Impact of Effectiveness of Physical Activity in a Virtual Environment on the Regulation of Sclerostin and Interleukin 6 Levels in Haemodialysis Patients

Background: Chronic kidney disease is a significant public health issue associated with reduced physical activity. This can lead to mineral and bone disorders and increased levels of inflammatory markers. One innovative solution that can significantly contribute to increasing patient motivation is the combination of physical training with virtual reality technology during haemodialysis sessions. The aim of this study is to comprehensively assess the impact of regular virtual reality-based physical activity on plasma sclerostin and interleukin 6 levels, as well as on physical performance and the level of physical activity in patients undergoing renal replacement therapy through haemodialysis. Methods: This study is a prospective cohort study. Patients included in the study were randomly assigned to two groups: the study group and the control group. The study group consisted of patients who were entrusted with the task of conducting training using the prototype of the NefroVR system. The duration of the study period for both the study and control groups was 3 months. Results: One hundred and two (102) patients with stage 5 chronic kidney disease who underwent haemodialysis as a renal replacement therapy participated in the study. Patients from the study group were characterized by higher physical activity compared to the control group. There was a significant difference in the level of IL-6 and SOST between the study and control groups in the second measurement. Conclusions: Regular physical activity, especially using approaches such as virtual reality, contributes to improving physical fitness and overall activity levels in patients undergoing haemodialysis. The study demonstrated that regular exercise may be associated with a reduction in inflammatory parameters and positive effects on bone metabolism in patients undergoing haemodialysis.

Does Exercising with the Use of Virtual Reality during Haemodialysis Have an Impact on Plasma Levels of Interleukin 1β, Interleukin 6, and Interleukin 8?

Cytokines are a group of fine proteins which play a key role in the regulation of various biological processes, including inflammatory reactions. Proinflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and interleukin 8 (IL-8), are produced in response to various stimuli, including infections, tissue damage, and oxidative stress. Virtual reality (VR) use during intradialytic exercises improves physical activity. The purpose of the study was to evaluate the relationship between exercising regularly with the use of virtual reality during haemodialysis and the levels of selected cytokines (Il-1, Il-6, Il-8). The study and the control groups consisted of end-stage renal disease patients who underwent haemodialysis as a renal replacement treatment. The study group comprised patients subject to haemodialysis as a renal replacement therapy who were to work out with the use of a prototype of the NefroVR system for 20 min when undergoing haemodialysis (HD). Statistical analyses utilised Statistica 13. The conducted research demonstrated that regular exercises with the use of virtual reality might be related to a decrease in inflammation in patients included in the chronic haemodialysis programme. It is key to encourage patients with end-stage renal disease treated with haemodialysis to exercise regularly because of the possibility of their proinflammatory parameters becoming reduced.

Cardiac involvement in patients with Autosomal Dominant Polycystic Kidney Disease and normal renal function after six years of follow-up

The aim of the follow-up study was to compare the changes of M-mode echocardiographic parameters in autosomal dominant polycystic kidney disease (ADPKD) patients and controls without renal failure during six years of observation and to explore the associations of these parameters with metabolic syndrome components and kidney function. We performed a follow-up examination in 37 ADPKD patients and 40 controls. Anthropometric parameters were measured and fasting venous blood sample from each patient was tested for glucose, insulin, C-peptide, HbA1c, creatinine, and urea concentrations. All subjects underwent standard two-dimensional M-mode echocardiography. Left ventricular hypertrophy (LVH) was diagnosed based on left ventricular mass index (LVMI) adjusted for body surface area (LVMI- -S, LVH-S) or for height (LVMI-H, LVH-H). The prevalence of LVH was significantly greater in ADPKD patients than in controls (35% vs. 10%, p=0.012) according to the ESH/ESC criteria from 2013, and (27.0% vs. 7.5%, p=0.032) according to criteria from 2017. In patients with ADPKD, no significant increase of the echocardiographic parameters was observed in the 6 years between the initial examination and the follow-up examination. Cardiac involvement in women with ADPKD occurs at an earlier stage of the disease than in men. In patients with ADPKD treated for hypertension in accordance with the 2013 ESH/ESC Guidelines the progression of LVH was not observed during the 6-year follow-up, despite the deterioration of renal function. Obesity, blood pressure and renal function do not affect LVMI changes.

Physical Activity versus Sclerostin and Interleukin 6 Concentration in Patients Receiving Renal Replacement Therapy by Hemodialysis

Introduction

Chronic kidney disease and renal replacement therapy are associated with reduced motor activity, which may result in the presence of mineral bone disorders and an increase in inflammation markers. The aim of the study was to assess the relationship between the performance of daily physical activity, expressed in the number of steps performed by patients undergoing hemodialysis and the concentration of selected biochemical parameters (SCL, IL-6).

Patients and Methods

The study group (B) involved 33 patients aged 59.8 ± 9.8 years from the dialysis station at the Department of Nephrology, Transplantology and Internal Medicine PUM. In group B, interventions considering an increase in physical activity expressed in the number of steps were introduced. Group C consisted of 30 people aged 54.9 (9.37), with GFR over 60 mL/min/1.73m. Physical activity was measured with pedometers. Anthropometric and biochemical parameters were assessed at baseline, after the third and sixth month of the study. Descriptive statistics, intergroup comparisons using Mann–Whitney U test and Spearman correlation analysis were performed. The level of significance was set at p≤0.005.

Results

A relationship between IL-6 concentration and the number of steps in group B after three months of intervention was demonstrated. In group C, the concentration of SCL and IL-6 decreased with the increase in the number of steps taken. Only in group C the waist circumference decreased with the increase of the number of steps performed.

Conclusion

Patients receiving renal replacement therapy by hemodialysis showed significantly lower physical activity compared to people without kidney disease. Performing bigger number of steps can lower interleukin 6 levels in hemodialysis patients.

Assessment of the Relationship between Selected Factors and Stress-Coping Strategies in Handcyclists-A Preliminary Study

Background and Objectives: Playing competitive sports is associated with stress, especially during the starting season. Disabled athletes are additionally burdened with physical and/or emotional factors, resulting from the trauma they have experienced. The aim of the work was to assess the relationship between strategies of coping with stress and the level of education, category of disability and its duration of handcyclists before the competition. Materials and Methods: 44 handcyclists with a mean age of 41.8 ± 11.6, from European countries, were divided according to the severity of mobility impairments, education and duration of the disability. The participants were asked to fill in the Mini-COPE Inventory for Measuring Coping with Stress, which provided answers in writing to some sociodemographic questions regarding age, sex, education, type of mobility impairment and duration of the disability. Results: The subjects who had suffered spinal injury at the cervical section obtained the lowest scores regarding their subjective assessment of their active stress management in difficult situations (p = 0.007). They scored the lowest, 1.5 points, when asked about acceptance in difficult circumstances compared to those with university education (p = 0.02). A statistically significant correlation was found to exist between education levels and positive revaluation, acceptance and seeking instrumental support. A negative correlation was observed between education and sustained use of psychoactive substances and denial. Conclusions: Highly educated cyclists with short-lasting disability, damage to the lower spine section or amputations tend to cope better with stress than other study participants.

Nonaccidental Out-of-Hospital Cardiac Arrest in an Urban Area as a Potential Source of Uncontrolled Organ Donors

BACKGROUND Donation after cardiac death offers the possibility of increasing the pool of organs for transplantation by up to 30%. Maastricht category type 3 (M3) dominates in most countries with active DCD programs. During preparations to introduce a permanent program for uncontrolled donation after circulatory death in Szczecin, Poland, the donor pool has been estimated. In Poland, Maastricht category type 2 (M2) is considered a basic source for organ recovery. MATERIAL AND METHODS This was a retrospective cohort study of out-of-hospital cardiac arrests (OHCA) reported to local Emergency Medical Services (EMS) between 1 December 2014 and 30 November 2015. The following inclusion criteria were used in the analysis: demographic (age 18-60 years, known identity), clinical (no chest or abdominal injury, no cachexia as an equivalent of wasting diseases), and organizational (weekdays from 8:00 am to 3:00 pm). RESULTS During 12-month period, 118 EMS interventions were recorded in response to sudden cardiac arrest. The stratification process mentioned above used criteria to establish potential, eligible, qualified, and actual donor pools (27 (30.3%), 24 (26.4%), 7 (7.3%), and 6 (6.7%), respectively). To establish a "virtual" actual number of uDCD, the nationwide average level of lack of authorization for donation was 12%. CONCLUSIONS Activation of a permanent program of organ recovery from uDCD would increase the donor pool by 6 cases. Compared to the number of brain-dead donors referred from regional hospitals, this increase would be equivalent to the formation of a new reporting center. The number of transplantable organs could increase by 22% per year.

The association of the Klotho polymorphism rs9536314 with parameters of calcium-phosphate metabolism in patients on long-term hemodialysis

BACKGROUND

Patients on long-term hemodialysis frequently suffer from complications, such as secondary hyperparathyroidism, bone fractures, and arteriosclerosis. The process of regulating Ca/P metabolism depends on factors, such as FGF23 and Klotho. This study aimed to answer the question of whether the Klotho polymorphism rs9536314 is associated with FGF23 plasma concentration.

METHODS

In 118 patients undergoing hemodialysis, blood was collected before and after hemodialysis. The following parameters were measured in plasma: FGF23, serum: Ca, P, PTH, HGB, and iron concentrations. The KL gene polymorphism rs9536314 was identified by PCR-RFLP.

RESULTS

The KL polymorphism rs9536314 was not associated with Ca, P, PTH, or FGF23. There was a negative correlation between FGF23 and blood HGB levels and positive correlation between FGF23 and ESA dose.

CONCLUSIONS

The results obtained may indicate that there is no association between the KL polymorphism and FGF23 concentration in patients undergoing long-term.

Autosomal dominant polycystic kidney disease and hypertension are associated with left ventricular mass in a gender-dependent manner

BACKGROUND

The aim of this study was to compare echocardiographic parameters in patients with autosomal dominant polycystic kidney disease (ADPKD) and in controls with normal kidney function taking into account gender and the presence of hypertension.

METHODS

47 patients with ADPKD (age 36.3 ± 11.0 years) and 49 healthy controls (36.8 ± 9.2 years) were enrolled. M-mode echocardiography was performed in all subjects. Left ventricular hypertrophy (LVH) was diagnosed when the left ventricular mass index (LVMI) was greater than or equal to 125 g/m2 in males and 110 g/m2 in females.

RESULTS

The prevalence of LVH was greater in ADPKD patients than in controls (13% vs. 2%; p=0.05). Among females, ADPKD patients demonstrated greater LVMI (87.9 ± 18.5 vs. 68.8 ± 15 g/m2, p=0.00009) than controls. There was a positive correlation between LVMI and blood pressure in ADPKD females (Rs=0.54, p=0.027 for systole blood pressure-SBP and Rs=0.50, p=0.0053 for diastole blood pressure-DBP) but not in males.

CONCLUSION

Left ventricular mass is increased in ADPKD females with normal renal function. A positive correlation between SBP and DBP and LVMI was found in ADPKD females but not in ADPKD males.

Three clinical cases of nonrespiratory acidosis in kidney transplant recipients receiving anti-CMV therapy

BACKGROUND

To preserve kidney graft function it is necessary to use ganciclovir or valganciclovir as a therapy for fresh CMV infection or prophylaxis in high-risk kidney transplant recipients. Ganciclovir-induced lactic acidosis has thus far not been reported.

CASE REPORT

Three cases of nonrespiratory acidosis in kidney transplant recipients receiving ganciclovir or valganciclovir as anti-CMV therapy or prophylaxis are presented. Lactic acidosis developed in 2 patients, and the other patient had nonrespiratory acidosis of unknown origin. The possible mechanism of the development of lactic acidosis in presented cases is explored.

CONCLUSIONS

The analysis of the described cases cannot eliminate the potential negative influence of anti-CMV therapy on acid-base equilibrium, especially with coexisting active viral infection.

The association between eNOS intron 4 VNTR polymorphism and delayed graft function of kidney allografts

Nitric oxide (NO) is a multifunctional agent which serves as a key signaling molecule in physiological processes such as host defense, neuronal communication, and the regulation of vascular tone. Different polymorphic variations have been identified in the human NOS3 (eNOS) gene.The aim of the present study was to examine the association between polymorphisms of the NOS3 gene (G894T substitution within exon 7 and intron 4 VNTR polymorphism) and the development of delayed graft function as well as acute and chronic rejection.One hundred eighty-seven recipients of first renal transplants were included in the study. There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection. The intron 4 polymorphism was associated with delayed graft function after transplantation. The results of this study suggest that patients with the a allele of the eNOS intron 4 VNTR polymorphism may be predisposed to delayed graft function.

Lack of association of polymorphisms 239+34A/C in the SOD1 gene and 47C/T in the SOD2 gene with delayed graft function and acute and chronic rejection of kidney allografts

The superoxide dismutases (SODs) seem to be the most important enzymes involved in defense against reactive oxygen species, in particular against superoxide anion radicals. We hypothesized that genetic variability of antioxidant enzymes may have a role in development of these complications. The objective of the present study was to examine the association between polymorphisms 239+34A/C in the SOD1 gene or 47C/T in the SOD2 gene and development of delayed graft function (DGF) and acute or chronic rejection. The study included 187 recipients of first renal transplants. Patient history was analyzed taking into account DGF, acute rejection episodes, and chronic rejection. The polymorphisms were analyzed using the polymerase chain reaction-restriction fragment length polymorphism method. There were no significant associations between the polymorphisms and DGF or acute or chronic rejection. Our findings suggest that polymorphisms in SOD1 and SOD2 are not associated with development of either DGF or acute or chronic rejection.

Circulating adhesion molecules during kidney allograft reperfusion

Adhesion molecule expression is an important event during early transplant failure. The aim of the present study was to examine the release of adhesion molecules during the first minutes of kidney allograft reperfusion in relation to delayed graft function and acute graft rejection. We enrolled 49 renal transplant recipients, including 13 cases of delayed graft function (DGF) and 11 cases of acute graft rejection (AR). Plasma concentrations of E-selectin, VCAM-1 and ICAM-1 after 3 min of reperfusion were significantly higher than in the iliac vein before reperfusion. There was no statistically significant difference between patients with and without DGF as regards E-selectin, VCAM-1 and ICAM-1 concentrations in the iliac vein before and in the renal vein after 3 min of reperfusion. Concentrations of adhesion molecules in the iliac vein before reperfusion and in the renal vein after 3 min of reperfusion did not differ significantly between patients with and without AR except for ICAM-1 iliac vein concentration which was significantly increased in AR patients. Plasma levels of E-selectin, ICAM-1 and VCAM-1 were increased after kidney allograft reperfusion. Moreover, elevated serum levels of ICAM-1 before transplantation correlated with subsequent acute kidney allograft rejection. The results suggest that elevated ICAM-1 levels may be implicated in acute graft rejection.

IL-2 and TNF-α Promoter Polymorphisms in Patients With Acute Kidney Graft Rejection

INTRODUCTION

Proinflammatory cytokines have been implicated in the pathogenesis of acute kidney allograft rejection. The aim of the study was to examine the association between interleukin (IL)-2 -330 and tumor necrosis factor (TNF)-alpha -308 promoter polymorphisms and acute kidney allograft rejection.

METHODS

The study included 72 patients with long-term stable graft function, and 57 diagnosed with acute kidney allograft rejection.

RESULTS

Patients with acute kidney allograft rejection showed a prevalence of subjects with TNF-alpha T2 allele (P < .05). The risk of acute kidney allograft rejection diagnosis was 2.5-fold greater among carriers of the T2 allele than those homozygous for T1T1 (OR 2.53, 95% CI 1.19 to 5.37, P < .05) There was no statistically significant difference in the distribution of IL-2 genotypes between patients with stable graft function and acute kidney allograft rejection.

CONCLUSION

The results suggest that TNF-alpha-308 promoter polymorphism is a risk factor for acute kidney allograft rejection.

The cytokine gene polymorphisms in patients with chronic kidney graft rejection

Chronic allograft rejection remains an important cause of morbidity after kidney transplantation. The aim of the study was to examine the association between IL-2, IL-6 and TNF-alpha promoter polymorphisms and chronic kidney allograft rejection. The study included 64 patients with long-term stable graft function and 62 with chronic allograft nephropathy. Among patients with chronic allograft nephropathy a statistically significant prevalence of the IL-6 CC genotype associated with low IL-6 expression was observed (p < 0.01, OR 3.18; 95% CI 1.27-8.15). There were no statistically significant differences in distribution of IL-2 and TNF-alpha genotypes between patients with stable graft function and chronic allograft rejection. The results of present study suggest that the genetically determined low IL-6 production may be the risk factor of chronic allograft nephropathy development.

The influence of oxidative stress on permeability of capillary vessels in the cheek pouch of hamsters with alloxan-induced diabetes

Background: The aim of the study was to assess the influence of oxidative stress on the increase of permeability of capillary vessels in animals with alloxan-induced diabetes. Material and methods: The studies were performed in microcirculation system of hamster cheek pouch. After the blockade of histamine receptors and administration of diamine oxidase (DAO) and histamine into circulation fluorescein angiography was done. In addition, the influence of superoxide dismutase, aminoguanidine (DAO inhibitor) and trascolan (protease inhibitor) on vascular permeability caused by superoxide radical generation in DAO/histamine system was assessed. Results: The number of extravasal leakages in the group receiving HA and DAO was significantly higher (p < 0.001) than in the groups receiving potential vascular "sealers", e.g. SOD, aminoguanidine or trascolan. In the group receiving aminoguanidine the number of leakages was significantly lower (p < 0.05) compared to the group receiving SOD or trascolan. Conclusions: The protective effect of aminoguanidine, superoxide dismutase or trascolan decreasing the vascular permeability, suggests that the increased vascular permeability is a result of superoxide radical generation by diamine oxidase.

The expansion of CD4+CD28- T cells in patients with chronic kidney graft rejection

CD4+CD28- T cells are oligoclonal lymphocytes rarely found in healthy subjects, but are present in high frequencies in patients with inflammatory diseases. Contrary to paradigm, they are functionally active and produce interferon gamma and cytolytic proteins, are cytotoxic in vessels and may contribute to tissue damage. The size of the peripheral blood CD4+CD28- T cell compartments was determined in 20 healthy individuals, 20 patients after renal transplantation with stable graft function, and 20 with chronic graft rejection by two-color FACS analysis. In patients with stable graft function, the median frequency of CD4+CD28- T cells was 3.1% and was significantly higher in comparison to the control group (1.4%) (P <.01). The highest subset CD4+CD28- cells was detected in patients with chronic graft rejection (10.65%). The amount of CD4+CD28- cells was significantly higher in this group in comparison to patients with stable graft function (P <.01). The evaluated number of CD4+CD28- cells in patients after renal transplantation, especially in graft recipients with chronic graft rejection, suggests a role of these cells in chronic graft destruction.

Chlorpropamide toxicity with survival despite 27-day hypoglycemia

CASE REPORT

In the past 5 years at our institution, 12 cases involving the ingestion of chlorpropamide 3-15 g were fatal. We report a 23-year-old woman with an estimated ingestion of chlorpropamide 5-10 g. Initial cardiovascular collapse, attributed to the blockade of potassium channel transport, responded to intensive support including 3 days of cardiac pacing. Urinary excretion of chlorpropamide and hypoglycemia persisted until day 27. The toxic mechanisms and high risk of chlorpropamide are summarized. A fatal therapeutic dose ratio as low as 4:1 has made this antidiabetic agent obsolete.