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Tesfaye W, Krass I, Sud K, Johnson DW, Van C, Versace VL, McMorrow R, Fethney J, Mullan J, Tran A, Robson B, Vagholkar S, Kairaitis L, Gisev N, Fathima M, Tong V, Coric N, Castelino RL. Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol. BMJ Open 2023; 13:e079110. [PMID: 38128937 DOI: 10.1136/bmjopen-2023-079110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is increasingly recognised as a growing global public health problem. Early detection and management can significantly reduce the loss of kidney function. The proposed trial aims to evaluate the impact of a community pharmacy-led intervention combining CKD screening and medication review on CKD detection and quality use of medicines (QUM) for patients with CKD. We hypothesise that the proposed intervention will enhance detection of newly diagnosed CKD cases and reduce potentially inappropriate medications use by people at risk of or living with CKD. METHODS AND ANALYSIS This study is a multicentre, pragmatic, two-level cluster randomised controlled trial which will be conducted across different regions in Australia. Clusters of community pharmacies from geographical groups of co-located postcodes will be randomised. The project will be conducted in 122 community pharmacies distributed across metropolitan and rural areas. The trial consists of two arms: (1) Control Group: a risk assessment using the QKidney CKD risk assessment tool, and (2) Intervention Group: a risk assessment using the QKidney CKD plus Point-of-Care Testing for kidney function markers (serum creatinine and estimated glomerular filtration rate), followed by a QUM service. The primary outcomes of the study are the proportion of patients newly diagnosed with CKD at the end of the study period (12 months); and rates of changes in the number of medications considered problematic in kidney disease (number of medications prescribed at inappropriate doses based on kidney function and/or number of nephrotoxic medications) over the same period. Secondary outcomes include proportion of people on potentially inappropriate medications, types of recommendations provided by the pharmacist (and acceptance rate by general practitioners), proportion of people who were screened, referred, and took up the referral to visit their general practitioners, and economic and other patient-centred outcomes. ETHICS AND DISSEMINATION The trial protocol has been approved by the Human Research Ethics Committee at the University of Sydney (2022/044) and the findings of the study will be presented at scientific conferences and published in peer-reviewed journal(s). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12622000329763).
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Affiliation(s)
- Wubshet Tesfaye
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Ines Krass
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Kamal Sud
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - David W Johnson
- Centre for Health Services Research, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Connie Van
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Rita McMorrow
- Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Judith Fethney
- School of Nursing, The University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sanjyot Vagholkar
- MQ Health General Practice, Macquarie University, Sydney, New South Wales, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, Sydney, New South Wales, Australia
- Western Sydney University School of Medicine, Sydney, New South Wales, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Mariam Fathima
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Vivien Tong
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Natali Coric
- Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ronald L Castelino
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
- Pharmacy Department, Blacktown Hospital, Sydney, New South Wales, Australia
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2
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Yeung EK, Brown L, Kairaitis L, Krishnasamy R, Light C, See E, Semple D, Polkinghorne KR, Toussaint ND, MacGinley R, Roberts MA. Impact of haemodialysis hours on outcomes in older patients. Nephrology (Carlton) 2023; 28:109-118. [PMID: 36401820 DOI: 10.1111/nep.14133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022]
Abstract
AIM Previous studies report an association between longer haemodialysis treatment sessions and improved survival. Worldwide, there is a trend to increasing age among prevalent patients receiving haemodialysis. This analysis aimed to determine whether the mortality benefit of longer haemodialysis treatment sessions diminishes with increasing age. METHODS This was a retrospective cohort study of people who first commenced thrice-weekly haemodialysis aged ≥65 years, reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2005 to 2015, included from 90 days after dialysis start. The primary outcome was all-cause mortality. Cox regression analysis was performed with haemodialysis session duration the exposure of interest. RESULTS Of 8224 people who commenced haemodialysis as their first treatment for kidney failure aged ≥65 years during this period, 4727 patients died. Longer dialysis hours per session was associated with a decreased risk of death in unadjusted analyses [hazard ratio, HR, for ≥5 h versus 4 to <4.5 h: 0.81 (0.75-0.88, p < .001)]. Patients having longer dialysis sessions were younger but had greater co-morbidity. In an adjusted model including age and other variables, the survival benefit of longer hours was only partially attenuated [HR for previous comparison: 0.75 (0.69-0.82, p < .001)], and no interaction between age and hours was demonstrated (p = .89). CONCLUSION The apparent survival benefit associated with longer haemodialysis session length appears to be preserved in patients 65 years or older. In practice, the benefit of longer dialysis hours should be carefully weighed against other factors in this patient group.
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Affiliation(s)
- Emily K Yeung
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Leanne Brown
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Casey Light
- Renal Service, Armadale Kalamunda Group, Mount Nasura, Western Australia, Australia
| | - Emily See
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kevan R Polkinghorne
- School of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.,Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Robert MacGinley
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Victoria, Australia
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3
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Chung EYM, Wang YM, Keung K, Hu M, McCarthy H, Wong G, Kairaitis L, Bose B, Harris DCH, Alexander SI. Membranous nephropathy: Clearer pathology and mechanisms identify potential strategies for treatment. Front Immunol 2022; 13:1036249. [PMID: 36405681 PMCID: PMC9667740 DOI: 10.3389/fimmu.2022.1036249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Primary membranous nephropathy (PMN) is one of the common causes of adult-onset nephrotic syndrome and is characterized by autoantibodies against podocyte antigens causing in situ immune complex deposition. Much of our understanding of the disease mechanisms underpinning this kidney-limited autoimmune disease originally came from studies of Heymann nephritis, a rat model of PMN, where autoantibodies against megalin produced a similar disease phenotype though megalin is not implicated in human disease. In PMN, the major target antigen was identified to be M-type phospholipase A2 receptor 1 (PLA2R) in 2009. Further utilization of mass spectrometry on immunoprecipitated glomerular extracts and laser micro dissected glomeruli has allowed the rapid discovery of other antigens (thrombospondin type-1 domain-containing protein 7A, neural epidermal growth factor-like 1 protein, semaphorin 3B, protocadherin 7, high temperature requirement A serine peptidase 1, netrin G1) targeted by autoantibodies in PMN. Despite these major advances in our understanding of the pathophysiology of PMN, treatments remain non-specific, often ineffective, or toxic. In this review, we summarize our current understanding of the immune mechanisms driving PMN from animal models and clinical studies, and the implications on the development of future targeted therapeutic strategies.
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Affiliation(s)
- Edmund Y. M. Chung
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- *Correspondence: Edmund Y. M. Chung,
| | - Yuan M. Wang
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Karen Keung
- Department of Nephrology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Min Hu
- The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, Westmead Hospital, Westmead, NSW, Australia
| | - Lukas Kairaitis
- Department of Nephrology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Bhadran Bose
- Department of Nephrology, Nepean Hospital, Kingswood, NSW, Australia
| | - David C. H. Harris
- The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
- Department of Nephrology, Westmead Hospital, Westmead, NSW, Australia
| | - Stephen I. Alexander
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, The Children’s Hospital at Westmead, Westmead, NSW, Australia
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4
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Chung EYM, Blazek K, Teixeira-Pinto A, Sharma A, Kim S, Lin Y, Keung K, Bose B, Kairaitis L, McCarthy H, Ronco P, Alexander SI, Wong G. Predictive Models for Recurrent Membranous Nephropathy After Kidney Transplantation. Transplant Direct 2022; 8:e1357. [PMID: 35935023 PMCID: PMC9355108 DOI: 10.1097/txd.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Recurrent membranous nephropathy (MN) posttransplantation affects 35% to 50% of kidney transplant recipients (KTRs) and accounts for 50% allograft loss 5 y after diagnosis. Predictive factors for recurrent MN may include HLA-D risk alleles, but other factors have not been explored with certainty.
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Affiliation(s)
- Edmund Y M Chung
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Katrina Blazek
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | | | - Ankit Sharma
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Yingxin Lin
- School of Mathematics and Statistics, The University of Sydney, Camperdown, NSW, Australia
| | - Karen Keung
- Department of Renal Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Bhadran Bose
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, Blacktown, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Renal Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Pierre Ronco
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche, Paris, France.,Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,School of Public Health, The University of Sydney, Camperdown, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
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5
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Rockett RJ, Draper J, Gall M, Sim EM, Arnott A, Agius JE, Johnson-Mackinnon J, Fong W, Martinez E, Drew AP, Lee C, Ngo C, Ramsperger M, Ginn AN, Wang Q, Fennell M, Ko D, Hueston L, Kairaitis L, Holmes EC, O'Sullivan MN, Chen SCA, Kok J, Dwyer DE, Sintchenko V. Co-infection with SARS-CoV-2 Omicron and Delta variants revealed by genomic surveillance. Nat Commun 2022; 13:2745. [PMID: 35585202 PMCID: PMC9117272 DOI: 10.1038/s41467-022-30518-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/21/2022] [Indexed: 12/02/2022] Open
Abstract
Co-infections with different variants of SARS-CoV-2 are a key precursor to recombination events that are likely to drive SARS-CoV-2 evolution. Rapid identification of such co-infections is required to determine their frequency in the community, particularly in populations at-risk of severe COVID-19, which have already been identified as incubators for punctuated evolutionary events. However, limited data and tools are currently available to detect and characterise the SARS-CoV-2 co-infections associated with recognised variants of concern. Here we describe co-infection with the SARS-CoV-2 variants of concern Omicron and Delta in two epidemiologically unrelated adult patients with chronic kidney disease requiring maintenance haemodialysis. Both variants were co-circulating in the community at the time of detection. Genomic surveillance based on amplicon- and probe-based sequencing using short- and long-read technologies identified and quantified subpopulations of Delta and Omicron viruses in respiratory samples. These findings highlight the importance of integrated genomic surveillance in vulnerable populations and provide diagnostic pathways to recognise SARS-CoV-2 co-infection using genomic data. Here, using genomic approaches, Rockett et al. identify Omicron and Delta SARS-CoV-2 co-infections in two adults, highlighting the usefulness of genomic surveillance for the timely recognition of co-infections in situations when different variants of the virus are circulating in the community.
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Affiliation(s)
- Rebecca J Rockett
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia
| | - Jenny Draper
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Mailie Gall
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Eby M Sim
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Alicia Arnott
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Jessica E Agius
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - Jessica Johnson-Mackinnon
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia
| | - Winkie Fong
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia
| | - Elena Martinez
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Alexander P Drew
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Clement Lee
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Christine Ngo
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Marc Ramsperger
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Andrew N Ginn
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Qinning Wang
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Michael Fennell
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Danny Ko
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Linda Hueston
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Lukas Kairaitis
- Renal Services Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Edward C Holmes
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia.,School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Matthew N O'Sullivan
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Sharon C-A Chen
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Jen Kok
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Dominic E Dwyer
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia.,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia
| | - Vitali Sintchenko
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia. .,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW, Australia. .,Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, NSW, Australia. .,School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
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6
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Hansen MS, Tesfaye W, Sud K, Sewlal B, Mehta B, Kairaitis L, Tarafdar S, Chau K, Razi Zaidi ST, Castelino R. Psychosocial factors in patients with kidney failure and role for social worker: A secondary data audit. J Ren Care 2022; 49:75-83. [PMID: 35526147 DOI: 10.1111/jorc.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with kidney failure face a multitude of psychosocial stressors that affect disease trajectory and health outcomes. OBJECTIVES To investigate psychosocial factors affecting people with kidney failure before or at start of kidney replacement therapy (KRT) and kidney supportive and palliative care (KSPC) phases of illness and to explore role of social worker during the illness trajectory. METHODS We conducted a secondary data audit of patients either before or at start of KRT (Phase 1) and at the KSPC (Phase 2) of illness and had psychosocial assessments between March 2012 and March 2020 in an Australian setting. RESULTS Seventy-nine individuals, aged 70 ± 12 years, had at least two psychosocial assessments, one in each of the two phases of illness. The median time between social worker evaluations in Phase 1 and Phase 2 was 522 (116-943) days. Adjustment to illness and treatment (90%) was the most prevalent psychosocial issue identified in Phase 1, which declined to 39% in Phase 2. Need for aged care assistance (7.6%-63%; p < 0.001) and carer support (7.6%-42%; p < 0.001) increased significantly from Phase 1 to Phase 2. There was a significant increase in psychosocial interventions by the social worker in Phase 2, including supportive counselling (53%-73%; p < 0.05), provision of education and information (43%-65%; p < 0.01), and referrals (28%-62%; p < 0.01). CONCLUSION Adults nearing or at the start of KRT experience immense psychosocial burden and adaptive demands that recognisably change during the course of illness. The positive role played by the nephrology social worker warrants further investigation.
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Affiliation(s)
- Micaella Sotera Hansen
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wubshet Tesfaye
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia.,Health Research Institute, University of Canberra, Canberra, Australia
| | - Kamal Sud
- Department of Renal Medicine, Nepean Hospital, Nepean and Blue Mountains Local Health District, Penrith, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Beena Sewlal
- Social Worker, Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, New South Wales, Australia
| | - Bharati Mehta
- Social Worker, Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, New South Wales, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Surjit Tarafdar
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Katrina Chau
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Syed Tabish Razi Zaidi
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, England.,HPS Pharmacies, Institutional Care, Dockland, Melbourne, Australia
| | - Ronald Castelino
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia
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7
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Trinh K, Bency R, Kairaitis L. Native renal biopsy: outcomes with a 4‐h observation period in low‐risk outpatients. Intern Med J 2022; 52:130-133. [DOI: 10.1111/imj.15645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Katie Trinh
- Western Renal Service Sydney New South Wales Australia
| | - Rosamma Bency
- Western Renal Service Sydney New South Wales Australia
- Tamworth Base Hospital Sydney New South Wales Australia
| | - Lukas Kairaitis
- Western Renal Service Sydney New South Wales Australia
- School of Medicine Western Sydney University Sydney New South Wales Australia
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8
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Hansen MS, Tesfaye W, Sewlal B, Mehta B, Sud K, Kairaitis L, Tarafdar S, Chau K, Zaidi ST, Castelino RL. Psychosocial factors affecting patients with end-stage kidney disease and the impact of the social worker. J Nephrol 2021; 35:43-58. [PMID: 34181197 DOI: 10.1007/s40620-021-01098-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND End-stage kidney disease (ESKD) incidence has been increasing over time, contributing significantly to morbidity and mortality. However, there is limited data examining the psychosocial factors affecting people with ESKD and how the social worker fits within the multidisciplinary CKD care. This integrative systematic review aims to summarise the existing evidence on psychosocial determinants of outcomes in ESKD and the role of the social worker in nephrology care. METHOD The literature search was conducted using PubMed and MEDLINE, targeting articles published from database inception until May 2021. This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Joanna Briggs Institute tools were employed to assess the quality of included studies. RESULTS Of the 397 citations, 13 studies applicable to 1465 patients met the inclusion criteria. The studies were of cross-sectional, experimental, and exploratory qualitative design in nature. The findings of the studies were summarised into three major themes-psychosocial factors, role of the renal social worker, and impact of the renal social worker. The studies demonstrated that concerns related to adjustment, death and dying, family and social functioning, and loss were common amongst participants of the included studies indicating the need for a social worker. Three studies explored the impact of social workers in ESKD, revealing that people who received support from social workers had an improved quality of life, lower depression scores, and reduced hospitalisations and emergency room visits. CONCLUSION This review summarizes the multitude of physical and psychological stressors that patients with ESRD face, and highlights the positive role social workers can play in improving the psychosocial stressors in this patient group, and the need for large-scale randomised trials to understand the role of social workers as part of a multidisciplinary nephrology care.
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Affiliation(s)
- Micaella Sotera Hansen
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Wubshet Tesfaye
- Health Research Institute, University of Canberra, Canberra, Australia.
| | - Beena Sewlal
- Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, Australia
| | - Bharati Mehta
- Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, Australia
- Westmead and Blacktown Hospitals, Western Sydney, Local Health District (WSLHD), Blacktown, Australia
| | - Kamal Sud
- Department of Renal Medicine, Nepean Hospital, Nepean and Blue Mountains Local Health District, Kingswood, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Surjit Tarafdar
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Katrina Chau
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Ronald Lynel Castelino
- School of Pharmacy, University of Sydney, Sydney, Australia
- Pharmacy Department, Blacktown Hospital, WSLHD, Blacktown, Australia
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Kairaitis L, Bek S, Oomens D. SAT-049 HOW GOLDEN IS THE STANDARD? MEASUREMENT ERRORS IN THE DETECTION OF HIGH FLOW ARTERIOVENOUS ACCESS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Swinnen J“J, Hitos K, Kairaitis L, Gruenewald S, Larcos G, Farlow D, Huber D, Cassorla G, Leo C, Villalba LM, Allen R, Niknam F, Burgess D. Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses. J Vasc Access 2018; 20:260-269. [DOI: 10.1177/1129729818801556] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Endovascular treatment of autogenous arteriovenous haemodialysis fistula stenosis has high reintervention rates. We investigate the effect of drug-eluting balloons in the treatment of recurrent haemodialysis fistula stenosis. Methods: This is a randomised, controlled, investigator-initiated and run, prospective, blinded, multicentre trial. Patients with recurrent autogenous arteriovenous haemodialysis fistula stenosis received standard endovascular treatment plus drug-eluting balloon or standard endovascular treatment plus uncoated balloon (Sham). Primary endpoint was late lumen loss in trial area on ultrasound at 6 weeks, 3, 6 and 12 months. Secondary endpoints were freedom from reintervention to the Index Trial Area and decline in fistula flow (Qa). Interim analysis was performed at 6 months (unblinded due to timeliness). Results: Patients with 132 recurrent stenoses (48% in bare Nitinol stents) were randomised with 70 receiving drug-eluting balloon and 62 Sham. At 6 months, decline in late lumen loss was 0.23 ± 0.03 mm/month for Sham and 0.045 ± 0.03 mm/month for drug-eluting balloon arm, a significant difference (0.18 mm, p = 0.0002). At 12 months, this difference persisted at 0.12 mm (p = 0.0003). At 6 months, significant difference in late lumen loss for instent restenoses (p = 0.0004) was observed, with non-significant difference for unstented restenoses (p = 0.065). Mean time for freedom from reintervention was 10.14 months for Sham versus 42.39 months for drug-eluting balloon (p = 0.001). The same was shown for instent (p = 0.014) and unstented (p = 0.029) restenoses. Qa decline rate at 6 months was 36.89 mL/min/month (Sham) and 0.41 mL/min (drug-eluting balloon). The difference was significant (36.48 mL/min; p = 0.02) and persisted to 12 months (p = 0.44). Conclusion: Paclitaxel drug-eluting balloon significantly delays restenosis after angioplasty for recurrent autogenous arteriovenous haemodialysis fistula stenosis, persisting to 12 months. Drug-eluting balloon significantly increases freedom from reintervention at 12 months with these effects true in stented and unstented fistulas.
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Affiliation(s)
- Jan “John” Swinnen
- Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Kerry Hitos
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Lukas Kairaitis
- Western Renal Service, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Simon Gruenewald
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - George Larcos
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - David Farlow
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - David Huber
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - Gabriel Cassorla
- Clínica Alemana de Santiago and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christopher Leo
- Renal Centre, University Medicine Cluster, National University Hospital, Singapore
| | - Laurencia M Villalba
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - Richard Allen
- Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Farshid Niknam
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - David Burgess
- Department of Cardiology, Western Sydney University, Blacktown Hospital, Blacktown, NSW, Australia
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Fahrtash F, Kairaitis L, Gruenewald S, Spicer T, Sidrak H, Fletcher J, Allen R, Swinnen J. Defining a significant stenosis in an autologous radio-cephalic arteriovenous fistula for hemodialysis. Semin Dial 2011; 24:231-8. [PMID: 21517992 DOI: 10.1111/j.1525-139x.2011.00861.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The current definition of a significant stenosis in an autologous arteriovenous fistula (aAVF), the percentage narrowing compared with the adjacent "normal" vessel, is inaccurate. We believe a significant stenosis in the aAVF is an absolute minimal luminal diameter determined by the requirements of the hemodialysis pump. To determine what absolute diameter constitutes a hemodynamically significant stenosis in a radio-cephalic autologous arteriovenous fistula (RC aAVF), the minimal luminal diameter of dysfunctional RC aAVF was compared to that of functional RC aAVF using grayscale and color ultrasound. There were 93 fistulas in study group and 77 in control group. The mean minimum luminal diameter in study group was significantly lower than in control group (2.19 vs. 4.71 mm, p 0.001). With a cutoff value of 2.7 mm, there was 90% sensitivity and 80% specificity in distinguishing functional fistula from dysfunctional fistula. The area under the receiver-operator curve was 90% (CI 84-94%), indicating that a 2.7 mm diameter is accurate in discriminating functional from dysfunctional fistulas. An absolute minimal luminal diameter of 2.7 mm, as determined with grayscale and color ultrasound, is a useful cutoff for defining significant stenosis in a RC aAVF.
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Yong K, Kairaitis L. Effects of proactive iron and erythropoiesis-stimulating agent protocol implementation on achieving clinical guideline targets for anaemia in a satellite haemodialysis patient cohort. Nephrology (Carlton) 2010; 15:288-93. [PMID: 20470296 DOI: 10.1111/j.1440-1797.2009.01184.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Anaemia management with erythropoiesis-stimulating agents (ESA) and i.v. iron replacement in haemodialysis patients poses several clinical challenges, including maintaining stable haemoglobin (Hb) levels within target ranges while achieving lowest effective ESA dose. This manuscript describes the effect of implementing proactive protocol-driven adjustments for iron and ESA in maintenance haemodialysis patients. METHODS This was a cohort study of 46 satellite haemodialysis patients examined from 2004 to 2006 with protocol implementation in 2005. Baseline haemoglobin, transferrin saturations (TSAT), ferritin values and ESA administration were obtained during 2004. Follow-up data was collected in 2006 and compared to baseline values in reference to specified targets in the 2004 Caring for Australasians with Renal Impairment (CARI) guidelines. RESULTS Fifty-four percent of patients achieved haemoglobin targets during follow up versus 43% patients during baseline. Seventy-nine percent of patients achieved TSAT targets during follow up versus 67% patients during baseline. Ninety percent of patients achieved ferritin targets during follow up versus 75% patients during baseline. Odds ratios for values falling within target ranges during follow up compared to baseline were 1.63 (Hb: P = 0.037; 95% confidence interval (CI), 1.03-2.57), 1.90 (TSAT: P = 0.006; 95% CI, 1.20-3.01) and 3.72 (ferritin: P = 0.003; 95% CI, 1.57-8.83). There was a trend toward lower average ESA dose (P = 0.07). CONCLUSION This study demonstrates the successful implementation and efficacy of a proactive protocol for iron and ESA treatment in haemodialysis patients. Benefits include increased concordance with historical guideline targets and decreased haemoglobin variability. Improved iron status and optimizing ESA response allows for lower ESA doses, limiting both potential side-effects of ESA (hypertension) and the burgeoning costs of anaemia management.
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Affiliation(s)
- Kenneth Yong
- Department of Renal Medicine, Sydney West Area Health Service, Westmead Hospital, Hawkesbury Road, Westmead, Australia.
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Roger SD, Suranyi MG, Walker RG, Disney A, Isbel NM, Kairaitis L, Pollock CA, Brown FG, Chow J, Truman MI, Ulyate KA. A randomised, cross-over study comparing injection site pain with subcutaneous epoetin beta and subcutaneous darbepoetin alfa in patients with chronic kidney disease. Curr Med Res Opin 2008; 24:2181-7. [PMID: 18565240 DOI: 10.1185/03007990802240552] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare injection site pain of subcutaneous (sc) epoetin beta and darbepoetin alfa in adult patients with chronic kidney disease. RESEARCH DESIGN AND METHODS This was a multi-centre, randomised, two-arm, single-blind, cross-over study. Patients were randomised to receive weekly sc darbepoetin alfa 30 mug or weekly sc epoetin beta 6000 IU for 2 weeks and were then crossed over to the alternative treatment for 2 weeks. Injection site pain was assessed using a 10 cm ungraduated visual analogue scale (0 = no pain, 10 = worst pain) and a six-point verbal rating scale. Patient preference for treatment was also assessed. TRIAL REGISTRATION http://clinicaltrials. gov/(NCT00377481). RESULTS All randomised patients (N = 48) completed the study. The sample comprised 29 chronic kidney disease patients (Stage 3 or Stage 4), 11 peritoneal dialysis patients and 8 renal transplant patients. Patients perceived significantly less pain with epoetin beta than darbepoetin alfa, using the visual analogue scale (relative pain score = 2.75, darbepoetin alfa:epoetin beta, 95% CI: 1.85, 4.07; p < 0.0001) and the verbal rating scale (median: 0.5, 95% CI: 0.5, 1.0 vs. median: 1.5, 95% CI: 1.0, 2.0; p < 0.0001). Epoetin beta was preferred by significantly more patients (65%) than darbepoetin alfa (10%) (p < 0.001); 25% of patients reported no preference. CONCLUSIONS Limitations included lack of an epoetin alfa comparator and limited blinding (patients were blinded to treatment, however, an unblinded nurse administered treatment). We show that sc injection of epoetin beta is significantly less painful than darbepoetin alfa and patient preference for epoetin beta confirms that the difference is clinically meaningful.
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Affiliation(s)
- Lukas Kairaitis
- Department of Renal Medicine, Westmead Hospital, Westmead NSW 2145, Australia.
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Zheng G, Zheng L, Wang Y, Wu H, Kairaitis L, Zhang C, Tay YC, Wang Y, Alexander SI, Harris DCH. NK cells do not mediate renal injury in murine adriamycin nephropathy. Kidney Int 2006; 69:1159-65. [PMID: 16467786 DOI: 10.1038/sj.ki.5000244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In adriamycin nephropathy (AN), a model of chronic proteinuric renal injury, the absence of functional B and T cells with residual natural killer (NK) cells, and macrophages in severe combined immunodeficient (SCID) mice results in more severe disease than in immunocompetent mice. We have recently shown expression of the stimulatory NK cell molecule NKG2D and its ligand RAE-1 in the adriamycin (ADR) kidney. Therefore, we sought to determine the role of NK cells in AN. We used anti-asialo GM1 NK cell depletion in immunocompetent BALB/c mice with AN, and also compared AN in immunodeficient SCID mice and immunodeficient nonobese diabetic (NOD)-SCID mice (that have impaired NK cell function). The number of NK cells was increased in AN in BALB/c mice compared with normal controls. NK cell depletion or reduction of NK function in NOD-SCID mice did not affect the severity of disease. In both wild type and immunodeficient models, ADR upregulated RAE-1 in the kidney. High levels of Class I major histocompatibility complex molecules were found in both models of AN. In conclusion, NK cells do not play a significant role in AN.
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Affiliation(s)
- G Zheng
- Centre for Transplantation and Renal Research, The University of Sydney at Westmead Millenium Institute, Sydney, Australia.
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Wang Y, Mahajan D, Tay YC, Bao S, Spicer T, Kairaitis L, Rangan GK, Harris DCH. Partial depletion of macrophages by ED7 reduces renal injury in Adriamycin nephropathy. Nephrology (Carlton) 2005; 10:470-7. [PMID: 16221097 DOI: 10.1111/j.1440-1797.2005.00438.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because macrophages are considered to be possible effectors of disease in Adriamycin (ADR) nephrosis, we hypothesized that depletion of macrophages might protect against the initiation of renal injury. In the present study, a monoclonal antibody (ED7) directed against CD11b/CD18 integrin, which is expressed by macrophages, was used to investigate the pathogenetic effects of macrophages in ADR nephropathy. METHODS Male Wistar rats were treated with ED7 antibody, starting 1 day prior to ADR (7.5 mg/kg) treatment, or 7 days post-ADR when overt proteinuria was established. RESULTS Circulating ED7-positive cells were reduced by approximately 30% in rats with ADR nephrosis by the ED7 antibody, while the number of macrophages in the renal cortex of ADR rats was reduced by nearly 50% with the ED7 treatment, whether administered before or after ADR. Creatinine clearance was significantly ameliorated by ED7 when commenced pre-ADR (P < 0.05), but not when commenced post-ADR (P = NS) in comparison to untreated ADR rats. However, proteinuria was not alleviated by either ED7 treatment. Morphometric analysis showed less glomerular sclerosis when ED7 was commenced pre-ADR compared with ADR alone (P < 0.01), but not when commenced post-ADR (P = NS). Tubular atrophy was reduced by ED7 when it was commenced pre-ADR (tubular cell height and tubular diameter: P < 0.01 and P < 0.001, respectively), as was interstitial expansion (P < 0.01) compared with ADR alone. Cortical macrophage infiltration was reduced by 50% compared with ADR alone by the ED7 commenced before or after ADR. The number of cortical CD4+ T cells fell with ED7 starting pre-ADR, but not with the ED7 treatment commencing after ADR. CONCLUSION Partial macrophage depletion starting before but not after ADR protected both renal function and structure in this model of chronic proteinuric renal disease.
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Affiliation(s)
- Yiping Wang
- Department of Renal Medicine, The University of Sydney at Westmead Hospital, Westmead, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Streptozotocin (STZ) is commonly used to induce diabetes in experimental animal models, but not without accompanying cytotoxic effects. This study was undertaken to (1) determine an optimal dose and administration route of STZ to induce diabetic nephropathy in wild-type mice but without the concurrent acute renal injury resulting from cytotoxic effects of STZ and (2) evaluate the pattern of tubular injury and interstitial inflammation in this model. METHODS Male Balb/c mice received either (1) STZ (225 mg/kg by intraperitoneal injection.); or (2) two doses of STZ 5 days apart (150 mg/150 mg/kg; 75 mg/150 mg/kg; 75 mg/75 mg/kg; and 100 mg/100 mg/kg by intravenous injection). Another strain of mice, C57BL/6J, also received STZ (200 mg/kg intravenously or intraperitoneally). Renal function and histology were examined at weeks 1, 2, 4, and 8 after induction of diabetes. In initial optimization studies, animals were sacrificed at week 1 or week 2 and histology examined for acute renal injury. RESULTS Following a single intraperitoneal injection of 225 mg/kg of STZ, only two thirds of animals developed hyperglycemia, yet the model was associated with focal areas of acute tubular necrosis (ATN) at week 2. ATN was also observed in C57BL/6J mice given a single intravenous or intraperitoneal dose of STZ (200 mg/kg), at week 2 post-diabetes. At an optimal diabetogenic dose and route (75 mg/150 mg/kg by intravenous injection 5 days apart), all mice developed diabetes and no ATN was observed histologically. However, even with this regimen, glomerular filtration rate (GFR) was significantly impaired from week 2. This regimen was accompanied by progressive histologic changes, including tubular and glomerular hypertrophy, mesangial area expansion, as well as interstitial macrophage, CD4+ and CD8+ T-cell accumulation. CONCLUSION By careful optimization of STZ dose, a stable and reproducible diabetic murine model was established. However, even in this optimized model, renal functional impairment was observed. The frequency of ATN and functional impairment casts doubt on conclusions about experimental diabetic nephropathy drawn from reports in which ATN has not been excluded rigorously.
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Affiliation(s)
- Yuet-Ching Tay
- Centre for Transplant and Renal Research, Westmead Millennium Institute, The University of Sydney at Westmead Hospital, Westmead, Sydney, Australia.
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Affiliation(s)
- Nimeshan Geevasinga
- Clinical School, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia.
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Sadlier DM, Connolly SB, Kieran NE, Roxburgh S, Brazil DP, Kairaitis L, Wang Y, Harris DCH, Doran P, Brady HR. Sequential extracellular matrix-focused and baited-global cluster analysis of serial transcriptomic profiles identifies candidate modulators of renal tubulointerstitial fibrosis in murine adriamycin-induced nephropathy. J Biol Chem 2004; 279:29670-80. [PMID: 15033991 DOI: 10.1074/jbc.m313408200] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Transcriptome analysis using microarray technology represents a powerful unbiased approach for delineating pathogenic mechanisms in disease. Here molecular mechanisms of renal tubulointerstitial fibrosis (TIF) were probed by monitoring changes in the renal transcriptome in a glomerular disease-dependent model of TIF (adriamycin nephropathy) using Affymetrix (mu74av2) microarray coupled with sequential primary biological function-focused and secondary "baited"-global cluster analysis of gene expression profiles. Primary cluster analysis focused on mRNAs encoding matrix proteins and modulators of matrix turnover as classified by Onto-Compare and Gene Ontology and identified both molecules and pathways already implicated in the pathogenesis of TIF (e.g. transforming growth factor beta1-CTGF-fibronectin-1 pathway) and novel TIF-associated genes (e.g. SPARC and Matrilin-2). Specific gene expression patterns identified by primary extracellular matrix-focused cluster analysis were then used as bioinformatic bait in secondary global clustering, with which to search the renal transcriptome for novel modulators of TIF. Among the genes clustering with ECM proteins in the latter analysis were endoglin, clusterin, and gelsolin. In several notable cases (e.g. claudin-1 and meprin-1beta) the pattern of gene expression identified in adriamycin nephropathy in vivo was replicated during transdifferentiation of renal tubule epithelial cells to a fibroblast-like phenotype in vitro on exposure to transforming growth factor-beta and epidermal growth factor suggesting a role in fibrogenesis. The further exploration of these complex gene networks should shed light on the core molecular pathways that underpin TIF in renal disease.
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Affiliation(s)
- Denise M Sadlier
- Department of Medicine and Therapeutics, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Mater Misericordiae University Hospital and Dublin Molecular Medicine Centre, Dublin, Ireland.
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Abstract
BACKGROUND Interaction between CD40 and CD40 ligand (CD40L) is involved in both cognate and innate immune responses. Blockade of CD40-CD40L interactions reduces severity of renal injury in murine lupus nephritis and membranous nephropathy. We hypothesized that CD40-CD40L could contribute to renal injury in models that are not antibody-dependent, and that anti-CD40L could diminish inflammation and fibrosis in murine adriamycin nephropathy. METHODS Male BALB/c mice were divided into three groups (N = 6 per group): (1). saline-treated, age-matched control; (2). adriamycin only; and (3). MR1 + adriamycin. In group 3, mice were treated with intraperitoneal injections of anti-CD40L antibody (clone MR1, 0.4 mg per mouse) after the onset of proteinuria at days 5, 7, 9, and 11 after adriamycin treatment. Animal subgroups were compared at 14 and 42 days after induction of adriamycin nephropathy. Functional and pathologic markers of disease severity, cellular components of interstitial inflammation, and the degree of CD40 expression were assessed. Relative cortical RNA expression of the chemokine monocyte-chemoattractant protein-1 (MCP-1) and regulated on activation normal T cell expressed and secreted (RANTES) was also compared between animal groups. RESULTS CD40 was weakly expressed in tubules of normal mice but was expressed in tubules, interstitium, and glomeruli of mice with adriamycin nephropathy in a time-dependent manner. MR1 treatment resulted in a significant attenuation of the severity of adriamycin nephropathy at day 42 [e.g., glomerular sclerosis (%), group 3, 20.1 +/- 4.7 vs. group 2, 30.2 +/- 7.2, P < 0.001]. CD40L blockade significantly reduced tubulointerstitial injury as well [tubular diameter microm), group 3, 42.5 +/- 6.9 vs. group 2, 66.3 +/- 13.7, P < 0.001; and group 1, 37.3 +/- 5.7, P < 0.01; tubular cell height microm), group 3, 16.3 +/- 1.7 vs. group 2, 11 +/- 1.8, P < 0.01; and group 1, 18.2 +/- 1.9, P < 0.01; interstitial volume (%), group 3, 13.9 +/- 5.1 vs. group 2, 26.2 +/- 4.9, P < 0.001; and group 1, 1.3 +/- 0.7, P < 0.001; proteinuria (mg/24 hours), group 3, 1.8 +/- 0.6 vs. group 2, 4.3 +/- 0.8, P < 0.001; and group 1, 0.7 +/- 0.2, P < 0.05; and creatinine clearance microL/min), group 3, 75 +/- 4 vs. group 2, 35 +/- 2, P < 0.001; and group 1, 82 +/- 4, P < 0.01] were also improved by MR1. MR1 treatment also resulted in a significant reduction in the number of cortical macrophages at both 14 and 42 days after adriamycin (P < 0.01). Cortical expression of MCP-1 and RANTES was significantly reduced by MR1 treatment at 42 days after adriamycin (P < 0.01 and P < 0.05, respectively). CONCLUSION Blockade of CD40-CD40L interaction protects against renal structural and functional injury in this murine model of chronic proteinuric renal disease.
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Affiliation(s)
- Lukas Kairaitis
- Department of Renal Medicine, The University of Sydney at Westmead Hospital, Westmead, Sydney, Australia.
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Abstract
BACKGROUND Since the Fas/Fas Ligand (FasL) interaction is recognized as a major pathway of apoptosis in immune cells, we hypothesized that selective expression of FasL by tubular cells (TC) may promote the resolution of interstitial inflammation by inducing apoptosis of infiltrating immune cells. In this study, the effect of FasL transfection of rat TC on apoptosis of leukocytes was examined. METHODS Rat tubule cells (NRK52E) were transfected with plasmids constructed using human and rat FasL (hFasL and rFasL). The propensity of activated, transfected TC to undergo apoptosis was examined. Similarly, the effects of FasL transfection on apoptosis of Jurkat cells and activated leukocytes were assessed directly following co-culture for 12 hours and in a cell insert system intended to assess the effects of soluble FasL. Fas and FasL expression was assessed by flow cytometry and apoptosis was examined using Annexin V staining and the TUNEL method. RESULTS Expression of FasL in TC was increased after FasL transfection. Transfected TC showed no detectable increase in apoptosis following lipopolysaccharide (LPS) or tumor necrosis factor-alpha (TNF-alpha) activation. Jurkat cell apoptosis was increased ninefold and eightfold after co-culture with TC transfected with hFasL and rFasL, respectively (67.0 +/- 12.1% and 60.1 +/- 8.8% vs. 6.7 +/- 1.8% with un-transfected TC, P < 0.01). Similarly, apoptosis of activated leukocytes was increased fourfold by co-culture (26.8 +/- 4.9% vs. 6.7 +/- 2.0% with untransfected TC, P < 0.01). Leukocyte apoptosis also was increased in an insert culture system (18.2 +/- 4.4% vs. 5.8 +/- 2.3% with un- transfected TC, P < 0.01). No increase of TC apoptosis was detected in any of the co-culture experiments. CONCLUSION Enhanced expression of FasL by TC is capable of inducing apoptosis of activated leukocytes, without evidence for increased susceptibility to apoptosis of the transfected cells themselves. This suggests a potential role for this approach in the limitation and resolution of renal tubulointerstitial inflammation.
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Affiliation(s)
- Yiping Wang
- Department of Renal Medicine, The University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia.
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Wang Y, Kairaitis L, Tay YC, Wang Y, Zheng L, Harris DC. RECONSTITUTION OF CD4 + T CELLS REDUCES RENAL INJURY IN SCID MICE WITH ADRIAMYCIN NEPHROPATHY. Nephrology (Carlton) 2002. [DOI: 10.1046/j.1440-1797.2002.00007-1-87.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang Y, Tay YC, Spicer T, Kairaitis L, Wang Y, Zheng L, Harris DC. PARTIAL DEPLETION OF MACROPHAGES BY ED7 REDUCES RENAL INJURY IN ADRIAMYCIN NEPHROPATHY. Nephrology (Carlton) 2002. [DOI: 10.1046/j.1440-1797.2002.00007-1-85.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang Y, Kairaitis L, Tay YC, Wang Y, Zheng L, Harris DC. BLOCKADE OF CD40-CD50 LIGAND REDUCED RENAL INJURY IN CHRONIC PROTEINURIC RENAL DISEASE. Nephrology (Carlton) 2002. [DOI: 10.1046/j.1440-1797.2002.00007-1-86.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang Y, Wang Y, Feng X, Bao S, Yi S, Kairaitis L, Tay YC, Rangan GK, Harris DC. Depletion of CD4+ T cells aggravates glomerular and interstitial injury in murine adriamycin nephropathy. Kidney Int 2001. [DOI: 10.1046/j.1523-1755.2001.00580.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang Y, Wang Y, Feng X, Bao S, Yi S, Kairaitis L, Tay YC, Rangan GK, Harris DC. Depletion of CD4(+) T cells aggravates glomerular and interstitial injury in murine adriamycin nephropathy. Kidney Int 2001; 59:975-84. [PMID: 11231352 DOI: 10.1046/j.1523-1755.2001.059003975.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND CD4(+) T cells play an important role in various types of immunologic renal disease, including lupus nephritis, IgA nephropathy, and crescentic glomerulonephritis. CD4(+) T cells are also major infiltrating lymphocytes in chronic tubulointerstitial inflammation associated with nonimmunological renal diseases. We suspected that CD4(+) T cells might contribute to disease progression and loss of renal function in chronic proteinuric renal disease (CPRD). To investigate this possibility, the effect of monoclonal antibody against CD4(+) lymphocytes (anti-CD4) was studied in a murine model (adriamycin nephropathy) of CPRD. METHODS Adriamycin nephropathy was produced in male BALB/c mice by a single intravenous injection of adriamycin (11 mg/kg). Anti-CD4 was given by intraperitoneal injection following the development of proteinuria at days 5, 6, 7, 21, and 37 after adriamycin. After six weeks, renal function and histology were studied by histomorphometry, immunohistochemistry, and flow cytometry. RESULTS Flow cytometric analysis showed a marked decrease in the number of CD4(+) T cells in blood and spleen of the antibody-treated animals (N = 7, P < 0.01). Adriamycin plus CD4(+) depletion mice had significantly greater mesangial expansion, glomerular sclerosis, and interstitial expansion than the mice on adriamycin alone. Interstitial infiltration with macrophages and CD8(+) cells was significantly increased in adriamycin plus CD4(+) depletion mice. Creatinine clearance (17.5 +/- 0.54 vs. 29.2 +/- 0.89 microL/min, P < 0.001) was significantly worse in the adriamycin plus CD4(+) depletion mice than in adriamycin alone mice and correlated with histologic change in glomeruli and interstitium. CONCLUSIONS Depletion of CD4(+) T cells promotes glomerular and interstitial injury in mice with established adriamycin nephropathy. These findings suggest that CD4(+) T cells have a protective role against the progression of adriamycin nephropathy.
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Affiliation(s)
- Y Wang
- Department of Renal Medicine, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia.
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