TY - JOUR A1 - Pippias, Maria A1 - Stel, Vianda S. A1 - Diez, José Maria Abad A1 - Afentakis, Nikolaos A1 - Herrero-Calvo, Jose Antonio A1 - Arias, Manuel A1 - Tomilina, Natalia A1 - Caamaño, Encarnación Bouzas A1 - Buturovic-Ponikvar, Jadranka A1 - Čala, Svjetlana A1 - Caskey, Fergus J. A1 - de la Nuez, Pablo Castro A1 - Cernevskis, Harijs A1 - Collart, Frederic A1 - de la Torre, Ramón Alonso A1 - de los Ángeles García Bazaga, Maria A1 - De Meester, Johan A1 - Díaz, Joan Manuel A1 - Djukanovic, Ljubica A1 - Alamar, Manuel Ferrer A1 - Finne, Patrik A1 - Garneata, Liliana A1 - Golan, Eliezer A1 - González Fernández, Raquel A1 - Gutiérrez Avila, Gonzalo A1 - Heaf, James A1 - Hoitsma, Andries A1 - Kantaria, Nino A1 - Kolesnyk, Mykola A1 - Kramar, Reinhard A1 - Kramer, Anneke A1 - Lassalle, Mathilde A1 - Leivestad, Torbjørn A1 - Lopot, Frantisek A1 - Macário, Fernando A1 - Magaz, Angela A1 - Martín-Escobar, Eduardo A1 - Metcalfe, Wendy A1 - Noordzij, Marlies A1 - Palsson, Runolfur A1 - Pechter, Ülle A1 - Prütz, Karl G. A1 - Ratkovic, Marina A1 - Resić, Halima A1 - Rutkowski, Boleslaw A1 - de Pablos, Carmen Santiuste A1 - Spustová, Viera A1 - Süleymanlar, Gültekin A1 - Van Stralen, Karlijn A1 - Thereska, Nestor A1 - Wanner, Christoph A1 - Jager, Kitty J. T1 - Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report JF - Clinical Kidney Journal N2 - Background This article summarizes the 2012 European Renal Association—European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as ≥65 years). Methods Data provided by 45 national or regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. Individual patient level data were received from 31 renal registries, whereas 14 renal registries contributed data in an aggregated form. The incidence, prevalence and survival probabilities of patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT) and renal transplantation rates for 2012 are presented. Results In 2012, the overall unadjusted incidence rate of patients with ESRD receiving RRT was 109.6 per million population (pmp) (n = 69 035), ranging from 219.9 pmp in Portugal to 24.2 pmp in Montenegro. The proportion of incident patients ≥75 years varied from 15 to 44% between countries. The overall unadjusted prevalence on 31 December 2012 was 716.7 pmp (n = 451 270), ranging from 1670.2 pmp in Portugal to 146.7 pmp in the Ukraine. The proportion of prevalent patients ≥75 years varied from 11 to 32% between countries. The overall renal transplantation rate in 2012 was 28.3 pmp (n = 15 673), with the highest rate seen in the Spanish region of Catalonia. The proportion of patients ≥65 years receiving a transplant ranged from 0 to 35%. Five-year adjusted survival for all RRT patients was 59.7% (95% confidence interval, CI: 59.3–60.0) which fell to 39.3% (95% CI: 38.7–39.9) in patients 65–74 years and 21.3% (95% CI: 20.8–21.9) in patients ≥75 years. KW - end-stage renal disease KW - incidence KW - prevalence KW - renal replacement therapy KW - survival Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150054 VL - 8 IS - 3 ER - TY - JOUR A1 - de Zeeuw, Dick A1 - Akizawa, Tadao A1 - Agarwal, Rajiv A1 - Audhya, Paul A1 - Bakris, George L. A1 - Chin, Melanie A1 - Krauth, Melissa A1 - Lambers Heerspink, Hiddo J. A1 - Meyer, Colin J. A1 - McMurray, John J. A1 - Parving, Hans-Henrik A1 - Pergola, Pablo E. A1 - Remuzzi, Giuseppe A1 - Toto, Robert D. A1 - Vaziri, Nosratola D. A1 - Wanner, Christoph A1 - Warnock, David G. A1 - Wittes, Janet A1 - Chertow, Glenn M. T1 - Rationale and Trial Design of Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes: The Occurrence of Renal Events (BEACON) JF - American Journal of Nephrology N2 - Background: Chronic kidney disease (CKD) associated with type 2 diabetes mellitus constitutes a global epidemic complicated by considerable renal and cardiovascular morbidity and mortality, despite the provision of inhibitors of the renin-angiotensin-aldosterone system (RAAS). Bardoxolone methyl, a synthetic triterpenoid that reduces oxidative stress and inflammation through Nrf2 activation and inhibition of NF-κB was previously shown to increase estimated glomerular filtration rate (eGFR) in patients with CKD associated with type 2 diabetes mellitus. To date, no antioxidant or anti-inflammatory therapy has proved successful at slowing the progression of CKD. Methods: Herein, we describe the design of Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes: the Occurrence of Renal Events (BEACON) trial, a multinational, multicenter, double-blind, randomized, placebo-controlled Phase 3 trial designed to determine whether long-term administration of bardoxolone methyl (on a background of standard therapy, including RAAS inhibitors) safely reduces renal and cardiac morbidity and mortality. Results: The primary composite endpoint is time-to-first occurrence of either end-stage renal disease or cardiovascular death. Secondary endpoints include the change in eGFR and time to occurrence of cardiovascular events. Conclusion: BEACON will be the first event-driven trial to evaluate the effect of an oral antioxidant and anti-inflammatory drug in advanced CKD. KW - clinical trial KW - diabetes mellitus KW - glomerular filtration rate KW - trial design KW - bardoxolone methyl KW - Nrf2 KW - end-stage renal disease KW - cardiovascular death KW - chronic kidney disease Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196832 SN - 0250-8095 SN - 1421-9670 N1 - This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. VL - 37 IS - 3 ER - TY - THES A1 - Sevastiadis, Emmanouil T1 - Mikrokernfrequenz peripherer Lymphozyten bei Dialyse- und Prädialysepatienten sowie bei gesunden Probanden nach in vitro Behandlung mit Methylmethansulfonat T1 - The micronucleus frequency in peripheral blood lymphocytes of patients on hemodialysis, of patients with advanced renal disease und healthy donors after in vitro treatment with methylmethanesulfonate. N2 - Nierenerkrankungen und die dazu gehörige Nierenersatztherapien spiegeln im Verlauf der letzten fünfzig Jahren die rasanten Entwicklungen der heutigen hochtechnisierten Medizin wider. Durch die zunehmende Lebenserwartung der Patienten unter langjährigen Blutreinigungsverfahren werden Probleme sichtbar, die vorher nicht zu erwarten waren, insbesondere ist hier die schwerwiegende Problematik der erhöhten Malignominzidenz in dieser Bevölkerungspopulation hervorzuheben. Die Ursachenforschung und die Prävention dieser erhöhten Malignominzidenz wird immer wichtiger. Die Zahl der Betroffenen steigt kontinuierlich. "Moderne" Erkrankungen wie Diabetes mellitus und arterielle Hypertonie, die zur terminalen Niereninsuffizienz führen, haben die Dimension von Volkserkrankungen erreicht. Die Entstehung von Mikrokernen im Zellplasma neben dem eigentlichen Zellkern steht im dringendem Verdacht, dass sie einen Schritt in der Mutationsinduktion und Kanzerogenese darstellen und/oder diese Entwicklung anzeigen. Die Mikrokernfrequenz wird auch als Marker für eine akzidentelle oder chronische Schädigung des Genmaterials (z.B. nach beruflicher Exposition) genutzt. Auf zellulärer Ebene ist die Mikrokerninduktion auch Zeichen einer herabgesetzten Funktion der DNA-Repairmechanismen. Defekte dieser Mechanismen begünstigen nachgewiesenermaßen die Entstehung von Malignomen aller Art. Ziel der Arbeit war zu zeigen ob die in vivo beobachtete erhöhte Malignominzidenz bei Patienten unter Hämodialyse auch in Mikrokernfrequenzen abgebildet werden kann. Hier wurde die in vitro Behandlung mit einer bekannten kanzerogenen Substanz verwendet, um eine eventuell veränderte zelluläre Antwort in Form von gesteigerter Mikrokernfrequenzen in vitro zu provozieren. Dies wird als indirektes Zeichen der DNA-Repairfähigkeit angesehen. Als Substanz wurde Methylmethansulfonat verwendet. Die dafür modifizierte Methodik mit der Zusatz des kanzerogenen Methylmethansulfonat in Konzentrationen von 10, 20 und 40 µg/ml war ein zusätzlicher Stress für die Zellkulturen. Diese ließ aber in ausreichendem Maße die Vermehrung und Induktion von doppelkernigen Lymphozyten zu, so dass die Registrierung der Mikrokerne glaubhaft und repräsentativ war. Es wurden drei Gruppen von Probanden untersucht: Personen unter Dialyse, Patienten in einem Prädialysestadium und nierengesunde Probanden als Kontrollgruppe. Die Hämodialysepatienten zeigten keinen signifikanten Unterschied im Vergleich zu den Kontrollpatienten. Tendenziell erhöhte Mikrokernraten zeigten die Prädialysepatienten in allen Kategorien. Erwartungsgemäß war bei älteren Personen-Subgruppen eine gesteigterte Rate an in vitro induzierten Mikrokernen nach Erhöhung der kanzerogenen Substanzkonzentration zu finden. Es müssen sicherlich weitere Faktoren identifiziert werden, um den genetischen Schaden durch die verminderte DNA-Repairkapazität in Form von Mikrokernen zuverlässig abbilden zu können. Hier könnten eine Mindestdauer der Dialyse von 10 Jahren sowie ein Kreatininwert von über 5 mg/dl eine entscheidende Rolle spielen. N2 - End-stage renal disease (ESRD) patients on hemodialysis or renal transplantation patients have an increased incidence of cancer compared with the general human population. Various factors associated with renal failure and its therapeutic treatment may favour malignant transformation and cancer formation. The induction of micronuclei in cytoplasm is used as a marker of chronic or accidental genetic damage and is well established as a standard method for monitoring chromosome damage in human populations. The incidence of micronuclei seems to correlated with DNA repair processes. A reduced DNA repair capacity is associated with enhanced incidence of malignancy. This study investigated the spontaneous micronuclei frequency in peripheral blood lymphocytes of 10 patients on hemodialysis, 10 patients with advanced chronic renal failure (creatine level 3.0 mg/dl- 8.2 mg/dl) and 10 healthy non smoking donors in age- and sex-matched groups with the cytokinesis-block micronucleus assay (CBMN assay) The micronuclei frequency has also been determinated after treatment of the lymphocytes culture with 10, 20 and 40 µg/ml of methyl methanesulfonate. The cultivation of these lymphocytes has shown reliable and representative results. There was no significant difference regarding the micronuclei frequency between the 3 groups. The group of patients with advanced chronic renal failure and the subgroup of long-term (more than 10 years) hemodialysis patients tended to show increased micronuclei frequencies in all age groups compared with all ESRD patients and the healthy control persons. In conclusion, more studies will have to be conducted in the future in order to identify the factors for an increased incidence of malignancy in those patients. KW - Hämodialyse KW - Mikrokerne KW - Mikrokernfrequenz KW - Hämodialyse KW - terminale Niereninsuffizienz KW - Cytochalasin-B micronucleus assay KW - Methymethansulfonat KW - micronuclei KW - end-stage renal disease KW - ESDR KW - cytokinesis-block micronucleus assay KW - methyl methanesulfonate Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-33283 ER - TY - THES A1 - Kirsch, Artur T1 - Klinische Performance und Biokompatibilität der PUREMA® H-Dialysemembran T1 - Clinical performance and biocompatibility of the PUREMA® H dialysis membrane N2 - Im Rahmen einer randomisierten, prospektiven Cross-over-Studie wurden während der Hämodialyse an chronisch dialysepflichtigen Patienten standardisiert Parameter der Dialyseeffektivität und Biokompatibilität einer neuen, mittels einem Polyelektrolytadditiv modifizierten Dialysemembran, PUREMA® H, im Vergleich zu einer Kontrolldialysemembran, Helixone®, gemessen. Im Vergleich zur Kontrollmembran wies die PUREMA® H-Membran eine verbesserte Entfernung kleinmolekulargewichtiger Eiweiße incl. 2-Mikroglobulin und eine insbesondere für die Komplementaktivierung optimierte Biokompatibilität auf. N2 - In a prospective, randomized, cross-over study on maintenance dialysis patients, a new polyelectrolyte modified hemodialysis membrane, PUREMA® H, was compared to a control membrane, Helixone®, during haemodialysis. Parameters of dialysis efficacy and biocompatibility were measured in a standardized manner. Compared to control, PUREMA® H showed a significantly higher removal of low-molecular-weight proteins, including beta 2-microglobulin and an optimized biocompatibility particulary in regard to complement system activation. KW - Hämodialyse KW - Klinisches Experiment KW - Kontrollierte klinische Studie KW - Chronische Niereninsuffizienz KW - Biokompatibilität KW - Performance KW - Dialysatorleistung KW - terminale Niereninsuffizienz KW - haemodialysis KW - biocompatibility KW - dialysis membrane KW - end-stage renal disease KW - performance Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-34717 ER - TY - JOUR A1 - Krieter, Detlef H. A1 - Kerwagen, Simon A1 - Rüth, Marieke A1 - Lemke, Horst-Dieter A1 - Wanner, Christoph T1 - Differences in dialysis efficacy have limited effects on protein-bound uremic toxins plasma levels over time JF - Toxins N2 - The protein-bound uremic toxins para-cresyl sulfate (pCS) and indoxyl sulfate (IS) are associated with cardiovascular disease in chronic renal failure, but the effect of different dialysis procedures on their plasma levels over time is poorly studied. The present prospective, randomized, cross-over trial tested dialysis efficacy and monitored pre-treatment pCS and IS concentrations in 15 patients on low-flux and high-flux hemodialysis and high-convective volume postdilution hemodiafiltration over six weeks each. Although hemodiafiltration achieved by far the highest toxin removal, only the mean total IS level was decreased at week three (16.6 ± 12.1 mg/L) compared to baseline (18.9 ± 13.0 mg/L, p = 0.027) and to low-flux dialysis (20.0 ± 12.7 mg/L, p = 0.021). At week six, the total IS concentration in hemodiafiltration reached the initial values again. Concentrations of free IS and free and total pCS remained unaltered. Highest beta2-microglobulin elimination in hemodiafiltration (p < 0.001) led to a persistent decrease of the plasma levels at week three and six (each p < 0.001). In contrast, absent removal in low-flux dialysis resulted in rising beta2-microglobulin concentrations (p < 0.001). In conclusion, this trial demonstrated that even large differences in instantaneous protein-bound toxin removal by current extracorporeal dialysis techniques may have only limited impact on IS and pCS plasma levels in the longer term. KW - protein-bound uremic toxins KW - end-stage renal disease KW - hemodialysis KW - hemodiafiltration KW - dialysis adequacy Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201770 VL - 11 IS - 4 ER -