TY - JOUR A1 - Chapdelaine, Isabelle A1 - de Roij van Zuijdewijn, Camiel L.M. A1 - Mostovaya, Ira M. A1 - Lévesque, Renée A1 - Davenport, Andrew A1 - Blankestijn, Peter J. A1 - Wanner, Christoph A1 - Nubé, Menso J. A1 - Grooteman, Muriel P.C. T1 - Optimization of the convection volume in online post-dilution haemodiafiltration: practical and technical issues JF - Clinical Kidney Journal N2 - In post-dilution online haemodiafiltration (ol-HDF), a relationship has been demonstrated between the magnitude of the convection volume and survival. However, to achieve high convection volumes (>22 L per session) detailed notion of its determining factors is highly desirable. This manuscript summarizes practical problems and pitfalls that were encountered during the quest for high convection volumes. Specifically, it addresses issues such as type of vascular access, needles, blood flow rate, recirculation, filtration fraction, anticoagulation and dialysers. Finally, five of the main HDF systems in Europe are briefly described as far as HDF prescription and optimization of the convection volume is concerned. KW - convection volume KW - haemodiafiltration KW - dialysis Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150020 VL - 8 IS - 2 ER - TY - JOUR A1 - Schneider, Andreas A1 - Gutjahr-Lengsfeld, Lena A1 - Ritz, Eberhard A1 - Scharnagl, Hubert A1 - Gelbrich, Götz A1 - Pilz, Stefan A1 - Macdougall, Iain C. A1 - Wanner, Christoph A1 - Drechsler, Christiane T1 - Longitudinal Assessments of Erythropoietin-Stimulating Agent Responsiveness and the Association with Specific Clinical Outcomes in Dialysis Patients JF - Nephron Clinical Practice N2 - Background: Dose requirements of erythropoietin-stimulating agents (ESAs) can vary considerably over time and may be associated with cardiovascular outcomes. We aimed to longitudinally assess ESA responsiveness over time and to investigate its association with specific clinical end points in a time-dependent approach. Methods: The German Diabetes and Dialysis study (4D study) included 1,255 diabetic dialysis patients, of whom 1,161 were receiving ESA treatment. In those patients, the erythropoietin resistance index (ERI) was assessed every 6 months during a median follow-up of 4 years. The association between the ERI and cardiovascular end points was analyzed by time-dependent Cox regression analyses with repeated ERI measures. Results: Patients had a mean age of 66 ± 8.2 years; 53% were male. During follow-up, a total of 495 patients died, of whom 136 died of sudden death and 102 of infectious death. The adjusted and time-dependent risk for sudden death was increased by 19% per 5-unit increase in the ERI (hazard ratio, HR = 1.19, 95% confidence interval, CI = 1.07-1.33). Similarly, mortality increased by 25% (HR = 1.25, 95% CI = 1.18-1.32) and infectious death increased by 27% (HR = 1.27, 95% CI = 1.13-1.42). Further analysis revealed that lower 25-hydroxyvitamin D levels were associated with lower ESA responsiveness (p = 0.046). Conclusions: In diabetic dialysis patients, we observed that time-varying erythropoietin resistance is associated with sudden death, infectious complications and all-cause mortality. Low 25-hydroxyvitamin D levels may contribute to a lower ESA responsiveness. KW - dialysis KW - erythropoietin KW - diabetes KW - epidemiology Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196511 SN - 1660-2110 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 - 128 IS - 1-2 ER - TY - JOUR A1 - Weidemann, F. A1 - Niemann, M. A1 - Stork, S. A1 - Breunig, F. A1 - Beer, M. A1 - Sommer, C. A1 - Herrmann, S. A1 - Ertl, G. A1 - Wanner, C. T1 - Long-term outcome of enzyme-replacement therapy in advanced Fabry disease: evidence for disease progression towards serious complications JF - Journal of Internal Medicine N2 - The long-term effects of enzyme-replacement therapy (ERT) in Fabry disease are unknown. Thus, the aim of this study was to determine whether ERT in patients with advanced Fabry disease affects progression towards 'hard' clinical end-points in comparison with the natural course of the disease. METHODS: A total of 40 patients with genetically proven Fabry disease (mean age 40 ± 9 years; n = 9 women) were treated prospectively with ERT for 6 years. In addition, 40 subjects from the Fabry Registry, matched for age, sex, chronic kidney disease stage and previous transient ischaemic attack (TIA), served as a comparison group. The main outcome was a composite of stroke, end-stage renal disease (ESRD) and death. Secondary outcomes included changes in myocardial left ventricular (LV) wall thickness and replacement fibrosis, change in glomerular filtration rate (GFR), new TIA and change in neuropathic pain. RESULTS: During a median follow-up of 6.0 years (bottom and top quartiles: 5.1, 7.2), 15 events occurred in 13 patients (n = 7 deaths, n = 4 cases of ESRD and n = 4 strokes). Sudden death occurred (n = 6) only in patients with documented ventricular tachycardia and myocardial replacement fibrosis. The annual progression of myocardial LV fibrosis in the entire cohort was 0.6 ± 0.7%. As a result, posterior end-diastolic wall thinning was observed (baseline, 13.2 ± 2.0 mm; follow-up, 11.4 ± 2.1 mm; P < 0.01). GFR decreased by 2.3 ± 4.6 mL min(-1) per year. Three patients experienced a TIA. The major clinical symptom was neuropathic pain (n = 37), and this symptom improved in 25 patients. The event rate was not different between the ERT group and the untreated (natural history) group of the Fabry Registry. CONCLUSION: Despite ERT, clinically meaningful events including sudden cardiac death continue to develop in patients with advanced Fabry disease. KW - Fabry disease KW - α-galactosidase A KW - dialysis KW - prognosis KW - stroke KW - sudden cardiac death Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-132075 VL - 247 IS - 4 ER - TY - JOUR A1 - Schupp, Nicole A1 - Heidland, August A1 - Stopper, Helga T1 - Genomic Damage in Endstage Renal Disease - Contribution of Uremic Toxins N2 - Patients with end-stage renal disease (ESRD), whether on conservative, peritoneal or hemodialysis therapy, have elevated genomic damage in peripheral blood lymphocytes and an increased cancer incidence, especially of the kidney. The damage is possibly due to accumulation of uremic toxins like advanced glycation endproducts or homocysteine. However, other endogenous substances with genotoxic properties, which are increased in ESRD, could be involved, such as the blood pressure regulating hormones angiotensin II and aldosterone or the inflammatory cytokine TNF-. This review provides an overview of genomic damage observed in ESRD patients, focuses on possible underlying causes and shows modulations of the damage by modern dialysis strategies and vitamin upplementation. KW - Toxin KW - dialysis KW - genotoxicity KW - uremic toxins Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68653 ER - TY - THES A1 - Fink, Kristin T1 - Toxins in Renal Disease and Dialysis Therapy : Genotoxic Potential and Mechanisms T1 - Toxine in Nierenerkrankung und Dialyse Therapie : Genotoxisches Potential und Mechanismus N2 - In patients suffering from end-stage renal disease who are treated by hemodialysis genomic damage as well as cancer incidence is elevated. One possible cause for the increased genomic damage could be the accumulation of genotoxic substances in the blood of patients. Two possible sources for those toxins have to be considered. The first possibility is that substances from dialysers, the blood tubing system or even contaminated dialysis solutions may leach into the blood of the patients during dialysis. Secondly, the loss of renal filtration leads to an accumulation of substances which are normally excreted by the kidney. If those substances possess toxic potential, they are called uremic toxins. Several of these uremic toxins are potentially genotoxic. Within this thesis several exemplary uremic toxins have been tested for genotoxic effects (homocysteine, homocysteine-thiolactone,leptine, advanced glycated end-products). Additionally, it was analysed whether substances are leaching from dialysers or blood tubing and whether they cause effects in in vitrotoxicity testing. The focus of chemical analytisis was on bisphenol A (BPA), the main component of plastics used in dialysers and dialyser membranes. N2 - Patienten, die an terminaler Niereninsuffizienz leiden und mittels Hämodialyse behandelt werden, weisen einen erhöhten Genomschaden auf. Dieser könnte ursächlich für die erhöhte Krebsinzidenz dieser Patientengruppe sein. Eine der möglichen Ursachen für den erhöhten Genomschaden stellt die Akkumulation genotoxischer Substanzen im Blut der Patienten dar. Diese Substanzen können prinzipiell aus zwei unterschiedlichen Quellen stammen. Erstens besteht die Möglichkeit, dass während der Dialyse Substanzen aus den Dialysatoren, dem Blutschlauchsystem oder gar aus verunreinigtem Dialysat in das Blut der Patienten übertreten. Zweitens führt der Verlust der Nierenfunktion zu einer stark verminderten Exkretion harnpflichtiger Substanzen. Diese Substanzen akkumulieren im Blut und bilden, sofern sie ein toxisches Potential besitzen, die Gruppe der so genannten urämischen Toxine. Einige dieser urämischen Toxine sind potentiell auch genotoxisch. Im Rahmen der vorliegenden Dissertation wurden exemplarische Vertreter der urämischen Toxine auf ihre genotoxische Wirkung hin untersucht (Homocstein, Homocystein-Thiolacton, Leptin, Advanced Glycation End-Products). Außerdem wurde analysiert, ob Substanzen aus Dialysatormembranen oder dem Blutschlauchsystem austreten und in in vitro-Toxizitätstests Effekte zeigen. Der Fokus der Analytik lag hierbei auf dem Nachweis von Bisphenol A, dem Hauptbestandteil verschiedener Kunststoffe die für Dialysatoren und Dialysatormembranen verwendet werden. KW - Bisphenol A KW - Homocystein KW - Extrakorporale Dialyse KW - Genomschaden KW - Urämische Toxine KW - bisphenol a KW - homocysteine KW - dialysis KW - genomic damage KW - uremic toxins Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-31082 ER -