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Ramírez-Guerrero G, de Cal M, Lorenzin A, Vigolo D, Toscano AI, Araya-Rojas M, Zanella M, Ronco C. Sorbent functionalization with vancomycin enhances bacteria killing in extracorporeal hemoadsorption. Artif Organs 2024; 48:543-549. [PMID: 38156403 DOI: 10.1111/aor.14704] [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] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The level of bacteremia in patients with sepsis and septic shock is a predictor of complications and mortality, regardless of the type of bacteria. Devices for bacteria, endotoxin and cytokines removal by adsorption have been recently developed. Thus, extracorporeal blood purification therapies have been proposed as adjunctive therapy in sepsis in combination with drugs. Some potentially useful drugs, however, are precluded due to their organ or metabolic toxicity. The present study represents a preliminary report on the in vitro effect of a sorbent device (minimodule with HA380 beads, Jafron medical, Zhuhai, China) in which the particles have been functionalized with vancomycin on the surface. The impact of the surface-modified beads on circulating bacteria (Staphylococcus aureus) has been tested in a simulated in vitro circulation. METHODS In vitro experiments were carried out with 800 mL of blood enriched with S. aureus species. Blood was circulated in the vancomycin-functionalized and non-functionalized mini-module cartridges in hemoadsorption setup (300 mL each) and the bactericidal effect was assessed. Also, 200 mL of blood was used as a control. RESULTS A significant increase in the time to positivity of blood cultures was observed after 60 min and also after 120 min of therapy with the mini-module functionalized with vancomycin as opposed to the non-functionalized cartridge. CONCLUSIONS These results suggest a possible way of treating sepsis by using drug- or antibiotic-functionalized cartridges without worrying about pharmacological toxicity. The prolongation of the time to bacterial culture positivity to S. aureus after a passage through a column packed with beads functionalized with vancomycin represents a proof of concept.
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Affiliation(s)
- Gonzalo Ramírez-Guerrero
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Nephrology and Dialysis Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Massimo de Cal
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Dario Vigolo
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
| | - Anna Italia Toscano
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
| | | | - Monica Zanella
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
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Pavan P, Lorenzin A, Chiementin L, Perin N, de Cal M, Brendolan A, Morisi N, Zanella M, Ronco C. Extracorporeal removal of per- and polyfluoroalkyl substances (PFAS) by hemoadsorption: in vitro kinetic model. Blood Purif 2024:000538179. [PMID: 38493768 DOI: 10.1159/000538179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Per- and polyfluoroalkyl substances (PFAS) are known water pollutants leading to potential public health consequences. High blood levels of PFAS have been associated with several pathological conditions including testicular and kidney cancer. Classic extracorporeal therapies have demonstrated limited efficiency and new approaches should be explored. In this study we studied the possible role of hemoadsorption to achieve a fast, safe and effective removal of PFAS from blood in patients with high blood levels. METHODS We developed an in vitro model of hemoadsorption to test the potential of PFAS removal by extracorporeal treatment. We recirculated a highly polluted batch of water (4 liters) through a sorbent cartridge (Jafron medical, Zuhai, China) for 120 minutes at a flow of 150 mL/min. We collected samples at different time points and analyzed 39 different PFAS compounds. RESULTS For the PFAS compounds with concentrations significantly above normal, we observed a removal ratio close to 90% already within the first 60 minutes of circulation leading to almost complete elimination of all pollutants at 120 minutes. CONCLUSIONS The in vitro model of hemoadsorption suggests the possible application in vivo of this technique to reduce/normalize the concentrations of PFAS in patients exposed to water or environmental pollution.
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Ramírez-Guerrero G, Reis T, Lorenzin A, Marcello M, de Cal M, Zanella M, Ronco C. EFFECT OF MECHANICAL VIBRATION ON KINETICS OF SOLUTE ADSORPTION. Blood Purif 2024:000536412. [PMID: 38281478 DOI: 10.1159/000536412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Hemoadsorption with new sorbent cartridges is an emerging extracorporeal blood purification technique. Flow distribution inside the sorbent is one of the main issues concerning the device's performance and optimal sorbent utilization. In this experiment, we aimed to investigate the efficacy of vibration during adsorption by measuring the removal of Vancomycin. METHODS In this experimental study, 1,000 mL of saline with 10 g of Vancomycin was circulated in a closed circuit (set flow of 250 mL/min) simulating a hemoadsorption blood run using HA380 minimodule cartridge containing 75 g of wet resin. This vibration model was implemented with a damping head device installed in front of the adsorption cartridge during the experiment. The kinetics of the Vancomycin were assessed by removal ratio over 120 minutes. RESULTS We found no difference between the two models. Adsorption with and without vibration did not differ significantly for partial reduction ratios, overall amount of adsorbed molecule, or adsorption kinetics. CONCLUSION The current design and structure of the minimodule cartridge demonstrated no difference in small-middle solute removal. Further improvement with the addition of mechanical vibration to the device was not observed.
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Ramírez-Guerrero G, Reis T, Marcello M, de Cal M, Ronco C. Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options? Int J Artif Organs 2024; 47:3-7. [PMID: 37589299 DOI: 10.1177/03913988231191954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Valparaiso Region, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Valparaiso Region, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Valparaiso Region, Chile
| | - Thiago Reis
- Deparment of Nephrology and Kidney Transplantation, Fenix Group, Sao Paulo, Brazil
- Laboratory of Molecular Pharmacology, University of Brasília, Brasília, Brazil
| | - Matteo Marcello
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
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Marcello M, Virzì GM, Marturano D, de Cal M, Marchionna N, Sgarabotto L, De Rosa S, Ronco C, Zanella M. The Cytotoxic Effect of Septic Plasma on Healthy RBCs: Is Eryptosis a New Mechanism for Sepsis? Int J Mol Sci 2023; 24:14176. [PMID: 37762478 PMCID: PMC10531772 DOI: 10.3390/ijms241814176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/04/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Sepsis is a life-threatening multiple-organ dysfunction induced by infection and is one of the leading causes of mortality and critical illness worldwide. The pathogenesis of sepsis involves the alteration of several biochemical pathways such as immune response, coagulation, dysfunction of endothelium and tissue damage through cellular death and/or apoptosis. Recently, in vitro and in vivo studies reported changes in the morphology and in the shape of human red blood cells (RBCs) causing erythrocyte death (eryptosis) during sepsis. Characteristics of eryptosis include cell shrinkage, membrane blebbing, and surface exposure to phosphatidylserine (PS), which attract macrophages. The aim of this study was to evaluate the in vitro induction of eryptosis on healthy RBCs exposed to septic plasma at different time points. Furthermore, we preliminary investigated the in vivo levels of eryptosis in septic patients and its relationship with Endotoxin Activity Assay (EAA), mortality and other biological markers of inflammation and oxidative stress. We enrolled 16 septic patients and 16 healthy subjects (no systemic inflammation in the last 3 months) as a control group. At diagnosis, we measured Interleukin-6 (IL-6) and Myeloperoxidase (MPO). For in vitro study, healthy RBCs were exposed to the plasma of septic patients and CTR for 15 min, 1, 2, 4 and 24 h. Morphological markers of death and eryptosis were evaluated by flow cytometric analyses. The cytotoxic effect of septic plasma on RBCs was studied in vitro at 15 min, 1, 2, 4 and 24 h. Healthy RBCs incubated with plasma from septic patients went through significant morphological changes and eryptosis compared to those exposed to plasma from the control group at all time points (all, p < 0.001). IL-6 and MPO levels were significantly higher in septic patients than in controls (both, p < 0.001). The percentage of AnnexinV-binding RBCs was significantly higher in septic patients with EAA level ≥0.60 (positive EAA: 32.4%, IQR 27.6-36.2) compared to septic patients with EAA level <0.60 (negative EAA: 14.7%, IQR 5.7-30.7) (p = 0.04). Significant correlations were observed between eryptosis and EAA levels (Spearman rho2 = 0.50, p < 0.05), IL-6 (Spearman rho2 = 0.61, p < 0.05) and MPO (Spearman rho2 = 0.70, p < 0.05). In conclusion, we observed a quick and great cytotoxic effect of septic plasma on healthy RBCs and a strong correlation with other biomarkers of severity of sepsis. Based on these results, we confirmed the pathological role of eryptosis in sepsis and we hypothesized its use as a biomarker of sepsis, potentially helping physicians to face important treatment decisions.
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Affiliation(s)
- Matteo Marcello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35100 Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Nicola Marchionna
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Luca Sgarabotto
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Silvia De Rosa
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy (M.Z.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy
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Virzì GM, Mattiotti M, Milan Manani S, Gnappi M, Tantillo I, Corradi V, de Cal M, Giuliani A, Carta M, Giavarina D, Ronco C, Zanella M. Peritoneal NGAL: a reliable biomarker for PD-peritonitis monitoring. J Nephrol 2023; 36:2139-2141. [PMID: 36646971 DOI: 10.1007/s40620-022-01547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/03/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.
- IRRIV-International Renal Research Institute, Vicenza, Italy.
| | - Maria Mattiotti
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
- Nephrology, Dialysis and Transplant Unit, IRCCS Policlinico Sant'Orsola, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Maddalena Gnappi
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
- DIMED, University of Padova, Padua, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Valentina Corradi
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
| | | | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
- DIMED, University of Padova, Padua, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
- IRRIV-International Renal Research Institute, Vicenza, Italy
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Clementi A, Virzì GM, Manani SM, de Cal M, Battaglia GG, Ronco C, Zanella M. Plasma Cell-Free DNA and Caspase-3 Levels in Patients with Chronic Kidney Disease. J Clin Med 2023; 12:5616. [PMID: 37685683 PMCID: PMC10488719 DOI: 10.3390/jcm12175616] [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: 06/12/2023] [Revised: 08/13/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Cell-free plasma DNA (cfDNA) is circulating extracellular DNA arising from cell death mechanisms (apoptosis, necrosis, etc.). It is commonly existent in healthy individuals, but its ranks increase in diverse clinical circumstances, such as kidney disease, sepsis, myocardial infarction, trauma and cancer. In patients with advanced chronic kidney disease, cfDNA is connected to inflammation, and it has been associated with higher mortality. Caspase-3 plays a dominant role in apoptosis, a mechanism of programmed cell death involved in the pathogenesis and progression of chronic kidney disease (CKD). The aim of this pilot study was the evaluation of cfDNA levels and caspase-3 concentrations in patients with chronic kidney disease, in order to investigate the potential role of these molecules, deriving from inflammatory and apoptotic mechanisms, in the progression of renal damage. METHODS We compared cfDNA and caspase-3 levels in 25 CKD patients and in 10 healthy subjects, evaluating their levels based on CKD stage. We also explored correlations between cfDNA and caspase-3 levels in CKD patients and between cfDNA and caspase-3 levels and serum creatinine and urea in this population. RESULTS We observed that cfDNA and caspase-3 levels were higher in patients with CKD compared to healthy subjects, in particular in patients with advanced renal disease (CKD stage 5). A positive correlation between cfDNA and caspase-3 levels and between cfDNA and caspase-3 and creatinine and urea were also noticed. CONCLUSIONS Patients with chronic kidney disease show higher levels of cfDNA and caspase-3 levels compared to the control group. Based on these preliminary results, we speculated that the worsening of renal damage and the increase in uremic toxin concentration could be associated with higher levels of cfDNA and caspase-3 levels, thus reflecting the potential role of inflammation and apoptosis in the progression of CKD. Future studies should focus on the validation of these promising preliminary results.
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Affiliation(s)
- Anna Clementi
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Acireale, Italy; (A.C.); (G.G.B.)
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
| | - Grazia Maria Virzì
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Sabrina Milan Manani
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimo de Cal
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Giovanni Giorgio Battaglia
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Acireale, Italy; (A.C.); (G.G.B.)
| | - Claudio Ronco
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
| | - Monica Zanella
- IRRIV-International Renal Research Institute, 36100 Vicenza, Italy; (S.M.M.); (M.d.C.); (C.R.); (M.Z.)
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
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de Cal M, Lorenzin A, Risino B, Zanetti F, Fanton G, Fallico L, Rassu M, De Rosa S, Ronco C, Zanella M. Extracorporeal therapy in the treatment of sepsis: In vitro assessment of the effect of an absorbent cartridge on the circulating bacterial concentration and its interaction with the antibiotic therapy. Int J Artif Organs 2023:3913988231168155. [PMID: 37066442 DOI: 10.1177/03913988231168155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Sepsis is one of the major causes of death worldwide. In its physiopathological process, a broad spectrum of pro and antiinflammatory mediators plays a strategic role, leading to a sepsis induced state of immunoparalysis. The rationale behind the employment of extracorporeal purification techniques as a complement to therapy for sepsis is based on their ability to remove the mediators involved. Until now, attention was focused on the immunomodulation allowed by purification therapies. However, the focus of studies on the application possibilities that these techniques offer as a supplement to antimicrobial therapy and resuscitation of critically ill patients must be extended. In this study, the possible removal by adsorption that the Jafron® HA330 cartridge operates against bacteria (S. aureus) was evaluated in vitro. Subsequently, it was evaluated whether the adsorptive capabilities toward bacteria were maintained by using a cartridge functionalized with Vancomycin and whether the latter maintains its bactericidal activity. This study showed that HA330 reduces the circulating bacterial load, even in the presence of pre-adsorbed Vancomycin. Vancomycin, once adsorbed by the cartridge, does not guarantee its bactericidal activity during the 2-h of hemoperfusion treatment.
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Affiliation(s)
- Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Anna Lorenzin
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Benedetta Risino
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Fiammetta Zanetti
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Giulia Fanton
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Loredana Fallico
- Department of Microbiology, St. Bortolo Hospital, Vicenza, Italy
| | - Mario Rassu
- Department of Microbiology, St. Bortolo Hospital, Vicenza, Italy
| | - Silvia De Rosa
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
- Department of Anesthesia and Intensive Care, Santa Chiara Regional Hospital, Trento, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
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Virzì GM, Mattiotti M, de Cal M, Ronco C, Zanella M, De Rosa S. Endotoxin in Sepsis: Methods for LPS Detection and the Use of Omics Techniques. Diagnostics (Basel) 2022; 13:diagnostics13010079. [PMID: 36611371 PMCID: PMC9818564 DOI: 10.3390/diagnostics13010079] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Lipopolysaccharide (LPS) or endotoxin, the major cell wall component of Gram-negative bacteria, plays a pivotal role in the pathogenesis of sepsis. It is able to activate the host defense system through interaction with Toll-like receptor 4, thus triggering pro-inflammatory mechanisms. A large amount of LPS induces inappropriate activation of the immune system, triggering an exaggerated inflammatory response and consequent extensive organ injury, providing the basis of sepsis damage. In this review, we will briefly describe endotoxin's molecular structure and its main pathogenetic action during sepsis. In addition, we will summarize the main different available methods for endotoxin detection with a special focus on the wider spectrum offered by omics technologies (genomics, transcriptomics, proteomics, and metabolomics) and promising applications of these in the identification of specific biomarkers for sepsis.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
- Correspondence: ; Tel.: +39-0444753650; Fax: +39-0444753949
| | - Maria Mattiotti
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
| | - Silvia De Rosa
- IRRIV—International Renal Research Institute Vicenza, 36100 Vicenza, Italy
- Centre for Medical Sciences—CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, 38122 Trento, Italy
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Lorenzin A, de Cal M, Marcello M, Sorbo D, Copelli S, Ronco C, de Rosa S, Zanella M. Vancomycin Adsorption during in vitro Model of Hemoperfusion with Mini-Module of HA380 Cartridge. Blood Purif 2022; 52:174-182. [PMID: 36096119 DOI: 10.1159/000526149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/28/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sepsis is a frequent complication in critically ill patients. Patients may require control of the source of infection, removal of pathogens and damaged cells, and organ support. Often, these targets can be achieved through the utilization of extracorporeal therapies including hemoperfusion for the adsorption of cytokines and other circulating mediators. On extracorporeal organ support, patients are generally treated with antibiotic therapy, and vancomycin is one of the most commonly used antibiotics. Because of the aspecific nature of adsorption, antibiotics can be removed from the circulation, leading to altered plasma levels and requiring prescription adjustment. The aim was to define the amount of vancomycin adsorbed by a sorbent cartridge (HA380, Jafron, China) during hemoperfusion and to establish possible strategies to maintain an effective plasma level in critically ill patients undergoing extracorporeal therapies. METHODS In vitro experiments with incremental concentrations of vancomycin in the test solution (500 and 1,000 mL) were carried out in a recirculation circuit until sorbent saturation was observed. A maximum of 10 g of vancomycin were injected and mini-modules containing 25 g of dry resin were utilized. RESULTS In different experiments with various concentration of vancomycin, a maximum amount of 244 mg/g of sorbent was adsorbed reaching saturation between 60 and 80 min from the beginning of the experiments. The kinetics of adsorption appears to be governed by a Langmuir-like isotherm with maximal removal speed in the early minutes and a plateau after 60 min. DISCUSSION/CONCLUSION HA380 adsorbs significant amounts of vancomycin. Adjusting the achieved results with the experimental mini-module to a full-scale cartridge, a total of 25 g of antibiotic can be removed. This might have affected outcome results in clinical trials. This suggests prescribing administration to critically ill patients requiring hemoperfusion, immediately after or in the inter-session time window. In case of administration during hemoperfusion, adequate adjustment and plasma level monitoring is strongly recommended.
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Affiliation(s)
- Anna Lorenzin
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Matteo Marcello
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - David Sorbo
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Sabrina Copelli
- Department of Science and High Technology, Università degli Studi dell'Insubria, Varese, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Silvia de Rosa
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
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11
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Lorenzin A, de Cal M, Sorbo D, Ronco C, Zanella M. MO274: Vancomycin Adsorption During In Vitro Model of Hemoperfusion with Mini-Module of HA380 Cartridge. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac067.073] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Septic shock is one of the most frequent causes in Intensive Care Unit (ICU) admission and is related to a very high risk of mortality. About one-third of patients with sepsis develops AKI which contributes to a worsening prognosis. AKI due to sepsis is the result of a dysregulated host immune response to infection, with the production of inflammatory mediators and cytokines that cause haemodynamic alterations, endothelial damage, apoptosis and, finally, immunoparalysis. The new Jafron HA380 cartridge has been specifically designed for use in clinical conditions characterized by cytokine storm such as sepsis. Given the growing application of these devices in cases of septic AKI in ICU, an unsolved problem is whether these polymers adsorb drugs, including antibiotics.
In vitro experiments were conducted to determine its adsorption capacity toward Vancomycin antibiotic.
METHOD
In vitro circulation was performed using a dedicated testing platform Galileo. A customized cartridge was built assembling mini-module components scaled in dimension toward HA380 and filled with 75 g of HA380 beads (25% of the regular size cartridge). Peristaltic pump was set at 250 mL/min. we performed two circulation containing extremely high quantity of Vancomycin (5 g in 500 mL and 10 g in 1000 mL) for 300 minutes. Samples were collected every 20 minutes. Vancomycin concentrations were measured.
The adsorption isotherm was represented using the equation: Massadsorbed = RR × Massinjected, where the RR in the Vancomycin removal ratio.
RESULTS
In vitro circulation confirms the affinity of beads material in binding Vancomycin molecules. The kinetics of vancomycin adsorption shows a rapid decay of the concentration in the first part of the experiments, after which we can observed a plateau (Fig. 1a). A total of 4500 mg of the 5000 mg were adsorbed in the end of the experiment (RR = 94%), of which 90% in the first 40 minutes (RR = 87%); after this period the curve became flat and the adsorption phenomenon negligible (Fig. 1b).
In the experiment with 10 000 mg, after 60 minutes of rapid adsorption (RR = 55%), the curve reached a plateau converging to a RR higher than 60% (Fig.). The sorbent beads were able to bind 6100 mg toward 10 000 mg injected. This amount saturated the mini-module binding sites.
CONCLUSION
The application of HA380 mini-modules allowed to determine the amount of Vancomycin necessary to reach the saturation of the sorbent material. Based on the obtained results, we estimated that the cartridge HA380 could retain more than 24 g of Vancomycin during HP circulation. Further investigation is needed to validate our results and to better understand HA380 performance in clinical practice.
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Affiliation(s)
- Anna Lorenzin
- Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
- International Renal Resarch Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Massimo de Cal
- Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
- International Renal Resarch Institute of Vicenza (IRRIV), Vicenza, Italy
| | - David Sorbo
- Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
- International Renal Resarch Institute of Vicenza (IRRIV), Vicenza, Italy
- University of Padova, Padova, Italy
| | - Monica Zanella
- Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
- International Renal Resarch Institute of Vicenza (IRRIV), Vicenza, Italy
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12
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Lorenzin A, Golino G, de Cal M, Pajarin G, Savastano S, Lupi A, Sandini A, Fiorin F, Ronco C. Flow Dynamic Analysis by Contrast-Enhanced Imaging Techniques of Medium Cutoff Membrane Hemodialyzer. Blood Purif 2021; 51:138-146. [PMID: 34034259 DOI: 10.1159/000516411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Medium cutoff (MCO) membranes represent an interesting innovation in the field of hemodialysis. Given the correlation between large (PM >25 kDa) middle molecules (LMM) and clinical outcomes, the possibility to broaden the spectrum of solutes removed in hemodialysis with MCO membranes introduces a new perspective for end-stage kidney disease patients. Due to low diffusion coefficients of LMM, the use of convection is required to maximize extracorporeal clearance. High convective rates are achieved with high-flux membranes in hemodiafiltration, a technique not available in the US. In case of the MCO membrane, remarkable clearances of LMM are achieved combining the permeability of the membrane with a significant amount of internal convection. The mechanism of filtration-backfiltration inside the dialyzer enables effective removal of LMM in a technique called expanded hemodialysis (HDx). Given such theoretical explanation, it is important to demonstrate the blood and ultrafiltration rheology inside the MCO dialyzer. METHOD This study for the first time describes flow dynamic parameters and internal cross-filtration, thanks to specific radiology and nuclear imaging techniques. RESULTS Flow dynamic analysis of the blood and dialysate compartment confirms excellent distribution of velocities and an excellent matching of blood and dialysate. Average blood flow velocity allows for wall shear rates adequate to avoid protein stagnation at the blood membrane interface and increase in blood viscosity. Cross-filtration analysis demonstrates a remarkable filtration/backfiltration flux reaching values >30 mL/min at a blood flow of 300 mL/min and zero net filtration. CONCLUSION The MCO dialyzer Theranova 400 appears to have a design optimized to perform expanded hemodialysis (HDx).
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Affiliation(s)
- Anna Lorenzin
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy
| | - Gianlorenzo Golino
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care Medicine, University of Padova, Padua, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy
| | - Giordano Pajarin
- Department of Radiology, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy
| | - Sergio Savastano
- Department of Radiology, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy
| | - Andrea Lupi
- Department of Nuclear Medicine, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy
| | - Alessandra Sandini
- Department of Transfusion Medicine, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy
| | - Francesco Fiorin
- Department of Transfusion Medicine, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, aULSS8 Berica, Vicenza, Italy.,Department of Medicine, University of Padua, Padua, Italy
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13
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Stasi A, Franzin R, Divella C, Sallustio F, Curci C, Picerno A, Pontrelli P, Staffieri F, Lacitignola L, Crovace A, Cantaluppi V, Medica D, Ronco C, de Cal M, Lorenzin A, Zanella M, Pertosa GB, Stallone G, Gesualdo L, Castellano G. PMMA-Based Continuous Hemofiltration Modulated Complement Activation and Renal Dysfunction in LPS-Induced Acute Kidney Injury. Front Immunol 2021; 12:605212. [PMID: 33868226 PMCID: PMC8047323 DOI: 10.3389/fimmu.2021.605212] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/12/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis-induced acute kidney injury (AKI) is a frequent complication in critically ill patients, refractory to conventional treatments. Aberrant activation of innate immune system may affect organ damage with poor prognosis for septic patients. Here, we investigated the efficacy of polymethyl methacrylate membrane (PMMA)-based continuous hemofiltration (CVVH) in modulating systemic and tissue immune activation in a swine model of LPS-induced AKI. After 3 h from LPS infusion, animals underwent to PMMA-CVVH or polysulfone (PS)-CVVH. Renal deposition of terminal complement mediator C5b-9 and of Pentraxin-3 (PTX3) deposits were evaluated on biopsies whereas systemic Complement activation was assessed by ELISA assay. Gene expression profile was performed from isolated peripheral blood mononuclear cells (PBMC) by microarrays and the results validated by Real-time PCR. Endotoxemic pigs presented oliguric AKI with increased tubulo-interstitial infiltrate, extensive collagen deposition, and glomerular thrombi; local PTX-3 and C5b-9 renal deposits and increased serum activation of classical and alternative Complement pathways were found in endotoxemic animals. PMMA-CVVH treatment significantly reduced tissue and systemic Complement activation limiting renal damage and fibrosis. By microarray analysis, we identified 711 and 913 differentially expressed genes with a fold change >2 and a false discovery rate <0.05 in endotoxemic pigs and PMMA-CVVH treated-animals, respectively. The most modulated genes were Granzyme B, Complement Factor B, Complement Component 4 Binding Protein Alpha, IL-12, and SERPINB-1 that were closely related to sepsis-induced immunological process. Our data suggest that PMMA-based CVVH can efficiently modulate immunological dysfunction in LPS-induced AKI.
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Affiliation(s)
- Alessandra Stasi
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Rossana Franzin
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Chiara Divella
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Fabio Sallustio
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Claudia Curci
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Angela Picerno
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Pontrelli
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Staffieri
- Veterinary Surgery Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luca Lacitignola
- Veterinary Surgery Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Antonio Crovace
- Veterinary Surgery Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Davide Medica
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Anna Lorenzin
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Giovanni B Pertosa
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
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14
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Godi I, Lorenzin A, De Rosa S, Golino G, Knust M, Gaspar A, Sandini A, Fiorin F, de Cal M, Navalesi P, Ronco C. Vancomycin Adsorption During in vitro Model of Hemoperfusion with HA380 Cartridge. Nephron Clin Pract 2021; 145:157-163. [PMID: 33567447 DOI: 10.1159/000513122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/23/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A critical point for using blood purification during sepsis may be the potential interaction with antimicrobial therapy, the mainstay of sepsis treatment. The aim of our study was to investigate the vancomycin removal during hemoperfusion (HP) using HA380 cartridge. METHODS This is an experimental study, in which 500 mL of solution was circulated in a closed-circuit (blood flow of 250 mL/min) simulating HP ran using HA380. Vancomycin was added to reach a through concentration or a very high concentration to evaluate the removal ratio (RR) during 120 min of HP. Comparison between blood-crystalloid solution and balanced solution was performed by using Kruskal-Wallis test. The kinetics of vancomycin removal and the adsorption isotherm were evaluated. RESULTS We found a complete removal of vancomycin at baseline through concentration of 23.0 ± 7.4 mg/L. Using extremely high concentration (baseline 777.0 ± 62.2 mg/L), RR was 90.1 ± 0.6% at 5 min and 99.2 ± 0.6% at 120 min. No difference in terms of RR was found between blood-crystalloid mixture and balanced solution. The kinetics of the vancomycin reduction followed an exponential decay. Repeated boluses (total amount of 2,000 mg) resulted in cumulative adsorption of 1,919.4 mg with RR of 96.6 ± 1.4%, regardless of the amount injected (100 vs. 500 mg). Vancomycin adsorption onto HA380 followed the Langmuir isotherm model. CONCLUSIONS A considerable amount of vancomycin was rapidly removed during in vitro HP with HA380. Clinical studies are needed to determine whether this may lead to underdosing. Drug therapeutic monitoring is highly recommended when using HA380 for blood purification in patients receiving vancomycin.
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Affiliation(s)
- Ilaria Godi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy, .,International renal Research Institute of Vicenza, Vicenza, Italy,
| | - Anna Lorenzin
- International renal Research Institute of Vicenza, Vicenza, Italy
| | - Silvia De Rosa
- International renal Research Institute of Vicenza, Vicenza, Italy.,Department of Anesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Gianlorenzo Golino
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy.,International renal Research Institute of Vicenza, Vicenza, Italy
| | - Maira Knust
- International renal Research Institute of Vicenza, Vicenza, Italy
| | - Ana Gaspar
- International renal Research Institute of Vicenza, Vicenza, Italy
| | - Alessandra Sandini
- Department of Transfusional Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Fiorin
- Department of Transfusional Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Claudio Ronco
- International renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine - DIMED, University of Padova, Padova, Italy
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15
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Husain-Syed F, Quattrone MG, Ferrari F, Bezerra P, Lopez-Giacoman S, Danesi TH, Samoni S, de Cal M, Yücel G, Yazdani B, Seeger W, Walmrath HD, Birk HW, Salvador L, Ronco C. Clinical and Operative Determinants of Acute Kidney Injury after Cardiac Surgery. Cardiorenal Med 2020; 10:340-352. [PMID: 32599584 DOI: 10.1159/000507777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. OBJECTIVES We aimed to identify potentially modifiable risk factors for CSA-AKI. METHODS This was asingle-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling. RESULTS A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with 6 patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure [PSPAP], acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell [RBC] volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables. CONCLUSIONS Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI.
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Affiliation(s)
- Faeq Husain-Syed
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany, .,International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy,
| | | | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Department of Intensive Care, I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Pércia Bezerra
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Salvador Lopez-Giacoman
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | | | - Sara Samoni
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Gökhan Yücel
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany.,First Department of Medicine, Faculty of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Babak Yazdani
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany.,Fifth Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Werner Seeger
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Hans-Dieter Walmrath
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Horst-Walter Birk
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Loris Salvador
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine (DIMED), University of Padua, Padua, Italy
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16
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Godi I, De Rosa S, Martino F, Bazzano S, Martin M, Boni E, Carta MR, Tamayo Diaz C, Mari G, Lorenzin A, de Cal M, Corradi V, Caprara C, Giavarina D, Ronco C. Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients. Ann Intensive Care 2020; 10:46. [PMID: 32318859 PMCID: PMC7174532 DOI: 10.1186/s13613-020-00665-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/13/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Biomarkers can play a critical role by facilitating diagnosis and stratification of disease, as well as assessment or prediction of disease severity. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 product ([TIMP-2] × [IGFBP7]) predict the development and progression of AKI and recently procalcitonin (PCT), a widely used biomarker for sepsis diagnosis and management, has been associated with AKI occurrence in ICU patients. To assess combinations of [TIMP-2] × [IGFBP7] and PCT results for prediction and risk stratification of short-term outcomes in septic and non-septic patients, a retrospective cohort analysis of critically ill patients was performed in a multidisciplinary ICU. ROC curve analysis was used in order to evaluate predictive performance of combined results of [TIMP-2] × [IGFBP7] and PCT at the time of admission for AKI development. To verify the utility of adding [TIMP-2] × [IGFBP7] and PCT results for risk assessment, we evaluated the predictive value of having a single-marker positivity compared to a double-marker positivity using the widely used cut-off of 0.3 (ng/mL)2/1000 for [TIMP-2] × [IGFBP7] and 0.5 μg/L for PCT. Risk assessment for AKI occurrence within 48 h, acute kidney disease (AKD) and mortality at 7 days was performed by logistic/Cox regression analysis. RESULTS 433 patients were analysed, of whom 168 had AKI within 48 h (93 septic and 65 non-septic patients). Combination of [TIMP-2] × [IGFBP7] and PCT showed a good predictive ability for AKI occurrence (AUC 0.81, 95% CI 0.77-0.86, p < 0.001, Sens 78%, Spec 73%). Combinations of biomarkers increased the odd ratios (OR) considerably. A single-marker positivity showed a fourfold risk increase, while the double-marker positivity a 26-fold risk increase for AKI occurrence. Moreover, the double-marker positivity showed an elevated risk for AKD at 7 days in non-septic patients (OR 15.9, 95% CI 3,21-73,57, p < 0.001) and for mortality within 7 days in septic patients (HR 4.1, 95% CI 1.4-11.8, p = 0.001). CONCLUSIONS Although combining the results of [TIMP-2] × [IGFBP7] and PCT may be a useful tool to identify and stratify ICU patients at high risk for septic AKI and short-term adverse outcomes, data should be confirmed in a large prospective study.
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Affiliation(s)
- Ilaria Godi
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy. .,Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care Medicine, University of Padova, Padua, Italy.
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Francesca Martino
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Simona Bazzano
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,Department of Anesthesiology and Intensive Care, Azienda Ospedalieriero-Universitaria Maggiore DELLA Carità, Novara, Italy
| | - Marina Martin
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Elisa Boni
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Maria Rosa Carta
- Department of Laboratory Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Claudia Tamayo Diaz
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Gaia Mari
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Valentina Corradi
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Carlotta Caprara
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Department of Laboratory Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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17
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Virzì GM, Milan Manani S, Clementi A, Castegnaro S, Brocca A, Riello C, de Cal M, Giuliani A, Battaglia GG, Crepaldi C, Ronco C. Eryptosis Is Altered in Peritoneal Dialysis Patients. Blood Purif 2019; 48:351-357. [PMID: 31291616 DOI: 10.1159/000501541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/11/2018] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Red blood cells (RBCs) undergo programmed cell death known as eryptosis. Triggers of eryptosis include increased cytosolic Ca(2+) concentration, oxidative stress, osmotic shock, energy depletion and several uremic toxins. Little is known about the pathogenesis of eryptosis in peritoneal dialysis (PD) patients; furthermore, its relevance in worsening clinical conditions in these patients is still not completely defined. OBJECTIVES We investigated eryptosis levels in PD patients and its association with inflammatory and clinical parameters. MATERIAL AND METHODS A total of 46 PD patients and 17 healthy subjects (CTR) were enrolled. All eryptosis measurements were made in freshly isolated RBCs using the flow cytometer. RESULTS Eryptosis was significantly higher in PD patients than that in CTR (p < 0.001). Eryptosis levels did not differ significantly between PD patients with and without diabetes, with and without hypertension, and with and without cardiovascular disease. Eryptosis showed no significant differences between patients treated with continuous ambulatory PD/automated PD, with Kt/Vurea value ≤1.7 and >1.7, with a negative or positive history of peritonitis. On the contrary, eryptosis showed significantly lower levels in PD patients with weekly creatinine clearance ≥45 L/week/1.73 m2 (2.8%, 1.7-4.9 vs. 5.6%, 5.0-13.5; p= 0.049). Eryptosis showed significantly lower levels in PD patients with residual diuresis (n = 23) than that in patients without (3.7%, 2.6-5.6 vs. 5%, 3.1-16; p = 0.03). In these 23 patients, significant negative correlations between percentage of eryptosis and residual glomerular filtration rate (rGFR; Spearman's rho = -0.51, p = 0.01) and diuresis volume (Spearman's rho = -0.43, p = 0.05) were found. CONCLUSIONS The present study demonstrated higher eryptosis levels in PD patients compared to corresponding levels in CTR. Furthermore, important PD comorbidity and main PD parameters do not influence eryptosis. Importantly, our data have reported an increase in eryptosis levels with progressive residual diuresis and rGFR loss, probably due to decreased uremic toxins clearance.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy, .,International Renal Research Institute, IRRIV, Vicenza, Italy,
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Anna Clementi
- International Renal Research Institute, IRRIV, Vicenza, Italy.,Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, Acireale, Italy
| | - Silvia Castegnaro
- International Renal Research Institute, IRRIV, Vicenza, Italy.,Hematology Project Foundation, St Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy.,Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Caterina Riello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | | | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
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18
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Virzì GM, Breglia A, Ankawi G, Bolin C, de Cal M, Cianci V, Vescovo G, Ronco C. Plasma Lipopolysaccharide Concentrations in Cardiorenal Syndrome Type 1. Cardiorenal Med 2019; 9:308-315. [PMID: 31238313 DOI: 10.1159/000500480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome (CRS) type 1 is characterized by a rapid worsening of cardiac function that leads to acute kidney injury (AKI). This study evaluated the role of lipopolysaccharide (LPS) in the development of AKI in patients with acute heart failure (AHF) and its relationship with renal parameters, to enable a better comprehension of the pathophysiology of CRS type 1. METHODS We enrolled 32 AHF patients, 15 of whom were classified as having CRS type 1. Eight of these 15 exhibited AKI at the time of admission (caused by AHF) and the other 7 developed AKI during their stay in hospital (in the first 48 h). We evaluated the plasmatic LPS concentrations as well as conventional (serum creatinine [sCr] and urea) and unconventional (neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C) renal markers. RESULTS LPS levels were significantly higher in the CRS type 1 patients. No significant difference in LPS level was found in patients who were admitted with AKI and those developed AKI in hospital, but there was a tendency towards a higher level of LPS in CRS type 1 patients admitted with AKI. The LPS concentrations at admission were similar in CRS type 1 survivors (n = 12) and nonsurvivors (n = 3) (p = 0.22). We observed a positive correlation between LPS level and NGAL, Scr at admission and peak Scr during hospitalization and urea at admission. CONCLUSION CRS type 1 patients present with an increased level of LPS and there is a direct correlation between LPS and renal parameters. This pilot research is the first study to explore the premise of LPS as novel pathophysiological factor in CRS type 1.
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Affiliation(s)
- Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy, .,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy,
| | - Andrea Breglia
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Emergency Department of Arzignano Hospital, Arzignano, Italy
| | - Ghada Ankawi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Internal Medicine and Nephrology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Vito Cianci
- Emergency Department of Arzignano Hospital, Arzignano, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit, Sant'Antonio Hospital Padua, Padua, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,Nephrology, Department of Medicine, University of Padua, Padua, Italy
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19
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Lorenzin A, Neri M, de Cal M, Pajarin G, Mansi Montenegro G, Savastano S, Alghisi A, Ronco C. Fluid Dynamics Analysis by CT Imaging Technique of New Sorbent Cartridges for Extracorporeal Therapies. Blood Purif 2019; 48:18-24. [PMID: 31039563 DOI: 10.1159/000499076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent innovations in biomaterials technology have led to the development of innovative sorbents adopted as adsorbing devices in the field of extracorporeal blood purification therapies. As removal mechanism, adsorption allows to remove specific molecules, selectively binding them to sorbent materials. In addition to the material properties, a quintessential aspect influencing device properties is blood flow distribution within the sorbent particles. OBJECTIVES In order to adequately characterize the potential adsorbing properties for an effective blood purification therapy, an in vitro study assessing the fluid dynamics inside 3 new cartridges, HA130, HA230 and HA330 (Jafron, Zhuhai City, -China) was conducted through CT imaging technique. -Methods: The cartridges were placed in vertical position in the CT -gantry. Dye solution was circulated through the cartridges at 250 mL/min, longitudinal sections, 0.5 cm thick, were recorded for 60 s. Furthermore, an in vitro test was conducted to build pressure drop profiles. Blood was circulated at a different flow rate, 100-400 mL/min, step 50 mL/min. Pre and post cartridges pressures were acquired and pressure drop calculated. RESULTS Sequential images demonstrated an excellent distribution of the flow inside the cartridges. Average flow velocity was 0.37 cm/s for the 3 cartridges. HA130 had a homogeneous flow profile along the entire length of the device; HA230 and HA330 showed minimal differences between central and peripheral regions. Pressure drop profiles resulted linear, increasing proportionally with blood flow rate and packing density. CONCLUSIONS We may conclude that the structural and functional design of the studied cartridges is adequate for haemoperfusion with no channelling phenomena. This ensures maximum and optimal utilization of the sorbent contained in the devices.
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Affiliation(s)
- Anna Lorenzin
- International Renal Research Institute of Vicenza, Vicenza, Italy, .,Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy,
| | - Mauro Neri
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy
| | | | | | | | - Alberta Alghisi
- Department of Transfusion Medicine, St. Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.,Department of Medicine, University of Padua, Padua, Italy
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20
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Neri M, Lorenzin A, de Cal M, Brendolan A, Marchionna N, Samoni S, Zanella M, De Rosa S, Martino F, Ricci Z, Maynar J, Auzinger G, Villa G, Payen D, Joannidis M, Ronco C. ACUsmart Continuous Renal Replacement Therapy Platform: Multicenter Pilot Study for Technical and Clinical Assessment (A.M.P. Study). Blood Purif 2019; 48:60-66. [PMID: 30712031 DOI: 10.1159/000496090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND ACUsmart (Medica S.P.A., Italy) is a new-generation, continuous renal replacement therapy (CRRT) machine for critically ill patients with acute kidney injury. We designed a multicenter international pilot study to provide a description of outlines of the ACUsmart system, evaluation aspects of functionality, usability, and feasibility, discriminating reasons of possible treatment's withdrawals or discontinuations and highlighting strong and weak points of the machine. METHODS Data of 23 CRRT (and 11 plasma exchange) treatments were collected from 4 intensive care units. Parameters such as treatment duration, downtime, delivered dose, and number and type of alarms were recorded. The general perception of the machine was quantified through the administration of a survey to each component of the evaluating staff. RESULTS A total treatment time of 447 h was carried with ACUsmart. Eleven continuous veno-venous hemofiltration, 4 continuous veno-venous hemodialysis , and 8 continuous veno-venous hemodiafiltration were performed. The average percentage of net treatment duration with respect to total treatment duration was 92.37%. The mean prescribed dose and delivered dose were 26.33 and 24.10 mL/kg/h, respectively. In general, the machine was rated by users involved as practical and easy to use, although few components need to be slightly improved. CONCLUSION ACUsmart is a new multifunctional machine that meets most of the features required in a fourth-generation CRRT equipment.
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Affiliation(s)
- Mauro Neri
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy,
| | - Anna Lorenzin
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brendolan
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Nicola Marchionna
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Sara Samoni
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Silvia De Rosa
- Department of Anesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Francesca Martino
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Zaccaria Ricci
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS Rome, Rome, Italy
| | - Javier Maynar
- Intensive Care Unit, University Hospital Araba, Vitoria-Gasteiz, Spain
| | - Georg Auzinger
- King's College Hospital, Denmark Hill, London, United Kingdom
| | - Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain, University of Florence, Florence, Italy
| | - Didier Payen
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Michael Joannidis
- Division of Emergency Medicine and Intensive Care, Department Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
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21
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Husain-Syed F, Ferrari F, Sharma A, Hinna Danesi T, Bezerra P, Lopez-Giacoman S, Samoni S, de Cal M, Corradi V, Virzì GM, De Rosa S, Muciño Bermejo MJ, Estremadoyro C, Villa G, Zaragoza JJ, Caprara C, Brocca A, Birk HW, Walmrath HD, Seeger W, Nalesso F, Zanella M, Brendolan A, Giavarina D, Salvador L, Bellomo R, Rosner MH, Kellum JA, Ronco C. Persistent decrease of renal functional reserve in patients after cardiac surgery-associated acute kidney injury despite clinical recovery. Nephrol Dial Transplant 2019; 34:308-317. [DOI: 10.1093/ndt/gfy227] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Faeq Husain-Syed
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Aashish Sharma
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Pércia Bezerra
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Sara Samoni
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Valentina Corradi
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Carla Estremadoyro
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Gianluca Villa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Jose J Zaragoza
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Carlotta Caprara
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Horst-Walter Birk
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Hans-Dieter Walmrath
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg—Campus Giessen, Giessen, Germany
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brendolan
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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22
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Virzì GM, Borga C, Pasqualin C, Pastori S, Brocca A, de Cal M, Nalesso F, Zanella M, Brendolan A, Ronco C. Direct Effect of Septic Plasma in Human Cell Lines Viability. Blood Purif 2018; 47:270-276. [PMID: 30522094 DOI: 10.1159/000494597] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sepsis is a life-threatening condition often associated with a high incidence of multiple organs injury. Several papers suggested the immune response by itself, with the production of humoral inflammatory mediators, is crucial in determining organ injury. However, little is known of how sepsis directly induces organ injury at the cellular levels. To assess this point, we set up an in vitro study to investigate the response of renal tubular cells (RTCs), monocytes (U937) and hepatocytes (HepG2) after 24 h-incubation with septic patients' plasma. METHODS We enrolled 26 septic patients ("test" group). We evaluated cell viability, apoptosis and necrosis by flow cytometer. Caspase-3,-8,-9 and cytochrome-c concentrations have been analyzed using the Human enzyme-linked immunosorbent assay kit. RESULTS We found that a decrease of cell viability in all cell lines tested was associated to the increase of apoptosis in RTCs and U937 (p < 0.0001) and increase of necrosis in HepG2 (p < 0.5). The increase of apoptosis in RTCs and U937 cells was confirmed by higher levels of caspase-3 (p < 0.0001). We showed that apoptosis in both RTCs and U937 was triggered by the activation of the intrinsic pathway, as caspase-9 and cytochrome-c levels significantly increased (p < 0.0001), while caspase-8 did not change. This assumption was strengthened by the significant correlation of caspase-9 with both cytochrome-c (r = 0.73 for RTCs and r = 0.69 for U937) and caspase-3 (r = 0.69 for RTCs and r = 0.63 for U937). CONCLUSION Humoral mediators in septic patients' plasma induce apoptosis. This fact suggests that apoptosis inhibitors should be investigated as future strategy to reduce sepsis-induced organ damages.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy, .,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy,
| | - Chiara Borga
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Chiara Pasqualin
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Medicine, UOC di Nefrologia 2, Azienda Ospedaliera, University of Padova, Padova, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Alessandra Brendolan
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
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23
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Ankawi G, Fan W, Pomarè Montin D, Lorenzin A, Neri M, Caprara C, de Cal M, Ronco C. A New Series of Sorbent Devices for Multiple Clinical Purposes: Current Evidence and Future Directions. Blood Purif 2018; 47:94-100. [PMID: 30253409 DOI: 10.1159/000493523] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 06/19/2018] [Accepted: 09/06/2018] [Indexed: 11/19/2022]
Abstract
Adsorption is an extracorporeal technique utilized for blood purification. It complements convection and diffusion (the main modalities of solute removal). It involves the passage of blood (or plasma) through an adsorption cartridge, where solutes are removed by direct binding to the sorbent material. Over the years, new adsorption cartridges, with improved characteristics have been developed. Furthermore, the therapeutic applications of adsorption have expanded. These now involve the treatment of inflammatory conditions, chronic uremic symptoms, and autoimmune disease, in addition to intoxication, which was once considered the classical indication for adsorption therapy. HA130, HA230, and HA330 (Jafron, Zhuhai City, China) are among the widely used adsorption cartridges in China. There has been sufficient body of evidence to support their effectiveness and safety. In this review, we aim to highlight their main clinical applications.
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Affiliation(s)
- Ghada Ankawi
- IRRIV, International Renal Research Institute Vicenza, Vicenza, .,Departments of Internal Medicine and Nephrology, King Abdulaziz University, Jeddah, Saudi
| | - Weixuan Fan
- IRRIV, International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Emergency and Critical Care Medicine, The second Hospital of Jilin University, Changchun, China
| | | | - Anna Lorenzin
- IRRIV, International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Mauro Neri
- IRRIV, International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Carlotta Caprara
- IRRIV, International Renal Research Institute Vicenza, Vicenza, Italy.,Istituto di Ricerca Pediatrica, Città della Speranza, Laboratorio di Genetica Clinica ed Epidemiologica, Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- IRRIV, International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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24
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Virzì GM, Breglia A, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C. Levels of Proinflammatory Cytokines, Oxidative Stress, and Tissue Damage Markers in Patients with Acute Heart Failure with and without Cardiorenal Syndrome Type 1. Cardiorenal Med 2018; 8:321-331. [PMID: 30205401 DOI: 10.1159/000492602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome type 1 (CRS type 1) is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Inflammation and oxidative stress seem to play a pivotal role in its pathophysiology. In this in vivo study, we examined the putative role of inflammation and humoral markers in the pathogenesis of the CRS type 1. METHODS We enrolled 53 patients with acute heart failure (AHF); 17 of them developed AKI (CRS type 1). The cause of AKI was presumed to be related to cardiac dysfunction after having excluded other causes. We assessed the plasma levels of proinflammatory cytokines (TNF-α, IL-6, IL-18, sICAM, RANTES, GMCSF), oxidative stress marker (myeloperoxidase, MPO), brain natriuretic peptide (BNP), and neutrophil gelatinase-associated lipocalin (NGAL) in AHF and CRS type 1 patients. RESULTS We observed a significant increase in IL-6, IL-18, and MPO levels in CRS type 1 group compared to AHF (p < 0.001). We found higher NGAL at admission in the CRS type 1 group compared to the AHF group (p = 0.008) and a positive correlation between NGAL and IL-6 (Spearman's rho = 0.45, p = 0.003) and between IL-6 and BNP (Spearman's rho = 0.43, p = 0.004). We observed lower hemoglobin levels in CRS type 1 patients compared to AHF patients (p < 0.05) and inverse correlation between hemoglobin and cytokines (IL-6: Spearman's rho = -0.38, p = 0.005; IL-18: Spearman's rho = -0.32, p = 0.02). CONCLUSION Patients affected by CRS type 1 present increased levels of proinflammatory cytokines and oxidative stress markers, increased levels of tissue damage markers, and lower hemoglobin levels. All these factors may be implicated in the pathophysiology of CRS type 1 syndrome.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Andrea Breglia
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy.,Department of Internal Medicine, University of Trieste, Trieste, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy.,Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit Sant'Antonio Hospital, Padua, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
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25
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Villa G, Neri M, De Rosa S, Samoni S, Chelazzi C, Romagnoli S, Lorenzin A, de Cal M, Ronco C, De Gaudio AR. Albumin Loss and Citrate Load in Pre-Dilution High Cut-Off-CVVHDF with Regional Citrate (18 mmol/L) and High Cut-Off CVVHD with Systemic Heparin: An in vitro Study. Blood Purif 2018; 46:205-213. [PMID: 29886476 DOI: 10.1159/000490342] [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: 02/05/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Convective therapies with high cut-off membranes (HCO) are usually not recommended because of theoretical excessive albumin loss. The aim of this in vitro study is to demonstrate the noninferior safety of pre-dilution hemodiafiltration with HCO (HCO-CVVHDF) with isotonic citrate anticoagulation (18 mmol/L) with respect to heparin anticoagulated hemodialysis with HCO (HCO-CVVHD) in terms of albumin removal and citrate load. METHOD -Albumin removal was compared in vitro between 3 pre--dilution-HCO-CVVHDF with citrate anticoagulation and 3 -HCO-CVVHD with heparin anticoagulation during 30-min single-pass and 180-min recirculation phases. RESULTS Considering concentrations and flows in the extracorporeal circuit, the transmembrane albumin removal was 2.06 (1.51; 2.09) g and 2.09 (1.9; 2.8) g respectively for HCO-CVVHDF and HCO-CVVHD, during the single-pass phase; 2.8 (2.67; 4.59) g and 2.54 (2.35; 4.67) g, respectively, for HCO-CVVHDF and HCO-CVVHD during the recirculation phase. Based on the citrate saturation coefficients, a citrate metabolic load of 8.86 mmol/h has been calculated for HCO-CVVHDF. CONCLUSION HCO-CVVHDF performed with regional anticoagulation with 18 mmol/L citrate solution does not induce higher -albumin transmembrane removal compared to HCO-CVVHD.
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Affiliation(s)
- Gianluca Villa
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence, Florence, Italy.,Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mauro Neri
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Sara Samoni
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Cosimo Chelazzi
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Angelo Raffaele De Gaudio
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence, Florence, Italy.,Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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26
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Dozio E, Corradi V, Proglio M, Vianello E, Menicanti L, Rigolini R, Caprara C, de Cal M, Corsi Romanelli MM, Ronco C. Usefulness of glycated albumin as a biomarker for glucose control and prognostic factor in chronic kidney disease patients on dialysis (CKD-G5D). Diabetes Res Clin Pract 2018; 140:9-17. [PMID: 29596954 DOI: 10.1016/j.diabres.2018.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Received: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 12/17/2022]
Abstract
In chronic kidney disease patients on dialysis (CKD-G5D) accurate assessment of glycemic control is vital to improve their outcome and survival. The best glycemic marker for glucose control in these patients is still debated because several clinical and pharmacological factors may affect the ability of the available biomarkers to reflect the patient's glycemic status properly. This review discusses the role of glycated albumin (GA) both as a biomarker for glucose control and as a prognostic factor in CKD-G5D; it also looks at the pros and cons of GA in comparison to the other markers and its usefulness in hemodialysis and peritoneal dialysis.
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Affiliation(s)
- Elena Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Valentina Corradi
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marta Proglio
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Elena Vianello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Roberta Rigolini
- Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Carlotta Caprara
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimiliano M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
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27
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Breglia A, Virzì GM, Pastori S, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C. Determinants of Monocyte Apoptosis in Cardiorenal Syndrome Type 1. Cardiorenal Med 2018; 8:208-216. [PMID: 29847820 DOI: 10.1159/000488949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/22/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome type 1 (CRS type 1) is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Its pathophysiology is complex and not completely understood. In this study, we examined the role of apoptosis and the caspase pathways involved. MATERIAL AND METHODS We enrolled 40 acute heart failure (AHF) patients, 11 of whom developed AKI characterizing CRS type 1. We exposed the human cell line U937 to plasma from the CRS type 1 and AHF groups and then we evaluated apoptotic activity by annexin-V evaluation, determination of caspase-3, -8 and -9 levels, and BAX, BAD, and FAS gene expression. RESULTS We observed significant upregulation of apoptosis in monocytes exposed to CRS type 1 plasma compared to AHF, with increased levels of caspase-3 (p < 0.01), caspase-9 (p < 0.01), and caspase-8 (p < 0.03) showing activation of both intrinsic and extrinsic pathways. Furthermore, monocytes exposed to CRS type 1 plasma had increased gene expression of BAX and BAD (intrinsic pathways) (p = 0.010 for both). Furthermore, strong significant correlations between the caspase-9 levels and BAD and BAX gene expression were observed (Spearman ρ = - 0.76, p = 0.011, and ρ = - 0.72, p = 0.011). CONCLUSION CRS type 1 induces dual apoptotic pathway activation in monocytes; the two pathways converged on caspase-3. Many factors may induce activation of both intrinsic and extrinsic apoptotic pathways in CRS type 1 patients, such as upregulation of proinflammatory cytokines and hypoxia/ischemia. Further investigations are necessary to corroborate the present findings, and to better understand the pathophysiological mechanism and consequent therapeutic and prognostic implications for CRS type 1.
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Affiliation(s)
- Andrea Breglia
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Internal Medicine, University of Trieste, Trieste, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Medicine DIMED, University of Padua Medical School, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit, Sant'Antonio Hospital, Padua, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy
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28
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Milan Manani S, Crepaldi C, Giuliani A, Virzì GM, Garzotto F, Riello C, de Cal M, Rosner MH, Ronco C. Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient's Independence. Blood Purif 2018; 46:111-117. [PMID: 29694954 DOI: 10.1159/000487703] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 01/30/2018] [Accepted: 02/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Remote monitoring (RM) supports a healthcare model that enhances patients' self-management. We evaluated the utility of RM in patients undergoing automated peritoneal dialysis (APD). METHODS We observed 37 -RM-APD patients, 16 incidents, and 21 prevalents switched from traditional APD (T-APD). We observed the number of changes for APD prescription, the frequency of visits, and PD adequacy parameters during 1 year of RM utilization in APD. RESULTS The APD prescriptions were modified more frequently in RM-APD vs. T-APD in incident (p = 0.002) and prevalent patients (p = 0.045). Visits were significant less in -RM-APD than in T-APD for incident patient (p = 0.008). No significant difference was found between prevalent populations. PD adequacy was similar in both groups. CONCLUSIONS Our results demonstrate that RM allows an efficient use of healthcare resources, helping to improve personalization of APD prescription and to intervene early with "trouble shooting", thereby reducing the frequency of in-person visits for emergency problems.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Francesco Garzotto
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Caterina Riello
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
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29
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Husain-Syed F, Ferrari F, Sharma A, Danesi TH, Bezerra P, Lopez-Giacoman S, Samoni S, de Cal M, Corradi V, Virzì GM, De Rosa S, Muciño Bermejo MJ, Estremadoyro C, Villa G, Zaragoza JJ, Caprara C, Brocca A, Birk HW, Walmrath HD, Seeger W, Nalesso F, Zanella M, Brendolan A, Giavarina D, Salvador L, Bellomo R, Rosner MH, Kellum JA, Ronco C. Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation. Ann Thorac Surg 2018; 105:1094-1101. [PMID: 29382510 DOI: 10.1016/j.athoracsur.2017.12.034] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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] [Received: 09/27/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although acute kidney injury (AKI) frequently complicates cardiac operations, methods to determine AKI risk in patients without underlying kidney disease are lacking. Renal functional reserve (RFR) can be used to measure the capacity of the kidney to increase glomerular filtration rate under conditions of physiologic stress and may serve as a functional marker that assesses susceptibility to injury. We sought to determine whether preoperative RFR predicts postoperative AKI. METHODS We enrolled 110 patients with normal resting glomerular filtration rates undergoing elective cardiac operation. Preoperative RFR was measured by using a high oral protein load test. The primary end point was the ability of preoperative RFR to predict AKI within 7 days of operation. Secondary end points included the ability of a risk prediction model, including demographic and comorbidity covariates, RFR, and intraoperative variables to predict AKI, and the ability of postoperative cell cycle arrest markers at various times to predict AKI. RESULTS AKI occurred in 15 patients (13.6%). Preoperative RFR was lower in patients who experienced AKI (p < 0.001) and predicted AKI with an area under the receiver operating characteristic curve (AUC) of 0.83 (95% confidence interval [CI]: 0.70 to 0.96). Patients with preoperative RFRs not greater than 15 mL · min-1 · 1.73 m-2 were 11.8 times more likely to experience AKI (95% CI: 4.62 to 29.89 times, p < 0.001). In addition, immediate postoperative cell cycle arrest biomarkers predicted AKI with an AUC of 0.87. CONCLUSIONS Among elective cardiac surgical patients with normal resting glomerular filtration rates, preoperative RFR was highly predictive of AKI. A reduced RFR appears to be a novel risk factor for AKI, and measurement of RFR preoperatively can identify patients who are likely to benefit from preventive measures or to select for use of biomarkers for early detection. Larger prospective studies to validate the use of RFR in strategies to prevent AKI are warranted. ClinicalTrials.gov identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759.
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Affiliation(s)
- Faeq Husain-Syed
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy; Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Aashish Sharma
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Pércia Bezerra
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Sara Samoni
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Valentina Corradi
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Silvia De Rosa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | | | - Carla Estremadoyro
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Gianluca Villa
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Jose J Zaragoza
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Carlotta Caprara
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Horst-Walter Birk
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Hans-Dieter Walmrath
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brendolan
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John A Kellum
- Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.
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30
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Virzì GM, Clementi A, Brocca A, de Cal M, Ronco C. Epigenetics: a potential key mechanism involved in the pathogenesis of cardiorenal syndromes. J Nephrol 2017; 31:333-341. [PMID: 28780716 DOI: 10.1007/s40620-017-0425-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/22/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022]
Abstract
Epigenetics is defined as the heritable changes in gene expression patterns which are not directly encoded by modifications in the nucleotide DNA sequence of the genome, including higher order chromatin organization, DNA methylation, cytosine modifications, covalent histone tail modifications, and short non-coding RNA molecules. Recently, much attention has been paid to the role and the function of epigenetics and epimutations in the cellular and subcellular pathways and in the regulation of genes in the setting of both kidney and cardiovascular disease. Indeed, deregulation of histone alterations has been highlighted in a large spectrum of renal and cardiac disease, including chronic and acute renal injury, renal and cardiac fibrosis, cardiac hypertrophy and failure, kidney congenital anomalies, renal hypoxia, and diabetic renal complications. Nevertheless, the role of epigenetics in the pathogenesis and pathophysiology of cardiorenal syndromes is currently underexplored. Given the significant clinical relevance of heart-kidney crosstalk, efforts in the research for new action mechanisms concurrently operating in both pathologies are thus of maximum interest. This review focuses on epigenetic mechanisms involved in heart and kidney disease, and their possible role in the setting of cardiorenal syndromes.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. .,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.
| | - Anna Clementi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology and Dialysis, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Medicine DIMED, University of Padova Medical School, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
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31
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Paderi F, Corradi V, Romero Gonzalez G, Ferrari F, Lorenzin A, de Cal M, Ronco C. SP449GLYCATED ALBUMIN DOSAGE IN DIABETIC DIALYSIS PATIENTS: A MORE APPROPRIATE MARKER OF GLYCEMIC CONTROL IN CHRONIC KIDNEY DISEASE ALBUMIN DOSAGE IN DIABETIC DIALYSIS PATIENTS: A MORE APPROPRIATE MARKER OF GLYCEMIC CONTROL IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx149.sp449] [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: 11/13/2022] Open
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32
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Gambero O, Corradi V, Romero G, Meligrana L, Mettifogo M, de Cal M, Brendolan A, Crepaldi C, Marcon M, Perini F, Ferrari F, Ronco C. MP756EVALUATION OF THE ONE YEAR FOLLOW UP OF DIALYSIS PTS BY RAPID NEUROPSYCHOLOGICAL SCREENING BATTERY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx181.mp756] [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: 11/14/2022] Open
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33
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Clementi A, Brocca A, Virzì GM, de Cal M, Giavarina D, Carta M, Muciño-Bermejo MJ, Hinna Danesi T, Salvador L, Ronco C. Procalcitonin and Interleukin-6 Levels: Are They Useful Biomarkers in Cardiac Surgery Patients? Blood Purif 2017; 43:290-297. [PMID: 28125806 DOI: 10.1159/000454672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Cardiac surgery-associated acute kidney injury is an independent predictor of chronic renal disease and mortality. The scope of this study was to determine the utility of procalcitonin (PCT) and plasma interleukin-6 (IL-6) levels in predicting renal outcome and mortality in these patients. METHODS PCT and plasma IL-6 levels of 122 cardiac surgery patients were measured at 48 h after the surgical procedure. Primary endpoints were adverse renal outcome and mortality. Secondary endpoints were length of stay, bleeding, and number of transfusions. RESULTS PCT was found to be a better predictor of adverse renal outcome than IL-6. IL-6 seemed to be a better predictor of both 30-day and overall mortality than PCT. Neither PCT nor IL-6 levels were found to be good predictors of intensive care unit stay and bleeding. CONCLUSION PCT may be considered a good predictor of adverse renal outcome in cardiac surgery patients, whereas IL-6 seems to possess a good predictive value for mortality in this population of patients.
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Affiliation(s)
- Anna Clementi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
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Corradi V, Giuliani A, Gastaldon F, de Cal M, Mancini B, Montaldi A, Alghisi A, Capelli I, La Manna G, Ronco C. Genetics and Autosomal Dominant Polycystic Kidney Disease Progression. Current Perspectives in Kidney Diseases 2017; 190:117-123. [DOI: 10.1159/000468956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Virzì GM, Clementi A, Brocca A, de Cal M, Marcante S, Ronco C. Cardiorenal Syndrome Type 5 in Sepsis: Role of Endotoxin in Cell Death Pathways and Inflammation. Kidney Blood Press Res 2016; 41:1008-1015. [PMID: 28006779 DOI: 10.1159/000452602] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cardiorenal Syndrome Type 5 (CRS Type 5) is characterized by concomitant cardiac and renal dysfunction in the setting of different systemic disorders, such as sepsis. In this study, we investigated the possible relationship between endotoxin levels, renal cell death and inflammation in septic patients with CRS Type 5. METHODS We enrolled 11 patients with CRS Type 5. CRS Type 5 was defined according to the current classification system. AKI was defined by Acute Kidney Injury Network (AKIN) criteria. Acute cardiac dysfunction was documented by echocardiography as acute left and/or right ventricular dysfunction leading to decreased ejection fraction. Endotoxin activity was measured by the Endotoxin Activity Assay (EAA). Plasma from CRS Type 5 patients was incubated with renal tubular cells (RTCs) and cell death levels were evaluated. Plasma cytokines levels were measured as well. RESULTS Accordingly to EAA levels, patients were divided into two groups: 45.4% of patients had low endotoxin activity level (negative EAA), while 54.5% of patients showed high endotoxin activity (positive EAA). RTCs incubated with plasma from EAA positive patients showed significantly higher apoptosis levels and higher caspase-3 activation compared to cells incubated with plasma from EAA negative patients, and a significant positive correlation was observed between EAA levels and RTC apoptosis levels. Furthermore, IL-6 and IFN-γ levels were significantly higher in CRS Type 5 patients with positive EAA. CONCLUSION Our data suggest a possible relationship between endotoxin levels and renal cell death in septic patients with CRS Type 5. Furthermore, this study highlights the presence of renal apoptosis, the immune deregulation and the strong inflammation in CRS Type 5 patients, especially in those with high endotoxin activity.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Vicenza, Italy
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Granata A, Clementi A, Virzì GM, Brocca A, de Cal M, Scarfia VR, Zanoli L, Ronco C, Corrao S, Malatino L. Cardiorenal syndrome type 4: From chronic kidney disease to cardiovascular impairment. Eur J Intern Med 2016; 30:1-6. [PMID: 26961461 DOI: 10.1016/j.ejim.2016.02.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Received: 11/22/2015] [Revised: 02/04/2016] [Accepted: 02/16/2016] [Indexed: 11/27/2022]
Abstract
Cardiorenal syndrome type 4 (CRS type 4), or chronic renocardiac syndrome, has been defined as "chronic abnormalities in renal function leading to cardiac disease" and recognizes the extreme burden of cardiovascular disease (CVD) risk in patients with chronic kidney disease (CKD). CKD is common and increasingly recognized as a risk factor for CVD. Even though the treatment for CVD has dramatically improved over the past decades, it still takes responsibility for up to 50% of deaths in CKD patients. For this reason, patients with CKD should be thoroughly evaluated for cardiovascular risk factors that require careful management, given the significant burden of CRS type 4 on the healthcare system. This review focuses on the most significant conventional and non-conventional CVD risk factors related to CKD.
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Affiliation(s)
- Antonio Granata
- Department of Nephrology and Dialysis, "San Giovanni di Dio" Hospital, Agrigento, Italy
| | - Anna Clementi
- Department of Nephrology and Dialysis, "San Giovanni di Dio" Hospital, Agrigento, Italy; International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; Department of Medicine, University of Padova Medical School, Padova, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | | | - Luca Zanoli
- Unit of Internal Medicine "A. Francaviglia", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Salvatore Corrao
- Internal Medicine Department, National Relevance Hospital Trust ARNAS "Civico, Di Cristina, Benfratelli", Palermo, Italy; Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M.), Di.Bi.M.I.S., University of Palermo, Palermo, Italy.
| | - Lorenzo Malatino
- Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Virzì GM, Milan Manani S, Brocca A, de Cal M, Tantillo I, Crepaldi C, Ronco C. MP508NEW ROLE OF PERITONEAL CELL-FREE DNA FOR MANAGMENT IN PD-RELATED PERITONITIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw195.24] [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: 11/14/2022] Open
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Virzì GM, Clementi A, Brocca A, de Cal M, Ronco C. Molecular and Genetic Mechanisms Involved in the Pathogenesis of Cardiorenal Cross Talk. Pathobiology 2016; 83:201-10. [DOI: 10.1159/000444502] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/04/2016] [Indexed: 11/19/2022] Open
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Virzì GM, Manani SM, Cantaluppi V, Brocca A, de Cal M, Tantillo I, Mason G, Ramponi F, Berti S, Crepaldi C, Clementi M, Ronco C. The Role of Cell-Free Plasma DNA in Peritoneal Dialysis Patients with Peritonitis. Perit Dial Int 2015; 35:755-8. [PMID: 26703846 DOI: 10.3747/pdi.2014.00245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Grazia Maria Virzì
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Sabrina Milan Manani
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino-"Molinette", Turin, Italy
| | - Alessandra Brocca
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy Department of Medicine DIMED, University of Padova Medical School, Padua, Italy
| | - Massimo de Cal
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Ilaria Tantillo
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Giacomo Mason
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Ramponi
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Sonia Berti
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Crepaldi
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Maurizio Clementi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Claudio Ronco
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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Milan Manani S, Virzì GM, Clementi A, Brocca A, de Cal M, Tantillo I, Ferrando L, Crepaldi C, Ronco C. Pro-inflammatory cytokines: a possible relationship with dialytic adequacy and serum albumin in peritoneal dialysis patients. Clin Kidney J 2015; 9:153-7. [PMID: 26798477 PMCID: PMC4720213 DOI: 10.1093/ckj/sfv137] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background Inflammation and serum albumin concentration are both important predictors of survival in patients treated with peritoneal dialysis (PD). Furthermore, systemic and local inflammatory mediators may induce structural and functional alterations in the peritoneal membrane, thus interfering with dialysis adequacy. PD adequacy is monitored primarily by indices of small solute clearance, such as Kt/V urea and weekly creatinine clearance (wCc). The aim of this study was to investigate the possible relationship between pro-inflammatory cytokines, such as interleukin-6 (IL-6) and interleukin-1β (IL-1β), and serum albumin and C-reactive protein (CRP). Moreover, the relationship between IL-6 and IL-1β and PD adequacy has been analysed. Methods We enrolled 46 stable PD patients undergoing maintenance PD for a minimum of 3 months. Plasma levels of serum albumin, high-sensitivity (hs)-CRP, IL-6 and IL-1β were measured in all patients. We used weekly Kt/V urea and wCc to monitor PD adequacy. Daily urine volume was measured in all patients. Results The median values of serum albumin, hs-CRP, IL-6 and IL-1β showed no significant differences between continuous ambulatory PD and automated PD patients. IL-6 levels showed a positive correlation with hs-CRP levels (P < 0.001) and a negative correlation with serum albumin concentration (P = 0.01). There was no statistically significant relationship between IL-1β and hs-CRP or serum albumin concentrations. Subsequently, PD patients were divided into two groups based on Kt/V urea value. PD patients with Kt/V ≤1.7 had significantly higher IL-6 levels compared with PD patients with Kt/V >1.7 (P = 0.015). No statistically significant relationship between IL-6 and wCc was observed. There was no significant difference in IL-1β levels between PD patients with Kt/V ≤1.7 and with Kt/V >1.7 [median (interquartile range) 0.82 (0.88–5.2) versus 1.82 (0.95–2.7)]. There was no significant difference in IL-6 and IL-1β levels in PD patients with and without residual diuresis (P = 0.32 and P = 0.77, respectively). Conclusion Our data suggest a possible relationship between serum IL-6 levels and serum albumin and hs-CRP in PD patients. Furthermore, IL-6 seems to be higher in patients with lower Kt/V, thus suggesting a possible use of this inflammatory biomarker in PD adequacy monitoring.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Anna Clementi
- IRRIV-International Renal Research Institute, Vicenza, Italy; Department of Nephrology and Dialysis, San Giovanni Di Dio Hospital, Cagliari, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy; Department of Medicine DIMED, University of Padova Medical School, Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Lorena Ferrando
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
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Clementi A, Virzì GM, Brocca A, Pastori S, de Cal M, Marcante S, Granata A, Ronco C. The Role of Cell-Free Plasma DNA in Critically Ill Patients with Sepsis. Blood Purif 2015; 41:34-40. [DOI: 10.1159/000440975] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022]
Abstract
Background: The identification of highly reliable outcome predictors in severe sepsis is important to define disease severity, predict bedside prognosis and monitor response to treatment. Cell-free plasma DNA (cfDNA) has been recently proposed as a possible prognostic marker of clinical outcome in septic patients. In this study, we investigated the prognostic value of cfDNA in patients with sepsis and its possible correlation with caspase-3, IL-6 and IL-18 levels. Methods: We enrolled 34 patients admitted to the intensive care unit (ICU). Out of these 34, 27 patients were septic and 7 were non-septic. cfDNA was extracted from plasma and quantified by real time PCR. Plasma levels of caspase-3, IL-6 and IL-18 were measured by ELISA. Results: We observed significantly higher levels of cfDNA in septic patients. No significant differences were found between cfDNA levels in patients with Gram+, Gram- and fungal infections. Out of the 27 septic patients, 12 developed acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), and cfDNA levels resulted to be higher in this group. Out of the 27 septic patients, 11 had a negative outcome during the ICU stay. The cfDNA concentrations at admission were higher in non-survivors than in survivors. Caspase-3, IL-6 and IL-18 levels were significantly higher in septic patients when compared to these levels in non-septic patients and correlated with cfDNA levels. Conclusion: cfDNA can be considered a good prognostic marker of clinical outcome in septic patients. Its levels increase in case of AKI complicating sepsis, in particular if CRRT is needed, and are associated with poor outcome. Caspase-3, IL-6 and IL-18 levels are higher in septic patients and correlate to cfDNA concentrations.
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Pastori S, Virzì GM, Brocca A, de Cal M, Cantaluppi V, Castellani C, Fedrigo M, Thiene G, Valente ML, Angelini A, Vescovo G, Ronco C. Cardiorenal Syndrome Type 1: Activation of Dual Apoptotic Pathways. Cardiorenal Med 2015; 5:306-15. [PMID: 26648947 DOI: 10.1159/000438831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/06/2015] [Indexed: 12/17/2022] Open
Abstract
Cardiorenal syndrome type 1 (CRS1) pathophysiology is complex, and immune-mediated damage, including alterations in the immune response with monocyte apoptosis and cytokine release, has been reported as a potential mechanism. In this study, we examined the putative role of renal tubular epithelial cell (RTC) apoptosis as a pathogenic mechanism in CRS1. In particular, we investigated the caspase pathways involved in induced apoptosis. We enrolled 29 patients with acute heart failure (AHF), 11 patients with CRS1, and 15 controls (CTR) without AHF or acute kidney injury (AKI). Patients who had AKI prior to the episode of AHF or who had any other potential causes of AKI were excluded. Plasma from different groups was incubated with RTCs for 24 h. Subsequently, cell apoptosis, DNA fragmentation, and caspase-3, -8, and -9 activities were investigated in RTCs incubated with AHF, CRS1, and CTR plasma. A p value <0.5 was considered statistically significant. A quantitative analysis of apoptosis showed significantly higher apoptosis rates in CRS1 patients compared to AHF patients and CTR (p < 0.01). This increase in apoptosis was strongly confirmed by caspase-3 levels (ρ = 0.73). Caspase-8 and -9 were significantly higher in CRS1 patients compared to AHF patients and CTR (p < 0.01). Furthermore, caspase-3 levels showed a significantly positive correlation with caspase-8 (ρ = 0.57) and -9 (ρ = 0.47; p < 0.001). This study demonstrated the significantly heightened presence of dual apoptotic disequilibrium in CRS1. Our findings indicated that apoptosis may have a central role in the mechanism of CRS1, and it could be a potential therapeutic target in this syndrome.
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Affiliation(s)
- Silvia Pastori
- Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; Department of IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy ; Department of Information Engineering, University of Padua, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; Department of IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; Department of IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy ; Department of Medicine DIMED, University of Padua Medical School, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; Department of IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Medical Sciences, University of Torino, Azienda Ospedaliera 'Città della Salute e della Scienza di Torino-Presidio Molinette', Torino, Italy
| | - Chiara Castellani
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Marny Fedrigo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Maria Luisa Valente
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Annalisa Angelini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Giorgio Vescovo
- Department of Internal Medicine, San Bortolo Hospital, Vicenza, Italy ; Internal Medicine Unit, Sant'Antonio Hospital Padua, Padua, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; Department of IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
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Neri M, Virzì GM, Brocca A, Garzotto F, Kim JC, Ramponi F, de Cal M, Lorenzin A, Brendolan A, Nalesso F, Zanella M, Ronco C. In vitro Cytotoxicity of Bisphenol A in Monocytes Cell Line. Blood Purif 2015; 40:180-6. [DOI: 10.1159/000437039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/17/2015] [Indexed: 11/19/2022]
Abstract
Background/Aim: Bisphenol A (BPA) is used in the production of many plastics, which are used to build biomaterials that sometimes are in direct contact with blood. It is believed that the release of BPA into bloodstream may give rise to cytotoxic events for blood components. The aim of the present study was to perform an in vitro investigation of the observable cytotoxic effect of BPA, at increasing concentrations, on the monocyte cell line. Methods: We incubated in vitro monocyte cells (U937) for 24 h in cell line medium samples (RPMI 1640) at different concentrations of BPA. We then generated curves to evaluate viability, necrosis and apoptosis of monocytes against increasing concentrations of BPA. Results: The percentage values of concentrations of BPA corresponding to 50% of the viability and necrosis of the monocytes were 1.39 and 1.48 ng/ml, respectively. Based on our observations, we reported an increasing cytotoxic effect for higher concentrations. The apoptotic effect reached the maximum value at BPA concentration of 1.5 ng/ml; at still higher concentrations, we observed a predominantly necrotic cell death. Conclusion: Viability, necrosis and apoptosis of monocytes are strongly and positively correlated with BPA concentration. A direct contact of such compound with biological components of blood may lead to high levels of cytotoxicity, and require us to evaluate additional factors while judging the bio-incompatibility of BPA.
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Virzì GM, de Cal M, Day S, Brocca A, Cruz DN, Castellani C, Cantaluppi V, Bolin C, Fedrigo M, Thiene G, Valente M, Angelini A, Vescovo G, Ronco C. Pro-Apoptotic Effects of Plasma from Patients with Cardiorenal Syndrome on Human Tubular Cells. Am J Nephrol 2015; 41:474-84. [PMID: 26228789 DOI: 10.1159/000438459] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The pathophysiology of Cardiorenal Syndrome Type 1 (CRS1) is widely studied, although the mechanisms by which renal tubular epithelial cells (TECs) cease to proliferate and embark upon terminal differentiation, following the initial insult of heart failure (HF), remain a key target. This study seeks to provide insight into the pathophysiological pathways in CRS1; we evaluated in vitro the effects of CRS1 plasma on TECs. METHODS We enrolled 40 acute HF patients and 15 controls (CTR) without HF or acute kidney injury (AKI). Ten out of 40 HF patients exhibited AKI at the time of admission for HF or developed AKI during hospitalization and were classified as CRS1. In vitro, cell viability, DNA fragmentation and caspase-3 levels were investigated in TECs incubated with HF, CRS1, and CTR plasma. We assessed inflammatory cytokines and NGAL expression at the gene and protein levels. RESULTS We observed a marked pro-apoptotic activity and a significantly increased in vitro level of apoptosis in TECs incubated with plasma from CRS1 patients compared to HF and CTR (p < 0.01). In the CRS1 group, the mRNA expression of IL-6, IL-18 and NGAL resulted significantly higher in TECs incubated with CRS1 plasma compared with those incubated with plasma from HF and CTR (p < 0.01). IL-6, IL-18, NGAL, and RANTES levels were significantly higher in TECs supernatant incubated with CRS1 plasma compared with HF patients and CTR plasma (p < 0.01). CONCLUSION In vitro exposure to plasma from CRS1 patients altered the expression profile of TECs characterized by increases in proinflammatory mediators, release of tubular damage markers, and apoptosis.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
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Brocca A, Virzì GM, Pasqualin C, Pastori S, Marcante S, de Cal M, Ronco C. Cardiorenal syndrome type 5: in vitro cytotoxicity effects on renal tubular cells and inflammatory profile. Anal Cell Pathol (Amst) 2015; 2015:469461. [PMID: 26266085 PMCID: PMC4525149 DOI: 10.1155/2015/469461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/07/2015] [Accepted: 07/05/2015] [Indexed: 12/14/2022] Open
Abstract
Background. Cardiorenal Syndrome Type 5 (CRS Type 5) reflects concomitant cardiac and renal dysfunctions in the setting of a wide spectrum of systemic disorders. Our aim was to study in vitro effects of CRS Type 5 plasma on renal tubular cells (RTCs), in terms of cellular death and the characterization of inflammatory plasma profile in these patients. Material and Methods. We enrolled 11 CRS Type 5 patients from ICU and 16 healthy controls. Plasma from patients and controls was incubated with renal tubular cells (RTCs) and cell death was evaluated. Plasma cytokines were detected. Results. RTCs incubated with CRS Type 5 plasma showed significantly higher apoptosis and necrosis with respect to controls. Plasma cytokine profile of CRS Type 5 patients was significantly different from controls: we observed the production of pro- and anti-inflammatory mediators in these patients. Caspase-3, caspase-8, and caspase-9 were activated in cells treated with CRS Type 5 plasma compared to controls. Conclusions. Our results underline the cytotoxic effect of CRS Type 5 mediators on RTC viability, probably due to the activation of both intrinsic and extrinsic pathways of apoptosis and to the deregulation of cytokine release. The consequence may be the damage of distant organs which lead to the worsening of condition of patients.
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Affiliation(s)
- Alessandra Brocca
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
- Department of Medicine DIMED, University of Padova Medical School, Via Giustiniani 2, 35100 Padova, Italy
- Laboratory of Experimental Hepatology, Department of Medicine, University of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Chiara Pasqualin
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
- Department of Information Engineering, University of Padua, Via Gradenigo 6, 35131 Padova, Italy
| | - Stefano Marcante
- Intensive Care Unit, San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
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Virzì GM, Milan Manani S, Brocca A, Cantaluppi V, de Cal M, Pastori S, Tantillo I, Zambon R, Crepaldi C, Ronco C. Peritoneal Cell-free DNA: an innovative method for determining acute cell damage in peritoneal membrane and for monitoring the recovery process after peritonitis. J Nephrol 2015; 29:111-8. [DOI: 10.1007/s40620-015-0212-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/18/2015] [Indexed: 02/07/2023]
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Virzì GM, Milan S, Brocca A, de Cal M, Tantillo I, Crepaldi C, Ronco C. FP584PERITONEAL CELL-FREE DNA: AN INNOVATIVE METHOD FOR DETERMINING ACUTE CELL DAMAGE IN PERITONEAL MEMBRANE AND FOR MONITORING THE RECOVERY PROCESS AFTER PERITONITIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv180.36] [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: 11/13/2022] Open
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Virzì GM, Gastaldon F, Corradi V, de Cal M, Cruz DN, Clementi M, Ronco C. [Plasma NGAL and ADPKD progression]. G Ital Nefrol 2015; 32:gin/00208.9. [PMID: 26093138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disease with variable rate of progression. It is associated with inter- and intra-familial variability. Neutrophil gelatinase-associated lipocalin (NGAL) has been implicated in pathological conditions and it is proposed as a biomarker for CKD progression. Our aim was to evaluate whether NGAL could be a good marker for progression of ADPKD, as we hypothesized. ADPKD patients with confirmed mutations (PKD1 n=33; PKD2 n=17) were enrolled and followed in a prospective study. Creatinine (sCr) and NGAL values were measured at baseline and on follow-up. Plasma NGAL was measured by Triage point of care test. CKD progression was defined as 15% decrease in eGFR from baseline to follow-up. Patients were divided into 2 groups based on median baseline NGAL and compared by the Kaplan-Meier curve. We enrolled 50 ADPKD pts (60%M age 41 yrs); mean sCr 1.30.7 mg/dl and median eGFR was 62 mL/min/1.73 m2. NGAL values are inversely correlated with baseline eGFR (r=-0.64, p<0.001). There was weak correlation between baseline NGAL and subsequent change in eGFR (r=0.28, p=0.05). 9/50 of patients had NGAL below limits of detection (60 pg/ml); median NGAL level was 79 pg/ml. At follow-up, 12 patients (24%) had progression as defined. No statistically significant relationship between higher NGAL and ADPKD progression was observed. We did not observe a relationship between NGAL and CKD progression in ADPKD patients; however 18% of patients had undetectable plasma NGAL levels. This raises doubt about the utility of the current NGAL assay as a biomarker for CKD progression in this population.
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Brocca A, Virzì GM, de Cal M, Vescovo G, Ronco C. SP101PRO APOPTOTIC AND PRO INFLAMMATORY EFFECTS OF PLASMA OF PATIENTS WITH CARDIORENAL SYNDROME TYPE 1 ON HUMAN RENAL TUBULAR EPITHELIAL CELLS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv188.64] [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: 11/14/2022] Open
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Clementi A, Virzì GM, Brocca A, de Cal M, Pastori S, Clementi M, Granata A, Vescovo G, Ronco C. Advances in the pathogenesis of cardiorenal syndrome type 3. Oxid Med Cell Longev 2015; 2015:148082. [PMID: 25821551 PMCID: PMC4364019 DOI: 10.1155/2015/148082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/23/2015] [Indexed: 12/23/2022]
Abstract
Cardiorenal syndrome (CRS) type 3 is a subclassification of the CRS whereby an episode of acute kidney injury (AKI) leads to the development of acute cardiac injury or dysfunction. In general, there is limited understanding of the pathophysiologic mechanisms involved in CRS type 3. An episode of AKI may have effects that depend on the severity and duration of AKI and that both directly and indirectly predispose to an acute cardiac event. Experimental data suggest that cardiac dysfunction may be related to immune system activation, inflammatory mediators release, oxidative stress, and cellular apoptosis which are well documented in the setting of AKI. Moreover, significant derangements, such as fluid and electrolyte imbalance, metabolic acidosis, and uremia, which are typical features of acute kidney injury, may impair cardiac function. In this review, we will focus on multiple factors possibly involved in the pathogenesis issues regarding CRS type 3.
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Affiliation(s)
- Anna Clementi
- Department of Nephrology and Dialysis, San Giovanni Di Dio, Agrigento 92100, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
- Department of Medicine (DIMED), University of Padova, Padova 35128, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
| | - Maurizio Clementi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Italy
| | - Antonio Granata
- Department of Nephrology and Dialysis, San Giovanni Di Dio, Agrigento 92100, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza 36100, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
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