ranged from moderate to very low. 12 studies were included in the meta-analyses with all four meta-analyses reporting statistically significant reductions in IS and PCS with pre- and probiotic therapy. Conclusion. There is a limited but supportive evidence for the effectiveness of pre- and probiotics on reducing PCS and IS in the chronic kidney disease population. Further studies are needed to provide more definitive findings before routine clinical use can be recommended. Megan Rossi, Kerenaftali Klein, David W. Johnson, and Katrina L. Campbell Copyright © 2012 Megan Rossi et al. All rights reserved. Sun, 16 Dec 2012 16:05:50 +0000 http://www.hindawi.com/journals/ijn/2012/139565/ To evaluate the significance of the renal resistive index (RI) as a noninvasive marker of renal histological damage and a prognostic indicator, we examined RI by Doppler ultrasonography in 202 chronic kidney disease (CKD) patients who underwent renal biopsy. RI increased as the CKD stage progressed and correlated with age, systolic blood pressure, estimated glomerular filtration rate (eGFR), and renal histological changes, including glomerulosclerosis, arteriolosclerosis, and tubulointerstitial damage. Prognostic evaluation with a median follow-up period of 38.5 months revealed that patients with (high RI group, ) had significantly poorer renal survival than those with (normal RI group, ) and (high-normal RI group, ). The patients in the high-normal RI group showed good response to steroids. However, in the high RI group, steroid therapy did not significantly improve renal survival. Of the clinical indices studied, , hypertension, proteinuria, and low eGFR at diagnosis were independent risk factors for worsening renal dysfunction. In conclusion, RI in CKD patients was considered as a marker of renal function, histological damage, and renal prognosis, and a possible determinant of indication for steroids. Kikuno Hanamura, Akihiro Tojo, Satoshi Kinugasa, Kensuke Asaba, and Toshiro Fujita Copyright © 2012 Kikuno Hanamura et al. All rights reserved. Tue, 11 Dec 2012 09:49:37 +0000 http://www.hindawi.com/journals/ijn/2012/156286/ Ayşe Balat, Halima Resic, Guido Bellinghieri, and Ali Anarat Copyright © 2012 Ayşe Balat et al. All rights reserved. Wed, 28 Nov 2012 13:38:27 +0000 http://www.hindawi.com/journals/ijn/2012/812609/ Peritoneal dialysis (PD) is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis. Despite these benefits, uptake of PD remains relatively low, especially in developed countries. Wider implementation of PD is compromised by higher technique failure from infections (e.g., PD peritonitis) and ultrafiltration failure. These are inevitable consequences of peritoneal injury, which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “unphysiologic” composition. In order to overcome these barriers, a number of more biocompatible PD fluids, with neutral pH, low glucose degradation product content, and bicarbonate buffer have been manufactured over the past two decades. Several preclinical studies have demonstrated their benefit in terms of improvement in host cell defence, peritoneal membrane integrity, and cytokine profile. This paper aims to review randomised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes. Yeoungjee Cho, Sunil V. Badve, Carmel M. Hawley, Kathryn Wiggins, and David W. Johnson Copyright © 2012 Yeoungjee Cho et al. All rights reserved. Wed, 28 Nov 2012 08:23:44 +0000 http://www.hindawi.com/journals/ijn/2012/760580/ A growing body of evidence supports the concept that changes in the intrauterine milieu during “sensitive” periods of embryonic development or in infant diet after birth affect the developing individual, resulting in general health alterations later in life. This phenomenon is referred to as “developmental programming” or “developmental origins of health and disease.” The risk of developing late-onset diseases such as hypertension, chronic kidney disease (CKD), obesity or type 2 diabetes is increased in infants born prematurely at <37 weeks of gestation or in low birth weight (LBW) infants weighing <2,500 g at birth. Both genetic and environmental events contribute to the programming of subsequent risks of CKD and hypertension in premature or LBW individuals. A number of observations suggest that susceptibility to subsequent CKD and hypertension in premature or LBW infants is mediated, at least in part, by reduced nephron endowment. The major factors influencing in utero environment that are associated with a low final nephron number include uteroplacental insufficiency, maternal low-protein diet, hyperglycemia, vitamin A deficiency, exposure to or interruption of endogenous glucocorticoids, and ethanol exposure. This paper discusses the effect of premature birth, LBW, intrauterine milieu, and infant feeding on the development of hypertension and renal disease in later life as well as examines the role of the kidney in developmental programming of hypertension and CKD. Euming Chong and Ihor V. Yosypiv Copyright © 2012 Euming Chong and Ihor V. Yosypiv. All rights reserved. Tue, 27 Nov 2012 09:41:12 +0000 http://www.hindawi.com/journals/ijn/2012/361528/ Aims of our study were to describe the long-term survival in patients surviving an acute tubular necrosis (ATN) episode and determine factors associated with late mortality. We performed a prospective cohort study that evaluated the long-term outcome of 212 patients surviving an ATN episode. Mortality at the end of followup was 24.5%, and the probability of these patients being alive 5 years after discharge was 55%. During the followup, 4.7% of patients needed chronic dialysis. Univariate analysis showed that previous CKD (), cardiovascular disease (), age greater than 60 years (), and higher SCr baseline (), after 12 months () and 36 months (), were predictors of long-term mortality. In multivariate analysis, older age (HR = 6.4, CI 95% = 1.2–34.5, ) and higher SCr after 12 months (HR = 2.1, 95% CI 95% = 1.14–4.1, ) were identified as risk factors associated with late mortality. In conclusion, 55% of patients surviving an ATN episode were still alive, and less than 5% required chronic dialysis 60 months later; older age and increased Scr after 12 months were identified as risk factors associated with late death. G. A. Brito, A. L. Balbi, J. M. G. Abrão, and D. Ponce Copyright © 2012 G. A. Brito et al. All rights reserved. Mon, 19 Nov 2012 19:08:08 +0000 http://www.hindawi.com/journals/ijn/2012/302974/ Kidney graft survival has been mainly evaluated using an up to 10-year threshold. Instead, in this study our aim was to evaluate predictive variables that impact long-term kidney graft survival (≥10 years). We enrolled 892 patients in our analysis: 638 patients with functioning graft at 10 years PT and 254 patients with graft failure at 10 years PT (considering patient death with a functioning graft <10 years PT as graft failure). Between groups comparisons were done using Mann-Whitney and chi-square test. To determine independent predictive variables for long-term graft survival a multivariate-adjusted logistic regression was performed. Significant predictors of long term graft survival were lower 12-month PT creatinine (, ), lower donor age (, ), shorter time on dialysis (, ), recipient positive CMV IgG (, ), absence of AR episodes (, ), 0 to 1 (versus 2) HLA-B mismatch (, ), and recipients male gender (, ). Our results show that an early KT, younger donor age, and an optimal first year graft function are of paramount importance for long-term graft survival. Measures that address these issues (careful donor selection, preemptive KT, and effective immunosuppressive protocols) are still warranted. Anabela Malho Guedes, Jorge Malheiro, Isabel Fonseca, La Salete Martins, Sofia Pedroso, Manuela Almeida, Leonídio Dias, António Castro Henriques, and António Cabrita Copyright © 2012 Anabela Malho Guedes et al. All rights reserved. Mon, 19 Nov 2012 14:08:49 +0000 http://www.hindawi.com/journals/ijn/2012/861296/ Background. Human immunodeficiency virus (HIV) is now a confirmed risk factor for kidney disease with an increased burden in persons of African descent. Method. We measured the serum cystatin C levels of 205 ART-naive, HIV-infected children by an ELISA technique and compared them with the levels of apparently healthy children. Result. The mean ± SD serum cystatin C level of children with HIV infection was 1.01 ± 0.44 mg/L, significantly higher than the mean value in the control group, that is, 0.72 ± 0.20 mg/L (). The mean ± SD cystatin C-based estimated GFR of children with HIV infection was 102.7 ± 31.0 mL/min/1.73 m2, significantly lower than 126.9 ± 28.5 mL/min/1.73 m2 in the control group, (). A significantly higher proportion of HIV-infected children compared to controls had eGFR < 90 mL/min/1.73 m2 (21.5% versus 5.4%; ). The prevalence of chronic kidney disease (CKD) among the HIV-infected children was 10.7%. The cystatin C-based eGFR of the HIV-infected children ≥5 years old correlated positively with their CD4 count (;  ). Conclusion. There is a high prevalence of CKD among HIV-infected children, requiring regular monitoring of their kidney function using a cystatin C-based method. Moses Temidayo Abiodun, Nosakhare J. Iduoriyekemwen, and Phillip O. Abiodun Copyright © 2012 Moses Temidayo Abiodun et al. All rights reserved. Tue, 06 Nov 2012 15:57:45 +0000 http://www.hindawi.com/journals/ijn/2012/718085/ Objective. Nanotechnology has the potential to improve hemodialysis membrane technology. Thus, a major objective is to understand how to enhance toxic solute fluxes across these membranes. The aim of this concept building study is to review the application of irreversible thermodynamic (IT) to solute fluxes. Methods. We expanded the application of the Nernst-Planck equation to include the Kedem-Katchalsky equation, pH, membrane thickness, pore size, and electric potential as variables. Results. (1) Reducing the membrane’s thickness from 25 μm to 25 nm increased the flux of creatinine, -microglobulin, and tumor necrosis factor-α (TNF-α) by a thousand times but prevented completely albumin flux, (2) applying an electric potential of 50–400 mV across the membrane enhanced the flux of the respective molecules by , , and  mol/s, and (3) changing the pH from 7.35 to 7.42 altered the fluxes minimally. Conclusions. The results supported an argument to investigate the application of IT to study forces of fluxes across membranes. Reducing the membrane’s thickness—together with the application of an electrical potential—qualities achievable by nanotechnology, can enhance the removal of uremic toxins by many folds. However, changing the pH at a specific membrane thickness does not affect the flux significantly. Assem Hedayat, Hamdi Elmoselhi, and Ahmed Shoker Copyright © 2012 Assem Hedayat et al. All rights reserved. Tue, 06 Nov 2012 13:36:48 +0000 http://www.hindawi.com/journals/ijn/2012/304135/ Background. Morphological characterization of hemodialysis membranes is necessary to improve pore design. Aim. To delineate membrane pore structure of a high flux filter, Polyflux 210H. Methods. We used a Joel JSM-6010LV scanning electron microscope (SEM) and a SU6600 Hitachi field emission scanning electron microscope (FESEM) to characterize the pore and fiber morphology. The maximal diameters of selected uremic toxins were calculated using the macromolecular modeling Crystallographic Object-Oriented Toolkit (COOT) software. Results. The mean pore densities on the outermost and innermost surfaces of the membrane were 36.81% and 5.45%, respectively. The membrane exhibited a tortuous structure with poor connection between the inner and outer pores. The aperture’s width in the inner surface ranged between 34 and 45 nm, which is 8.76–11.60 times larger than the estimated maximum diameter of β2-microglobulin (3.88 nm). Conclusion. The results suggest that the diameter size of inner pore apertures is not a limiting factor to middle molecules clearance, the extremely diminished density is. Increasing inner pore density and improving channel structure are strategies to improve clearance of middle molecules. A. Hedayat, J. Szpunar, N. A. P. Kiran Kumar, R. Peace, H. Elmoselhi, and A. Shoker Copyright © 2012 A. Hedayat et al. All rights reserved. Sun, 04 Nov 2012 13:27:39 +0000 http://www.hindawi.com/journals/ijn/2012/912189/ Nephrogenic systemic fibrosis (NSF) is a rare and a debilitating disease noted uncommonly in patients with impaired renal function when exposed to low-stability gadolinium-based contrast agents (Gd-CAs). According to experimental studies, cytokines released by the stimulation of effector cells such as skin macrophages and peripheral blood monocytes activate circulating fibroblasts which play a major role in the development of NSF lesions. The presence of permissive factors, presumably, provides an environment conducive to facilitate the process of fibrosis. Multiple treatment modalities have been tried with variable success rates. More research is necessary to elucidate the underlying pathophysiological mechanisms which could potentially target the initial steps of fibrosis in these patients. This paper attempts to collate the inferences from the in vivo and in vitro experiments to the clinical observations to understand the pathogenesis of NSF. Schematic representations of receptor-mediated molecular pathways of activation of macrophages and fibroblasts by gadolinium and the final pathway to fibrosis are incorporated in the discussion. Tushar Chopra, Kiran Kandukurti, Silvi Shah, Raheel Ahmed, and Mandip Panesar Copyright © 2012 Tushar Chopra et al. All rights reserved.