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Villela-Torres MDLL, Prado-Uribe MDC, Díaz MÁ, Pablo HQ, Soria-Castro E, Escofet NE, Maldonado CEF, Paniagua R. Effect of High Sodium Intake on Gut Tight Junctions' Structure and Permeability to Bacterial Toxins in a Rat Model of Chronic Kidney Disease. Arch Med Res 2024; 55:102969. [PMID: 38484487 DOI: 10.1016/j.arcmed.2024.102969] [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: 06/20/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Uremic toxicity changes the gut structure and permeability, allowing bacterial toxins to translocate from the lumen to the blood during chronic kidney failure (CKD). Clinical fluid overload and tissue edema without uremia have similar effects but have not been adequately demonstrated and analyzed in CKD. AIMS To investigate the effect of sodium intake on the plasma concentration of gut-derived uremic toxins, indoxyl sulfate (IS), and p-cresyl sulfate (pCS) and the expression of genes and proteins of epithelial gut tight junctions in a rat model of CKD. METHODS Sham-operated (control group, CG) and five-sixths nephrectomized (5/6Nx) Sprague-Dawley rats were randomly assigned to low (LNa), normal (NNa), or high sodium (HNa) diets., Animals were then sacrificed at 8 and 12 weeks and analyzed for IS and pCS plasma concentrations, as well as for gene and protein expression of thigh junction proteins, and transmission electron microscopy (TEM) in colon fragments. RESULTS The HNa 5/6Nx groups had higher concentrations of IS and pCS than CG, NNa, and LNa at eight and twelve weeks. Furthermore, HNa 5/6Nx groups had reduced expression of the claudin-4 gene and protein than CG, NNa, and LNa. HNa had reduced occludin gene expression compared to CG. Occludin protein expression was more reduced in HNa than in CG, NNa, and LNa. The gut epithelial tight junctions appear dilated in HNa compared to NNa and LNa in TEM. CONCLUSION Dietary sodium intake and fluid overload have a significant role in gut epithelial permeability in the CKD model.
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Affiliation(s)
- María de la Luz Villela-Torres
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - María-Del-Carmen Prado-Uribe
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Marcela Ávila Díaz
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Héctor Quezada Pablo
- Immunnology and Proteomics Research Lab, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Elizabeth Soria-Castro
- Cardiovascular Biomedicine Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Nuria Esturau Escofet
- Physical Chemistry Department, Laboratorio Universitario de Resonancia Magnética Nuclear, Instituto de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Ramón Paniagua
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Paniagua R, Ávila-Díaz M, Trejo-Villeda MÁ, Bernal-Amador AS, Ramos A. Utility of remote monitoring in patients on automated peritoneal dialysis. Rev Invest Clin 2023; 75:318-326. [PMID: 37913763 DOI: 10.24875/ric.23000206] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023]
Abstract
Home hemodialysis (HD) and automated peritoneal dialysis (APD) have advantages over HD in hospitals or HD centers. Home therapies are generally less expensive and give patients greater mobility and freedom for work, school, family, and recreational activities. Technological advances have made it possible to complement APD with devices for remote monitoring (RM) of the patient. With them, objective information generated in the APD device is collected and sent to repositories "in the cloud" for analysis or at the time decided by the health team. With APD+RM, it is possible to monitor therapeutic compliance, effective dialysis time, ultrafiltration volumes, inflow and outflow patterns of dialysis fluid, and patient actions to respond to alarms that indicate deviations from the parameters set by the nephrologist. The results of APD+RM show good acceptance by the patient, nephrologists, and nurses, treatment adherence has improved, hospitalizations and technique failure have decreased, and some aspects of quality of life have improved. However, there is a lack of controlled clinical trials that reliably demonstrate lower mortality and comorbidity due to specific causes.
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Affiliation(s)
- Ramón Paniagua
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Marcela Ávila-Díaz
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Á Trejo-Villeda
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Alma S Bernal-Amador
- Medical Research Unit in Nephrological Diseases, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Cuevas-Budhart MA, Trejo-Villeda MA, Cabrera Delgado M, Hernandez-Franco B, Ávila Díaz M, Ramos-Sanchez A, Paniagua R. Remote monitoring as a surveillance method in patients on automated peritoneal dialysis for preventing complications and COVID-19 contagion. J Infect Public Health 2023; 16:1619-1624. [PMID: 37586134 DOI: 10.1016/j.jiph.2023.07.019] [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: 02/22/2023] [Revised: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Due to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion. METHODS Study of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves. RESULTS Of the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19, and one by surgical intervention. CONCLUSION APD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients.
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Affiliation(s)
- Miguel A Cuevas-Budhart
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | - Miguel A Trejo-Villeda
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | | | - Beatriz Hernandez-Franco
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | - Marcela Ávila Díaz
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | | | - Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico.
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Ávila M, Prado MDC, Cuevas-Budhart MÁ, Paniagua R. Reduced phosphorus is associated with older age and hypoalbuminemia. Risk factors for all-cause mortality in peritoneal dialysis patients. Front Nutr 2023; 10:1094256. [PMID: 37497059 PMCID: PMC10367340 DOI: 10.3389/fnut.2023.1094256] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/20/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction/aim Hyperphosphatemia is a mortality risk factor in dialysis patients; however, low phosphorus levels too. Diabetes and malnutrition are strongly associated with mortality and with reduced serum phosphorus. This study analyzed the pattern of serum phosphorus in patients on Peritoneal Dialysis (PD) and its association with mortality. Methods A Secondary analysis was performed on a multicenter cohort study in peritoneal dialysis patients from two previous studies done by our group. Results Six hundred fifty-four patients were included. Serum phosphorus was <3.6 mg/dL in 28.29% of patients, 3.6 to 5.2 mg/dL in 48.16%, and >5.2 mg/dL in 23.55%. In logistic regression analysis; education, age, and hypoalbuminemia were risk factors for low P levels. In multivariate Cox analysis P < 3.6 mg/dL, age, and low albumin were predictors for all-cause mortality. When lower P and lower albumin were combined, this group had the highest risk for all cause and cardiovascular mortality. Conclusion The frequency of patients with reduced serum phosphorus was higher in the Mexican population than in Europe or Asia. Low serum phosphorus levels, older age and hypoalbuminemia were risk factors for all-cause mortality. Low phosphorus combined with low albumin levels were the highest risk factor for all-cause and cardiovascular mortality.
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Paniagua R, García-López E, Ávila-Díaz M, Ventura MDJ, Orihuela O, Prado-Uribe MDC, Gallardo-Montoya JM, Lindholm B. Sex Modulates Cardiovascular Effects of Icodextrin-Based Peritoneal Dialysis Solutions. Front Physiol 2022; 13:911072. [PMID: 35677090 PMCID: PMC9168216 DOI: 10.3389/fphys.2022.911072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background/Aims: Some previous observations have noted that after six months of peritoneal dialysis (PD) treatment with icodextrin solutions, blood pressure (BP) and NT-proBNP tend to return to baseline values. This may be due to accumulation of icodextrin products that exert a colloid osmotic effect, which drives water into the bloodstream, causing the rise in blood pressure. Since icodextrin is metabolized by α-Amylase and its gene copies are lower in females than in males, we hypothesized icodextrin metabolites reach higher concentrations in females and that cardiovascular effects of icodextrin are influenced by sex. Methods: Secondary analysis of a RCT comparing factors influencing fluid balance control in diabetic PD patients with high or high average peritoneal transport receiving icodextrin (n = 30) or glucose (n = 29) PD solutions. Serum icodextrin metabolites, osmolality, body composition and Inferior Vena Cava (IVC) diameter were measured at baseline, and at 6 and 12 months of follow-up. Results: After six months of treatment, icodextrin metabolites showed higher levels in females than in males, particularly G5-7 and >G7, serum osmolality was lower in females. In spite of reduction in total and extracellular body water, ultrafiltration (UF) was lower and IVC diameter and BP increased in females, suggesting increment of blood volume. Conclusion: Females undergoing PD present with higher levels of icodextrin metabolites in serum that may exert an increased colloid-osmotic pressure followed by less UF volumes and increment in blood volume and blood pressure. Whether this could be due to the lesser number of α-Amylase gene copies described in diabetic females deserves further investigation.
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Affiliation(s)
- Ramón Paniagua
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
- *Correspondence: Ramón Paniagua, ; Marcela Ávila-Díaz,
| | | | - Marcela Ávila-Díaz
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
- *Correspondence: Ramón Paniagua, ; Marcela Ávila-Díaz,
| | - María-de-Jesús Ventura
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
| | - Oscar Orihuela
- Centro Médico Nacional Siglo XXI, Departamento de Cardiología, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
| | - María-del-Carmen Prado-Uribe
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
| | - Juan-Manuel Gallardo-Montoya
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
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Muñoz-Menjivar C, Reyes-Sánchez I, Aguilar-Martínez C, Rodríguez-Rodríguez A, Mendoza-Gómez JL, Guerrero-Soto J, Lizardi-Gómez LF, Venegas-Vera AV, Hernández-Rivera JCH, Ramos-Sánchez A, Paniagua R. Meeting Treatment Goals in Patients on Extramural Dialysis in Health Social Security in Mexico. Blood Purif 2020; 50:93-101. [PMID: 32604095 DOI: 10.1159/000508410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION For the majority of renal replacement therapy history, the main treatment option for patients with end-stage renal disease (ESRD) in Mexico has been peritoneal dialysis. However, the use of hemodialysis is overwhelmingly increasing, driving public health care institutions to subrogate this service. Even when the actual hiring model for subrogation is accurate, there is a lack of quality control points in the hemodialysis prescription, poor adherence to clinical practice guidelines, and a few or no record of outcomes in hemodialysis patients of these subrogated services. The objective of this work is to fill this information gap to allow for uniform and safe hemodialysis for patients of Mexico. MATERIAL AND METHODS An observational and cross-sectional study was performed, including all patients receiving chronic hemodialysis treatment in subrogated units of Mexican Social Security Institute (IMSS) in the northern region of Mexico City. Clinical and biochemical data as well as hemodialysis dose by Kt/V and urea reduction rate were collected and evaluated. To determine distribution, mean or median and SD or interquartile range were used; for nominal variables, the difference in proportions was estimated using the χ2 test; proportions were analyzed for biochemical values using the statistical package SPSS version 25. RESULTS In our study, >60% (485) of the patients were anemic with an average hemoglobin of 9.39 mg/dL (SD ± 1.83); serum calcium was found below 8.4 mg/dL in 51.3% (383) of patients, and only in 45.8% (342) was at an optimal level of this parameter. Only 33.5% of patients have arteriovenous fistula for dialysis access. The hemodialysis dose was optimal in >75% of patients. CONCLUSIONS It is necessary to enhance and monitor treatment of comorbidities in patients with ESRD in subrogated hemodialysis units in México. We observed adequate prescription of hemodialysis in a majority of patients, achieving quality control points for removal of nitrogen products. Yet, there is a lack of quality control of comorbidities; therefore, we should aim to optimize treatment for mineral-bone disorder, anemia, and nutritional status.
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Affiliation(s)
- Cristhian Muñoz-Menjivar
- Nephrology Service, Hospital de Especialidades, Centro Médico Nacional La Raza, Mexico City, Mexico,
| | - Ivonne Reyes-Sánchez
- Nephrology Service, Hospital de Especialidades, Centro Médico Nacional La Raza, Mexico City, Mexico
| | | | | | | | - Joseph Guerrero-Soto
- Nephrology Service, Hospital de Especialidades, Centro Médico Nacional La Raza, Mexico City, Mexico
| | | | | | - Juan Carlos H Hernández-Rivera
- Medical Investigation Unit in Kidney Diseases, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Alfonso Ramos-Sánchez
- Specialist in Chronic Kidney Disease Management in Latin America, BAXTER, Mexico City, Mexico
| | - Ramón Paniagua
- Medical Investigation Unit in Kidney Diseases, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
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Paniagua R, de Jesús Ventura M, Rodríguez E, Sil J, Galindo T, Hurtado ME, Alcántara G, Chimalpopoca A, González I, Sanjurjo A, Barrón L, Amato D, Mujais S. Impact of Fill Volume on Peritoneal Clearances and Cytokine Appearance in Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080402400206] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Current adequacy guidelines for peritoneal dialysis encourage the use of large fill volumes for the attainment of small solute clearance targets. These guidelines have influenced clinical practice in a significant way, and adoption of higher fill volumes has become common in North America. Several studies, however, have challenged the relevance of increasing small solute clearance; this practice may result in untoward consequences in patients. Objective The present study was designed to explore the relationship between dialysate volume and the clearance of different sized molecules, fluid dynamics, and appearance of peritoneal cytokines. Methods Thirteen adult prevalent patients on continuous ambulatory peritoneal dialysis were studied. Three different dialysate volumes (2.0, 2.5, and 3.0 L) were infused on consecutive days in a random order. Several measurements of peritoneal fluid dynamics (intraperitoneal pressure, net ultrafiltration, fluid absorption), solute clearances (urea, creatinine, β2-microglobulin, albumin, IgG, and transferrin), and appearance of interleukin-6 and tumor necrosis factor alpha (TNFα) were assessed. Results Increase in dialysate fill volume (from 2 to 2.5 to 3 L) was examined in relationship to body surface area (BSA). The dialysate volume/BSA (DV/BSA) ratio increased from 1262 to 1566 to 1871 mL/m2 on 2.0, 2.5, and 3.0 L dialysate volumes, respectively. In parallel, diastolic blood pressure increased from 82.7 ± 8.8 to 87.0 ± 9.5 to 92 ± 8.3 mmHg ( p < 0.05). Net ultrafiltration rate also increased, from 0.46 ± 0.48 to 0.72 ± 0.42 to 0.97 ± 0.49 mL/minute ( p < 0.01), despite a concomitant increase in fluid absorption, from 1.05 ± 0.34 to 1.21 ± 0.40 to 1.56 ± 0.22 mL/min ( p < 0.01). Urea peritoneal clearance increased from 8.27 ± 0.68 to 9.92 ± 1.6 to 12.98 ± 4.03 mL/min ( p < 0.01); creatinine peritoneal clearance increased from 6.69 ± 1.01 to 7.64 ± 1.12 to 8.69 ± 1.76 mL/min ( p < 0.01). Clearance of the other measured molecules did not change. Appearance of interleukin-6 increased 17% and 43% ( p < 0.01), and TNFα appearance increased 14% and 50% ( p < 0.01) when dialysate volumes of 2.5 and 3.0 L were used, compared with 2.0 L. Conclusions These results show that, with higher values of DV/BSA ratio, small solute peritoneal clearance is increased, but clearances of large molecules remain unchanged. With the use of higher volumes, fluid absorption rate and the appearance of proinflammatory cytokines in the dialysate are increased.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, México
| | - María de Jesús Ventura
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, México
| | - Ernesto Rodríguez
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, México
| | - Juana Sil
- Hospital General Regional Gabriel Mancera IMSS, México
| | | | | | | | | | | | | | | | - Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, México
| | - Salim Mujais
- Baxter Healthcare Corporation, Deerfield, Illinois, USA
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Paniagua R, Frías Y, De Jesús Ventura M, Rodríguez E, Hurtado ME, Alcántara G, Vázquez R, Ortiz R, Salcedo M, Rios ME, Kaji J, Amato D. C-Reactive Protein and Anti-Chlamydia Pneumoniae Antibodies as Risk Factors of Cardiovascular Death in Incident Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080302300207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti- Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD). Design Single-cohort, prospective observational study. Setting Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico. Patients A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied. Primary Outcome Mortality. Methods Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart. Results Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status. Conclusion These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Yolanda Frías
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Maria De Jesús Ventura
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Ernesto Rodríguez
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | | | | | - Roberto Vázquez
- Hospital General de Zona IMSS, Juárez, Chihuahua, Mexico City, México
| | - Ruth Ortiz
- Hospital General de Zona IMSS, Juárez, Chihuahua, Mexico City, México
| | - Mario Salcedo
- Hospital General de Zona IMSS, Durango, Durango, Mexico City, México
| | - Maria Elena Rios
- Hospital General de Zona IMSS, Durango, Durango, Mexico City, México
| | - Julio Kaji
- Hospital Regional 1° de Octubre, ISSSTE, Mexico City, México
| | - Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
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De Jesús Ventura M, Amato D, Correa–Rotter R, Paniagua R. Relationship between Fill Volume, Intraperitoneal Pressure, Body Size, and Subjective Discomfort Perception in CAPD Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000205] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To determine changes in intraperitoneal pressure (IPP) when dialysate fill volume is increased from 2.0 L to 2.5 L to 3.0 L per exchange, and to evaluate the relationship with subjective discomfort perception. Design Cross-sectional survey. Setting Seven Mexican hospital-based dialysis centers. Patients Eighty-one adult patients on continuous ambulatory peritoneal dialysis (CAPD) without restriction criteria for age, gender, or time on dialysis, were studied. Patients seropositive for HIV or hepatitis B, and those with cancer or receiving immunosuppressive drugs were excluded. Participants were studied as outpatients. Main Measures Blindly and in random order, 2.0-, 2.5-, and 3.0-L volumes of dialysate were infused consecutively. Body surface area (BSA) was calculated from patient height and weight. IPP was assessed with the patient lying supine, measuring the height of the dialysate column inside the peritoneal dialysis bag tubing. Blood pressure and subjective discomfort perception (using a visual analog scale of 0 – -100 mm) were also evaluated and registered after each of the three exchanges. Results The IPP rose with each increase of dialysate volume and was higher in males than in females for each fill volume level. For males IPP was 18.9 ± 6.9, 20.8 ± 7.1, and 22.9 ± 7.5 cm H2O; and for females it was 16.5 ± 5.7, 18.4 ± 5.5, and 19.7 ± 6.2 cm H2O for 2.0-, 2.5-, and 3.0-L fill volumes respectively ( p < 0.01 among fill volumes and between genders). Intraperitoneal pressure showed significant negative correlation with the fill volume corrected for patient body size as reflected by the dialysate volume/ BSA ratio ( r = –0.393, p < 0.01; r = 0.319, p < 0.01; and r = –0.274, p < 0.02 for 2.0-, 2.5-, and 3.0-L fill volumes respectively). Discomfort score rose as fill volume rose, with a median of 0, 2.5, and 13.0 for 2.0-, 2.5-, and 3.0-L fill volumes respectively ( p < 0.001). It is interesting, however, that with 2.5-L and 3.0-L dialysate infusion volumes, 64% and 44% of the patients, respectively, had no discomfort at all. Conclusion Dialysate volume increase is associated with higher IPP, which is modulated by the gender and body size of the patients. Although the mean discomfort score was higher with larger dialysate volumes, there was no significant correlation between discomfort and IPP or the dialysate volume/BSA ratio. Many patients had no discomfort with 2.5-L or even with 3.0-L dialysate infusions; theoretically, they can be treated with larger volumes.
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Paniagua R, Amato D, Correa–Rotter R, Ramos A, Vonesh EF, Mujais SK. Correlation between Peritoneal Equilibration Test and Dialysis Adequacy and Transport Test, for Peritoneal Transport Type Characterization. Perit Dial Int 2020. [DOI: 10.1177/089686080002000110] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to analyze the correlation between the peritoneal equilibration test (PET) and the dialysis adequacy and transport test (DATT) for peritoneal transport type characterization, and the degree of patients’ acceptance for each test. Design Cross-sectional, observational multicenter study. Setting Five referral (tertiary) dialysis centers of institutional practice. Patients The study included 107 adult continuous ambulatory peritoneal dialysis (CAPD) patients with a prescription of four exchanges of 2 L per day, irrespective of age, gender, cause of end-stage renal disease, time on dialysis, nutritional status, or residual renal function. Patients on immunosuppressive therapy and those with cancer, hepatitis B, or HIV, and those having a peritonitis episode within the previous 30 days, or three or more episodes during the previous 12 months, were excluded. Main Measures Peritoneal transport type as classified by creatinine and urea dialysis-to-plasma (D/P) ratios by PET and DATT. Results Correlation coefficients between D/P ratios for creatinine and urea, obtained for the PET and the DATT, were 0.73 for D/P creatinine and 0.96 for D/P urea. Patients were classified into high, high-average, low-average, and low transport categories according to the mean and standard deviation of D/P creatinine values obtained from the PET at 4 hours. These values showed excellent concordance with those generated from the DATT data (κ = 0.82, 95% confidence interval 0.67 – 0.93). Nineteen percent of patients showed discordance in their category when classified according to the PET versus the DATT. Patients’ acceptance was better for the DATT than for the PET, as evaluated with a questionnaire. Conclusion The DATT is an easy, inexpensive, and reliable test to assess peritoneal transport type, and it also provides information about peritoneal clearance of solutes and ultrafiltration. The DATT has better patient acceptance than the PET. Since the DATT has only been validated for patients on a fixed CAPD daily schedule of 4 x 2 L, the results should be confined only to patients receiving such a prescription.
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11
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Ávila-Díaz M, Matos M, García-López E, Prado MDC, Castro-Vázquez F, Ventura MDJ, Dante Amato EG, Paniagua R. Serum Markers of Low-Turnover Bone Disease in Mexican Children with Chronic Kidney Disease Undergoing Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080602600112] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BackgroundThe frequency of low-turnover bone disease (LTBD) in patients with chronic kidney disease (CKD) has increased in past years. This change is important because LTBD is associated with bone pain, growth delay, and higher risk for bone fractures and extraosseous calcifications. LTBD is a histological diagnosis. However, serum markers such as parathyroid hormone (PTH) and calcium levels offer a noninvasive alternative for diagnosing these patients.ObjectiveTo describe the prevalence of LTBD in pediatric patients with renal failure undergoing some form of renal replacement therapy, using serum calcium and intact PTH levels as serum markers.MethodsIn this cross-sectional study, 41 children with CKD undergoing dialysis treatment (31 on continuous ambulatory peritoneal dialysis and 10 on hemodialysis) were included. There were no inclusion restrictions with respect to gender, cause of CKD, or dialysis modality. The children were studied as outpatients. The demographic data, CKD course, time on dialysis, phosphate-binding agents, and calcitriol prescription were registered, as well as weight, height, Z-score for height, linear growth rate, and Z-score for body mass index. Serum calcium, phosphorus, aluminum, PTH, alkaline phosphatase, osteocalcin, glucose, creatinine, urea, cholesterol, and triglycerides were measured.ResultsThere were 20 (48.8%) children with both PTH <150 pg/mL and corrected total calcium >10 mg/dL who were classified as having LTBD[(+)]; the remaining 21 (51.2%) children were classified as having no LTBD[(–)]. The LTBD(+) patients were younger (11.2 ± 2.7 vs 13.2 ± 2.4 years, p < 0.01) but they had no differences regarding Z-scores for height. Linear growth in 6 months was less than expected in both groups (-0.15 ± 0.23 cm/month), but the difference between expected and observed growth was higher in the LTBD(+) group (-0.24 ± 0.14 vs –0.07 ± 0.28 cm/mo, p < 0.03). LTBD(+) patients also had lower serum creatinine (8.69± 2.75 vs 11.19 ± 3.17 mg/dL, p < 0.01), higher serum aluminum levels [median (range) 38.4 (9 – 106) vs 28.1 (9 – 62) μg/L, p < 0.05], and lower systolic blood pressure (112.0 ± 10.3 vs 125.0 ±12.9 mmHg, p < 0.015) and diastolic blood pressure (76.0 ± 9.7 vs 84.5 ± 8.2 mmHg, p < 0.017). A significant correlation was found between PTH and alkaline phosphatase ( r = 0.68, p < 0.001), but not between PTH and aluminum.ConclusionThe LTBD(+) biochemical profile was found in 48.8% of the children and was associated with impaired linear growth. Aluminum contamination, evidenced by higher serum aluminum levels, may have had a pathogenic role in these disorders. Higher systolic and diastolic blood pressure levels may be related to higher serum PTH levels.
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Affiliation(s)
- Marcela Ávila-Díaz
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Mario Matos
- Departamento de Nefrología, Hospital General, Centro Médico Nacional La Raza
| | - Elvia García-López
- Departamento de Nefrología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF, México
| | - María-del-Carmen Prado
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Florencia Castro-Vázquez
- Departamento de Nefrología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF, México
| | - María-de-Jesús Ventura
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Elia González Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
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12
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Ávila-Díaz M, Ventura MDJ, Valle D, Vicenté-Martínez M, García-González Z, Cisneros A, Furlong MDC, Gómez AM, Prado-Uribe MDC, Amato D, Paniagua R. Inflammation and Extracellular Volume Expansion are Related to Sodium and Water Removal in Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080602600510] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundInflammation is an important risk for mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a condition commonly seen in peritoneal dialysis (PD) patients, may be associated with inflammation. However, published support for this relationship is scarce.ObjectivesTo quantify the proportion of patients on PD with inflammation and to analyze the role of ECFv expansion and the factors related to these conditions.DesignA prospective, multicenter cross-sectional study in six hospitals with a PD program.Patients and MethodsAdult patients on PD were studied. Clinical data, body composition, and sodium and fluid intake were recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and urinary fluid and sodium removal were also measured.ResultsCRP values positive (≥ 3.0 mg/L) for inflammation were found in 147 (80.3%) and negative in 36 patients. Patients with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69 ± 0.69 vs 47.36 ± 0.65, men 43.15 ± 1.14 vs 42.84 ± 0.65; p < 0.05), higher serum glucose (125.09 ± 81.90 vs 103.28 ± 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86 ± 0.54 vs 3.17 ± 0.38 g/dL, p < 0.001) levels. They also had lower ultrafiltration (1003 ± 645 vs 1323 ± 413 mL/day, p < 0.005) and total fluid removal (1260 ± 648 vs 1648 ± 496 mL/day, p < 0.001), and less peritoneal (15.59 ± 162.14 vs 78.11 ± 110.70 mEq/day, p < 0.01) and total sodium removal (42.06 ± 142.49 vs 118.60 ± 69.73 mEq/day, p < 0.001). In the multivariate analysis, only ECFv/TBW was significantly ( p < 0.04) and independently associated with inflammation. ECFv/TBW was correlated with fluid removal ( r = 0.16, p < 0.03) and renal sodium removal ( r = 0.2, p < 0.01).ConclusionThe data suggest that ECFv expansion may have a significant role as an inflammatory stimulus. The results disclose a relationship between the two variables, ECFv expansion and inflammation, identified as independent risk factors for mortality in PD patients.
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Affiliation(s)
- Marcela Ávila-Díaz
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - María-de-Jesús Ventura
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - Delfilia Valle
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | | | - Zuzel García-González
- Hospital General de Zona 25, Instituto Mexicano del Seguro Social, México City, México
| | - Alejandra Cisneros
- Hospital General de Zona 27, Instituto Mexicano del Seguro Social, México City, México
| | | | - Ana María Gómez
- Hospital General de Zona 32, Instituto Mexicano del Seguro Social, México City, México
| | - María-del-Carmen Prado-Uribe
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
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13
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Abstract
The increasing rates in incidence and prevalence of chronic kidney disease (CKD) are important challenges for health systems around the world, and are even more significant for undeveloped countries. In Mexico the prevalence of CKD seems to be similar to that in highly developed nations, with diabetes as the leading cause of CKD; however, human and economic resources seem to be insufficient for treatment needs. This is reflected in the unacceptably high mortality rates and in noncompliance with established standards and guidelines. Several measures need to be taken to improve this picture, such as more efficient programs for the prevention of obesity, diabetes, and hypertension. Organizing a national registry of patients with CKD is now a pressing need, as is a continuous search for additional funding and budgets to increase the number of qualified nephrologists and specialized nurses and to continue the much-needed research on CKD.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | | | - Rosaura Fabian
- UMAE Hospital General Gaudencio González Garza, Instituto Mexicano del Seguro Social, México City, México
| | - Jesús Lagunas
- UMAE Hospital General Gaudencio González Garza, Instituto Mexicano del Seguro Social, México City, México
| | - Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
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14
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Goossen K, Becker M, Marshall MR, Bühn S, Breuing J, Firanek CA, Hess S, Nariai H, Sloand JA, Yao Q, Chang TI, Chen J, Paniagua R, Takatori Y, Wada J, Pieper D. Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis 2020; 75:830-846. [PMID: 32033860 DOI: 10.1053/j.ajkd.2019.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 03/07/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022]
Abstract
RATIONALE & OBJECTIVE The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD. STUDY DESIGN Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies. SETTING & STUDY POPULATIONS Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition. SELECTION CRITERIA FOR STUDIES Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports. DATA EXTRACTION 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. ANALYTIC APPROACH Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs. RESULTS 19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, -40.84 [95% CI, -48.09 to-33.59] g/long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (-0.50 [95% CI, -1.19 to 0.18] mmol/L; low certainty) and hemoglobin A1c levels (-0.14% [95% CI, -0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive. LIMITATIONS Trial quality was variable. The follow-up period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data. CONCLUSIONS Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and cost-effectiveness associated with icodextrin is needed.
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Affiliation(s)
- Käthe Goossen
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Monika Becker
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Mark R Marshall
- Baxter Healthcare (Asia) Pte Ltd, Singapore; School of Medicine, University of Auckland, New Zealand; Department of Renal Medicine, Counties Manukau District Health Board, New Zealand.
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Jessica Breuing
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | | | - Simone Hess
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | | | | | - Qiang Yao
- Baxter (China) Investment Co. Ltd, China
| | - Tae Ik Chang
- Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Korea
| | - JinBor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Ramón Paniagua
- Research Unit, Unidad de Investigación Médica en Enfermedades Nefrológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México
| | - Yuji Takatori
- Internal Medicine, Rijinkai Medical Foundation, Socio-Medical Corporation, Kohsei General Hospital, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
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15
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Dodagatta-Marri E, Meyer DS, Reeves MQ, Paniagua R, To MD, Binnewies M, Broz ML, Mori H, Wu D, Adoumie M, Del Rosario R, Li O, Buchmann T, Liang B, Malato J, Arce Vargus F, Sheppard D, Hann BC, Mirza A, Quezada SA, Rosenblum MD, Krummel MF, Balmain A, Akhurst RJ. α-PD-1 therapy elevates Treg/Th balance and increases tumor cell pSmad3 that are both targeted by α-TGFβ antibody to promote durable rejection and immunity in squamous cell carcinomas. J Immunother Cancer 2019. [PMID: 30832732 DOI: 10.1186/s40425-018-0493-9.pmid:30832732;pmcid:pmc6399967] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Checkpoint blockade immunotherapy has improved metastatic cancer patient survival, but response rates remain low. There is an unmet need to identify mechanisms and tools to circumvent resistance. In human patients, responses to checkpoint blockade therapy correlate with tumor mutation load, and intrinsic resistance associates with pre-treatment signatures of epithelial mesenchymal transition (EMT), immunosuppression, macrophage chemotaxis and TGFβ signaling. METHODS To facilitate studies on mechanisms of squamous cell carcinoma (SCC) evasion of checkpoint blockade immunotherapy, we sought to develop a novel panel of murine syngeneic SCC lines reflecting the heterogeneity of human cancer and its responses to immunotherapy. We characterized six Kras-driven cutaneous SCC lines with a range of mutation loads. Following implantation into syngeneic FVB mice, we examined multiple tumor responses to α-PD-1, α-TGFβ or combinatorial therapy, including tumor growth rate and regression, tumor immune cell composition, acquired tumor immunity, and the role of cytotoxic T cells and Tregs in immunotherapy responses. RESULTS We show that α-PD-1 therapy is ineffective in establishing complete regression (CR) of tumors in all six SCC lines, but causes partial tumor growth inhibition of two lines with the highest mutations loads, CCK168 and CCK169. α-TGFβ monotherapy results in 20% CR and 10% CR of established CCK168 and CCK169 tumors respectively, together with acquisition of long-term anti-tumor immunity. α-PD-1 synergizes with α-TGFβ, increasing CR rates to 60% (CCK168) and 20% (CCK169). α-PD-1 therapy enhances CD4 + Treg/CD4 + Th ratios and increases tumor cell pSmad3 expression in CCK168 SCCs, whereas α-TGFβ antibody administration attenuates these effects. We show that α-TGFβ acts in part through suppressing immunosuppressive Tregs induced by α-PD-1, that limit the anti-tumor activity of α-PD-1 monotherapy. Additionally, in vitro and in vivo, α-TGFβ acts directly on the tumor cell to attenuate EMT, to activate a program of gene expression that stimulates immuno-surveillance, including up regulation of genes encoding the tumor cell antigen presentation machinery. CONCLUSIONS We show that α-PD-1 not only initiates a tumor rejection program, but can induce a competing TGFβ-driven immuno-suppressive program. We identify new opportunities for α-PD-1/α-TGFβ combinatorial treatment of SCCs especially those with a high mutation load, high CD4+ T cell content and pSmad3 signaling. Our data form the basis for clinical trial of α-TGFβ/α-PD-1 combination therapy (NCT02947165).
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MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers
- CD4 Lymphocyte Count
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/metabolism
- Cell Line, Tumor
- Drug Synergism
- Epithelial-Mesenchymal Transition
- Humans
- Immunohistochemistry
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/metabolism
- Signal Transduction/drug effects
- Smad3 Protein/metabolism
- T-Lymphocytes, Helper-Inducer/drug effects
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Transforming Growth Factor beta/antagonists & inhibitors
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Affiliation(s)
- E Dodagatta-Marri
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - D S Meyer
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Q Reeves
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - R Paniagua
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Dermatology, UCSF, San Francisco, CA, USA
| | - M D To
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Binnewies
- Department of Pathology, UCSF, San Francisco, CA, USA
| | - M L Broz
- Department of Pathology, UCSF, San Francisco, CA, USA
| | - H Mori
- Center for Comparative Medicine UC Davis, Davis, CA, USA
| | - D Wu
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Adoumie
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - R Del Rosario
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - O Li
- Department of Medicine, UCSF, San Francisco, CA, USA
| | - T Buchmann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - B Liang
- Xoma Corporation, Berkeley, CA, USA
| | - J Malato
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - F Arce Vargus
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | | | - B C Hann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - A Mirza
- Department of Medicine, UCSF, San Francisco, CA, USA
| | - S A Quezada
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | - M D Rosenblum
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Dermatology, UCSF, San Francisco, CA, USA
| | - M F Krummel
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Pathology, UCSF, San Francisco, CA, USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - A Balmain
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Department of Biochemistry and Biophysics, UCSF, San Francisco, CA, USA
| | - R J Akhurst
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA.
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
- Department of Anatomy, UCSF, San Francisco, CA, USA.
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16
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Dodagatta-Marri E, Meyer DS, Reeves MQ, Paniagua R, To MD, Binnewies M, Broz ML, Mori H, Wu D, Adoumie M, Del Rosario R, Li O, Buchmann T, Liang B, Malato J, Arce Vargus F, Sheppard D, Hann BC, Mirza A, Quezada SA, Rosenblum MD, Krummel MF, Balmain A, Akhurst RJ. α-PD-1 therapy elevates Treg/Th balance and increases tumor cell pSmad3 that are both targeted by α-TGFβ antibody to promote durable rejection and immunity in squamous cell carcinomas. J Immunother Cancer 2019; 7:62. [PMID: 30832732 PMCID: PMC6399967 DOI: 10.1186/s40425-018-0493-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Checkpoint blockade immunotherapy has improved metastatic cancer patient survival, but response rates remain low. There is an unmet need to identify mechanisms and tools to circumvent resistance. In human patients, responses to checkpoint blockade therapy correlate with tumor mutation load, and intrinsic resistance associates with pre-treatment signatures of epithelial mesenchymal transition (EMT), immunosuppression, macrophage chemotaxis and TGFβ signaling. METHODS To facilitate studies on mechanisms of squamous cell carcinoma (SCC) evasion of checkpoint blockade immunotherapy, we sought to develop a novel panel of murine syngeneic SCC lines reflecting the heterogeneity of human cancer and its responses to immunotherapy. We characterized six Kras-driven cutaneous SCC lines with a range of mutation loads. Following implantation into syngeneic FVB mice, we examined multiple tumor responses to α-PD-1, α-TGFβ or combinatorial therapy, including tumor growth rate and regression, tumor immune cell composition, acquired tumor immunity, and the role of cytotoxic T cells and Tregs in immunotherapy responses. RESULTS We show that α-PD-1 therapy is ineffective in establishing complete regression (CR) of tumors in all six SCC lines, but causes partial tumor growth inhibition of two lines with the highest mutations loads, CCK168 and CCK169. α-TGFβ monotherapy results in 20% CR and 10% CR of established CCK168 and CCK169 tumors respectively, together with acquisition of long-term anti-tumor immunity. α-PD-1 synergizes with α-TGFβ, increasing CR rates to 60% (CCK168) and 20% (CCK169). α-PD-1 therapy enhances CD4 + Treg/CD4 + Th ratios and increases tumor cell pSmad3 expression in CCK168 SCCs, whereas α-TGFβ antibody administration attenuates these effects. We show that α-TGFβ acts in part through suppressing immunosuppressive Tregs induced by α-PD-1, that limit the anti-tumor activity of α-PD-1 monotherapy. Additionally, in vitro and in vivo, α-TGFβ acts directly on the tumor cell to attenuate EMT, to activate a program of gene expression that stimulates immuno-surveillance, including up regulation of genes encoding the tumor cell antigen presentation machinery. CONCLUSIONS We show that α-PD-1 not only initiates a tumor rejection program, but can induce a competing TGFβ-driven immuno-suppressive program. We identify new opportunities for α-PD-1/α-TGFβ combinatorial treatment of SCCs especially those with a high mutation load, high CD4+ T cell content and pSmad3 signaling. Our data form the basis for clinical trial of α-TGFβ/α-PD-1 combination therapy (NCT02947165).
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MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers
- CD4 Lymphocyte Count
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/metabolism
- Cell Line, Tumor
- Drug Synergism
- Epithelial-Mesenchymal Transition
- Humans
- Immunohistochemistry
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/metabolism
- Signal Transduction/drug effects
- Smad3 Protein/metabolism
- T-Lymphocytes, Helper-Inducer/drug effects
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Transforming Growth Factor beta/antagonists & inhibitors
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Affiliation(s)
- E. Dodagatta-Marri
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - D. S. Meyer
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Q. Reeves
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - R. Paniagua
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Dermatology, UCSF, San Francisco, CA USA
| | - M. D. To
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Binnewies
- Department of Pathology, UCSF, San Francisco, CA USA
| | - M. L. Broz
- Department of Pathology, UCSF, San Francisco, CA USA
| | - H. Mori
- Center for Comparative Medicine UC Davis, Davis, CA USA
| | - D. Wu
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Adoumie
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - R. Del Rosario
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - O. Li
- Department of Medicine, UCSF, San Francisco, CA USA
| | - T. Buchmann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - B. Liang
- Xoma Corporation, Berkeley, CA USA
| | - J. Malato
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - F. Arce Vargus
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | | | - B. C. Hann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - A. Mirza
- Department of Medicine, UCSF, San Francisco, CA USA
| | - S. A. Quezada
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | - M. D. Rosenblum
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Dermatology, UCSF, San Francisco, CA USA
| | - M. F. Krummel
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Pathology, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
| | - A. Balmain
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
- Department of Biochemistry and Biophysics, UCSF, San Francisco, CA USA
| | - R. J. Akhurst
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
- Department of Anatomy, UCSF, San Francisco, CA USA
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17
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Laguna-Alcaraz AD, Mejía-Rodríguez O, Rendón-Paredes AL, Villa-Barajas R, Paniagua R. Impact of a comprehensive intervention to families with teenage sons with overweight and obesity in a primary care setting: A case report. Diabetes Metab Syndr 2017; 11 Suppl 1:S195-S200. [PMID: 28024831 DOI: 10.1016/j.dsx.2016.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/13/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Overweight and obesity in adolescence is a public health problem and a risk factor for chronic noncommunicable diseases. To prevent further diseases, preventive interventions are needed, including educational programmes, addressed in a primary care setting, that include the whole family. The objective of this study was to evaluate the impact of a comprehensive intervention, targeting families with teenage sons with overweight and obesity, in the lifestyle, cardiovascular risk factors and metabolic syndrome in a primary care setting. METHODS A pre-post intervention study was conducted. Twelve families with teenage sons between 10 and 14 years were enrolled; all the families were affiliated to the IMSS (Insituto Mexicano del Seguro Social). The comprehensive strategy was applied for 6 months (educational sessions for self-care, physical activity and nutritional counselling). The following measurements were performed before and after the intervention: the FANTASTIC lifestyle survey was applied. Clinical, anthropometric and biochemical assessments were performed. The changes in life style and cardiovascular risk factors were analyzed with Student's t-test or Mann-Whitney U test. RESULTS The lifestyle was improved after the intervention in the domains of family and friends, nutrition and alcohol intake (p<0.05). Body mass index, waist circumference and diastolic blood pressure and fasting glucose decreased significantly. CHDL increased (p<0.05). Metabolic syndrome improved (p<0.05). CONCLUSIONS Our comprehensive intervention for the families in a primary care setting, improved their lifestyle, decreased cardiovascular risk factors and decreased the metabolic syndrome.
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Affiliation(s)
- Alma Delia Laguna-Alcaraz
- Hospital General de Subzona con Medicina Familiar N° 2, Zacapu, Mich, Mexico; Facultad de Ciencias Médicas y Biológicas "Dr. Ignacio Chávez", Universidad Michoacna de San Nicolás de Hidalgo, Mexico
| | - Oliva Mejía-Rodríguez
- Centro de Investigación Biomédica de Michoacán, del Instituto Mexicano del Seguro Social, Morelia, Michoacán, Mexico.
| | | | - Rafael Villa-Barajas
- Facultad de Ciencias Médicas y Biológicas "Dr. Ignacio Chávez", Universidad Michoacna de San Nicolás de Hidalgo, Mexico
| | - Ramón Paniagua
- Unidad de Investigación Médica en Enfermeades Nefrológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México
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18
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Prado-Uribe MDC, Ventura MDJ, Ávila-Díaz M, Mora CJ, Méndez-Durán A, Villanueva-Noches D, Cisneros A, Ilabaca B, Cueto-Manzano A, García-Contreras F, Lindholm B, García-López E, Paniagua R. Low triiodothyronine is associated with elevation of N-terminal pro-brain natriuretic peptide (NT-proBNP) and mortality in dialysis patients. Nefrologia 2017; 37:598-607. [PMID: 28755902 DOI: 10.1016/j.nefro.2017.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/18/2016] [Revised: 04/11/2017] [Accepted: 05/22/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low thyroid hormone (TH) levels and myocardial damage are common in dialysis patients and are associated with mortality. However, little is known about the role of THs on myocardial damage as has been described in primary thyroid diseases. The aim of this study was to explore the potential relationship between low total triiodothyronine (total T3) and biomarkers of myocardial damage and the effect of their interaction on mortality, to ascertain if cardiovascular damage is the link between low THs and the risk of death in dialysis patients with CKD. MATERIAL AND METHODS TH plasma levels, nutritional markers, inflammation and myocardial damage were studied in 296 patients undergoing peritoneal dialysis or haemodialysis, who were followed up for 16 months to ascertain the association between biochemical variables and mortality. RESULTS Low total T3 levels were found in 45% of patients, which was inversely correlated with C-reactive protein (CRP) and NT-proBNP, and directly correlated with albumin and transferrin. Diabetes, CRP and total T3 were risk factors for all-cause mortality, and CRP, NT-proBNP and total T3 for cardiovascular mortality. CONCLUSIONS Low total T3 levels are common in dialysis patients and are associated with inflammation, malnutrition and myocardial damage. The latter may be the link between low THs and all-cause and cardiovascular mortality.
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Affiliation(s)
- María Del Carmen Prado-Uribe
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México
| | - María-de-Jesús Ventura
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México
| | - Marcela Ávila-Díaz
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México
| | - Carmen J Mora
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México
| | | | | | | | - Begoña Ilabaca
- Hospital General de Zona 1A, IMSS, Ciudad de México, México
| | | | | | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Estocolmo, Suecia
| | - Elvia García-López
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Estocolmo, Suecia
| | - Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México.
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19
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Avila M, Mora C, Prado MDC, Zavala M, Paniagua R. Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients. Am J Nephrol 2017; 46:39-46. [PMID: 28614819 DOI: 10.1159/000477380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 11/13/2016] [Accepted: 03/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). METHODS We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. RESULTS Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). CONCLUSION OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.
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Affiliation(s)
- Marcela Avila
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN SXXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
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20
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Sánchez V, Paniagua R, Prado MDC, Mora C, Orihuela O, Martínez-Baca F, Pérez EE, Calzada C, Romero R, Avila M. High Prevalence of Diastolic Dysfunction in Incident Patients on Peritoneal Dialysis: Association with Low Thyroid Hormones. Nephron Clin Pract 2016; 135:120-128. [PMID: 27842310 DOI: 10.1159/000452342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Diastolic dysfunction (DD) and low levels of thyroid hormones (TH) are frequent found in chronic kidney disease; both are associated with all-cause and cardiovascular mortality. However, a link between them has not yet been established. The aim of this study was to analyze DD as a surrogate marker of fibrosis and its association with TH in incident patients on peritoneal dialysis (PD). METHODS A cross-sectional study with 183 incident patients on PD with preserved ejection fraction was performed. Clinical and demographic data were registered. Serum total and free (t/f) triiodothyronine (T3), thyroxin (T4), and thyroid stimulating hormone levels were determined by RIA kits, albumin and high-sensitivity C-reactive protein by conventional assays. Transthoracic 2D echocardiogram was performed for evaluation of left ventricular (LV) mass and ejection fraction. DD was evaluated using pulsed-wave tissue Doppler imaging. RESULTS Patients were 43 ± 12, 42% with diabetes mellitus (DM). Some degree of DD was found in 62% of patients; 18% had grade I DD, 8% grade II DD and 36% grade III DD. Patients with grade III DD were more likely to have diabetes, older, high LV mass and low serum albumin, t/fT3 and tT4 levels. In logistic multivariate regression analysis, it was found that diabetes (B = -0.86, 95% CI 0.182-0.992, p < 0.05), hypertension (B = -0.95, 95% CI 0.184-0.817, p = 0.01) and tT3 (B = -1.94, 95% CI 0.023-0.876, p < 0.05) were associated with grade III DD. CONCLUSIONS High prevalence of grade III DD was found in incident patients on PD. In addition to DM and hypertension, tT3 was found to be an independent risk factor for grade III DD and more studies are needed to understand the reasons as to why this association is present.
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Affiliation(s)
- Virginia Sánchez
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN, SXXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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21
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Almeida-Gutiérrez E, Paniagua R, Furuya ME. [Network Research on Human Papillomavirus]. Rev Med Inst Mex Seguro Soc 2015; 53 Suppl 2:S116-S117. [PMID: 26462505] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In order to increase the research in important health questions at a national and institutional levels, the Human Papillomavirus Research Network of the Health Research Coordination of the Instituto Mexicano del Seguro Social offers this supplement with the purpose of assisting patients that daily look for attention due to the human papillomavirus or to cervical cancer.
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Affiliation(s)
- Eduardo Almeida-Gutiérrez
- Área de Promoción y Seguimiento de la Investigación, División de Desarrollo de la Investigación, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Distrito Federal, México.
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22
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Orihuela O, de Jesús Ventura M, Ávila-Díaz M, Cisneros A, Vicenté-Martínez M, Furlong MDC, García-González Z, Villanueva D, Alcántara G, Lindholm B, García-López E, Villanueva C, Paniagua R. Effect of icodextrin on heart rate variability in diabetic patients on peritoneal dialysis. Perit Dial Int 2014; 34:57-63. [PMID: 24525598 DOI: 10.3747/pdi.2012.00279] [Citation(s) in RCA: 4] [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] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED INTRODUCTION Spectral analysis of heart rate variability is a noninvasive method for evaluating autonomic cardiovascular dysfunction under various clinical conditions, such as in dialysis patients, in whom an imbalance between the sympathetic and parasympathetic nervous system appears to be an important risk factor for sudden cardiovascular death and arrhythmia. ♢ OBJECTIVE We compared the effect of icodextrin-based dialysis solution, an option that allows for better metabolic and fluid overload control, with that of glucose-based dialysis fluid on sympathetic and parasympathetic activity in the heart, as assessed by heart rate variability, in diabetic patients on peritoneal dialysis (PD). ♢ METHODS This secondary analysis uses data from a randomized controlled trial in diabetic PD patients with high or high-average peritoneal transport using icodextrin-based (ICO group, n = 30) or glucose-based (GLU group, n = 29) solutions for the long dwell. All patients underwent 24-hour electrocardiographic Holter monitoring at baseline, and at 6 and 12 months of follow-up. ♢ RESULTS We observed no significant differences between the groups in most of the variables analyzed, although values were, in general, below reference values. In the ICO group, total power and both low- and high-frequency power in normalized units increased, but the percentage of RR intervals with variation of more than 50 ms declined over time; in the GLU group, all those values declined. Plasma catecholamine levels were higher at baseline and declined over time. ♢ CONCLUSIONS These results indicate a partial recovery of sympathetic activity in the ICO group, probably because of better extracellular fluid control and lower exposure to glucose with the use of icodextrin-based dialysis solutions.
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Affiliation(s)
- Oscar Orihuela
- Unidad de Investigación Médica en Enfermedades Nefrológicas,1 Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City
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23
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Debowska M, Paniagua R, Ventura MDJ, Ávila-Díaz M, Prado-Uribe C, Mora C, García-López E, Qureshi AR, Lindholm B, Waniewski J. Dialysis adequacy indices and body composition in male and female patients on peritoneal dialysis. Perit Dial Int 2014; 34:417-25. [PMID: 24497588 DOI: 10.3747/pdi.2013.00018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
OBJECTIVES Creatinine clearance scaled to body surface area (BSA) and urea KT/V normalized to total body water (TBW) are used as indices for peritoneal dialysis (PD) adequacy. We investigated relationships of indices of dialysis adequacy (including KT/V, KT, clearance, dialysate over plasma concentration ratio) and anthropometric and body composition parameters (BSA, TBW, body mass index (BMI), weight, height, fat mass (FM), and fat-free mass (FFM)) in male and female patients on continuous ambulatory peritoneal dialysis. METHODS Ninety-nine stable patients (56 males) performed four 24-hr collections of drained dialysate for four dialysis schedules with three daily exchanges of glucose 1.36% and one night exchange of either: 1) glucose 1.36%, 2) glucose 2.27%, 3) glucose 3.86% or 4) icodextrin 7.5%. RESULTS KT and dialysate over plasma concentration ratio, CD/CP, for urea and creatinine were similar for males and females and, in general, did not depend on body-size parameters including V (= TBW), which means that the overall capacity of the transport system in females and males is similar. However, after normalization of KT to V or 1.73/BSA yielding KT/V and creatinine clearance, Cl(1.73/BSA), respectively, the normalized indices were substantially higher in females than in males and correlated inversely with body-size parameters, especially in males. CONCLUSIONS As KT/V depends strongly on body size, treatment target values for KT/V should take body size and therefore also gender into account. As KT is less influenced by body size, body composition and gender, KT should be considered as a potential auxiliary index in PD.
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Affiliation(s)
- Malgorzata Debowska
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Ramón Paniagua
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - María-de-Jesús Ventura
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Marcela Ávila-Díaz
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Carmen Prado-Uribe
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Carmen Mora
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Elvia García-López
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Bengt Lindholm
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Jacek Waniewski
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
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Prado-Uribe MDC, Soto-Abraham MV, Mora-Villalpando CJ, Gallardo JM, Bonilla E, Avila M, Tena E, Paniagua R. Role of thyroid hormones and mir-208 in myocardial remodeling in 5/6 nephrectomized rats. Arch Med Res 2013; 44:616-22. [PMID: 24246300 DOI: 10.1016/j.arcmed.2013.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 10/23/2013] [Accepted: 10/30/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Thyroid hormones exert important effects on heart remodeling through mir-208. The process may have a role in myocardial changes in chronic kidney disease where thyroid abnormalities are common. In this study the effect of T4 supplementation on left ventricle (LV) remodeling in 5/6 nephrectomized rats (5/6Nx) was analyzed. METHODS 5/6Nx rats and 5/6Nx under T4 supplementation (5/6Nx + T4) were compared with control (C) and thyroidectomized (Tx) rats. After 8 weeks of follow-up, LV was analyzed for α-MHC, β-MHC, TGF-β, and mir-208 expression, hydroxyproline content, and myocardial fibrosis. Serum collagenase activity was also analyzed. RESULTS Heart weight increased in 5/6Nx rats compared to C, which was prevented with T4 supplementation (C, 1.5 ± 0.04; 5/6Nx, 1.8 ± 0.09; 5/6Nx + T4, 1.6 ± 0.07 g, p <0.05). The same pattern was seen for LV wall thickness, hydroxyproline content, LV fibrosis, and mRNA TGF-β expression (C, 0.47 ± 0.17; 5/6Nx, 10.55 ± 3.4; 5/6Nx + T4, 3.01 ± 0.52, p <0.01). Tx rats had reduction in heart weight, increased LV wall thickness, and fibrosis. Collagenase activity did not change in any group. mRNA expression of α-, β-MHC, and TGF-β increased in 5/6Nx in comparison to C and 5/6Nx + T4. Expression of mir-208 decreased in 5/6Nx groups, and levels were restored with T4 supplementation (4.21 ± 0.28, 3.39 ± 0.29, and 4.26 ± 0.37 RU, respectively, p <0.01). CONCLUSIONS Decreased plasma level of thyroid hormones or sensitivity at tissue level observed in chronic kidney disease induced by 5/6Nx has an important effect in heart remodeling processes, some of it related or mediated by mir-208 and TGF-β expression in the heart.
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Affiliation(s)
- María-Del-Carmen Prado-Uribe
- Medical Research Unit in Nephrology Diseases, Specialty Hospital, Centro Médico Nacional Siglo XXI, Mexican Social Security Institute, Mexico City, Mexico.
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25
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Paniagua R, Ventura MDJ, Ávila-Díaz M, Hinojosa-Heredia H, Méndez-Duran A, Cisneros A, Gómez AM, Cueto-Manzano A, Trinidad P, Obrador GT, García-López E, Lindholm B. Reaching Targets for Mineral Metabolism Clinical Practice Guidelines and Its Impact on Outcomes Among Mexican Chronic Dialysis Patients. Arch Med Res 2013; 44:229-34. [DOI: 10.1016/j.arcmed.2013.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/23/2013] [Indexed: 11/30/2022]
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26
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Waniewski J, Paniagua R, Stachowska-Pietka J, Ventura MDJ, Ávila-Díaz M, Prado-Uribe C, Mora C, García-López E, Lindholm B. Threefold peritoneal test of osmotic conductance, ultrafiltration efficiency, and fluid absorption. Perit Dial Int 2013; 33:419-25. [PMID: 23378471 DOI: 10.3747/pdi.2011.00329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 11/15/2022] Open
Abstract
BACKGROUND Fluid removal during peritoneal dialysis depends on modifiable factors such as tonicity of dialysis fluids and intrinsic characteristics of the peritoneal transport barrier and the osmotic agent-for example, osmotic conductance, ultrafiltration efficiency, and peritoneal fluid absorption. The latter parameters cannot be derived from tests of the small-solute transport rate. We here propose a simple test that may provide information about those parameters. METHODS Volumes and glucose concentrations of drained dialysate obtained with 3 different combinations of glucose-based dialysis fluid (3 exchanges of 1.36% glucose during the day and 1 overnight exchange of either 1.36%, 2.27%, or 3.86% glucose) were measured in 83 continuous ambulatory peritoneal dialysis (CAPD) patients. Linear regression analyses of daily net ultrafiltration in relation to the average dialysate-to-plasma concentration gradient of glucose allowed for an estimation of the osmotic conductance of glucose and the peritoneal fluid absorption rate, and net ultrafiltration in relation to glucose absorption allowed for an estimation of the ultrafiltration effectiveness of glucose. RESULTS The osmotic conductance of glucose was 0.067 ± 0.042 (milliliters per minute divided by millimoles per milliliter), the ultrafiltration effectiveness of glucose was 16.77 ± 7.97 mL/g of absorbed glucose, and the peritoneal fluid absorption rate was 0.94 ± 0.97 mL/min (if estimated concomitantly with osmotic conductance) or 0.93 ± 0.75 mL/min (if estimated concomitantly with ultrafiltration effectiveness). These fluid transport parameters were independent of small-solute transport characteristics, but proportional to total body water estimated by bioimpedance. CONCLUSIONS By varying the glucose concentration in 1 of 4 daily exchanges, osmotic conductance, ultrafiltration efficiency, and peritoneal fluid absorption could be estimated in CAPD patients, yielding transport parameter values that were similar to those obtained by other, more sophisticated, methods.
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Affiliation(s)
- Jacek Waniewski
- Institute of Biocybernetics and Biomedical Engineering PAS,1 Warsaw, Poland.
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Obrador GT, Paniagua R. A Decade After the KDOQI CKD Guidelines: A Perspective From Mexico. Am J Kidney Dis 2012; 60:736-7. [DOI: 10.1053/j.ajkd.2012.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 08/09/2012] [Indexed: 11/11/2022]
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Paniagua R, Debowska M, Ventura MDJ, Ávila-Díaz M, Prado-Uribe C, Mora C, García-López E, Lindholm B, Waniewski J. Ultrafiltration and dialysis adequacy with various daily schedules of dialysis fluids. Perit Dial Int 2012; 32:545-51. [PMID: 22302769 DOI: 10.3747/pdi.2011.00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dialysis regimens for continuous ambulatory peritoneal dialysis (CAPD) patients vary with the need for fluid removal, but also because of concerns about the local and systemic consequences of high glucose exposure. The implications of various regimens for dialysis adequacy--that is, fluid and small-solute removal--are not always clear. We therefore analyzed ultrafiltration (UF) and adequacy indices for 4 different combinations of dialysis fluid. Collections of 24-hour dialysate and urine were carried out in 99 patients on CAPD. On 4 separate occasions, each patient performed 4 exchanges in 24 hours, including 3 daily exchanges with 1.36% glucose and 1 night exchange with either 1.36% glucose (G1 schedule), 2.27% glucose (G2 schedule), 3.86% glucose (G3 schedule), or icodextrin (Ico schedule). Weekly, total, and dialysis Kt/V and KT were calculated for both urea and creatinine. The mean values of urea Kt/V and KT were significantly lower for the G1 schedule than for the G3 and Ico schedules. The adequacy indices for overnight application of 3.86% glucose and icodextrin were similar. Using dialysis fluids with 1.36% and 2.27% glucose overnight reduces glucose exposure, but those schedules may provide inadequate UF and small-solute removal in some patients (UF < 1 L daily, Kt/V < 1.7).
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
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Bouraoui Y, Ben Jemaa A, Rodriguez G, Ben Rais N, Fraile B, Paniagua R, Sellemi S, Royuela M, Oueslati R. Profile of NF-κBp(65/NFκBp50) among prostate specific antigen sera levels in prostatic pathologies. ACTA ACUST UNITED AC 2011; 60:301-5. [PMID: 21889270 DOI: 10.1016/j.patbio.2011.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 07/26/2011] [Indexed: 12/27/2022]
Abstract
AIM The aim of this work was to characterise the immunoexpression of NF-κB (p50/p65) in human prostatic pathologies and to study its profiles of activation among sera prostate specific antigen antigen (PSA) according the three groups: 0-4ng/mL, 4-20ng/mL and >20ng/mL. PATIENTS AND METHODS Twenty-four men with benign prostate hyperplasia (BPH); 19 men with prostate cancer (PC) and five men with normal prostates (NP). Immunohistochemical and western blot analysis was performed. Serum levels of PSA were assayed by immulite autoanalyser. RESULTS In BPH and PC samples, immunoexpressions were observed for NF-κBp65 and NF-κBp50; while in NP samples, only were detected NF-κBp50. PC samples showed immunoreactions to NF-κBp65 and NF-κBp50 more intense (respectively 24.18±0.67 and 28.23±2.01) than that observed in BPH samples (respectively18.46±2.04 and 18.66±1.59) with special localisation in the nucleus. Different profiles of NF-κBp65 immunoexpressions were observed and BPH patients with sera PSA levels between 0-4ng/mL presented a significant weak percentage compared to BPH patients with sera PSA levels between 4-20ng/mL and >20ng/mL. No immunoreactions to NF-κBp65 were observed in PC patients with sera PSA levels between 4-20ng/mL. CONCLUSION The sensibility of both NF-κB and PSA to inflammation allowed confirming the relationship between these two molecules and its involvement in prostatic diseases progression (inflammatory and neoplasic).
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Affiliation(s)
- Y Bouraoui
- Faculty of Sciences of Bizerte, Unit of Immunology and Microbiology Environmental and Carcinogenesis (IMEC), University of Carthage, 7021 Zarzouna, Tunisia
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30
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Kaul P, George R, Paniagua R, Petsa A, Congiu S. Innominate truncal dissection and rupture into right pleural cavity following acute type A dissection of the aorta with right coronary ostial avulsion and inferior STEMI. Perfusion 2011; 26:435-40. [DOI: 10.1177/0267659111408997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An innominate truncal dissection and rupture into the right pleural cavity with massive hemothorax is the initial presentation in this 66-year-old lady with type A dissection of the aorta complicated by right coronary ostial avulsion and inferior STEMI. She underwent supracoronary interposition graft replacement of the ascending aorta and hemiarch, interposition graft replacement of the innominate trunk and saphenous vein bypass grafting of the right coronary artery successfully. Innominate truncal rupture following aortic dissection is practically unknown and has not been described before in the absence of aortic rupture. Innominate truncal rupture secondary to other pathologies presents with supraaortic and mediastinal hematomas, but almost never with right hemothorax. On the backdrop of this unusual presentation with no neurological injury, we review the literature for innominate truncal dissection and rupture, other etiologies for innominate truncal rupture, the complex interplay of factors determining neurological injury and discuss the changes in the strategies and conduct of arterial return during cardiopulmonary bypass and selective antegrade perfusion imposed by this previously undescribed instance of innominate truncal rupture due to dissection.
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Affiliation(s)
- P Kaul
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - R George
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - R Paniagua
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - A Petsa
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - S Congiu
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
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Cansino JR, Vera R, Rodríguez de Bethencourt F, Bouraoui Y, Rodríguez G, Prieto A, de la Peña J, Paniagua R, Royuela M. [Prostate specific antigen and NF-kB in prostatic disease: relation with malignancy]. Actas Urol Esp 2011; 35:16-21. [PMID: 21256390 DOI: 10.1016/j.acuro.2010.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 03/21/2010] [Revised: 08/09/2010] [Accepted: 08/31/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION NF-kB (p50/p65) is a transcription factor involved in TNF-α-induced cell death resistance by promoting several antiapoptotic genes. We intend to relate the expression of NF-kB (p50 and p65) with serum levels of prostate-specific antigen (PSA), both in normal males and in those with pathologic conditions of the prostate. MATERIALS AND METHODS this study was carried out in 5 normal, 24 benign prostatic hyperplastic (BPH) and 19 patients with prostate cancer (PC). Immunohistochemical and Western blot analyses were performed on tissue and serum PSA was assayed by PSA DPC Immulite assays (Diagnostics Products Corporation, Los Angeles, CA). RESULTS in controls, p65 NF-kB was not found and p50 was scantly detected in 60% normal samples in the cytoplasm of epithelial cells. Both p50 and p65 were expressed in 62.5% of the samples with BPH and in 63.2% of those with PC. Both increased its frequency of expression with higher PSA serum levels. CONCLUSIONS Activation of NF-kB revealed by its nuclear translocation in prostate cancer could be related to cancer progression and elevated seric PSA levels. A better understanding of the biologic mechanism by which circulating PSA levels increase and its relation with NF-kB expression is needed. Possibly, NF-kB blockage could be used as a therapeutic target to counteract proliferation in prostate cancer.
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Affiliation(s)
- J R Cansino
- Hospital Universitario La Paz, Madrid, España.
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Cansino J, Vera R, Rodríguez de Bethencourt F, Bouraoui Y, Rodríguez G, Prieto A, Peña JDL, Paniagua R, Royuela M. Antígeno prostático específico y NF-kB en patología prostática: relación con la malignidad. Actas Urol Esp 2011. [DOI: 10.4321/s0210-48062011000100006] [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: 11/11/2022]
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33
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Paniagua R, Villasís-Keever A, Prado-Uribe MDC, Ventura-García MDJ, Alcántara-Ortega G, Ponce de Leon SR, Cure-Bolt N, Rangel-Frausto S. Elevated Prevalence of Hepatitis B in Mexican Hemodialysis Patients. A Multicentric Survey. Arch Med Res 2010; 41:251-4. [DOI: 10.1016/j.arcmed.2010.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 04/23/2010] [Indexed: 11/25/2022]
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34
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Avila M, Prado C, Ventura MDJ, Mora C, Briones D, Valdez H, Hurtado ME, Lindholm B, Qureshi A, Castillo-Henkel C, Paniagua R. Vitamin D receptor gene, biochemical bone markers and bone mineral density in Mexican women on dialysis. Nephrol Dial Transplant 2010; 25:2259-65. [PMID: 20124547 DOI: 10.1093/ndt/gfq019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The influence of the Bsm1 polymorphism of the vitamin D receptor (VDR) gene on mineral and bone disorders in chronic kidney disease (CKD) is still under discussion. The aim of this study was to analyse the relationship between VDR polymorphism, bone mineral density (BMD), biochemical bone markers and clinical factors in women on peritoneal dialysis (PD) and haemodialysis (HD). METHODS In a cross-sectional study, 197 women (42 +/- 10 years; 25% with diabetes mellitus (DM); body mass index (BMI) 25.26 +/- 4.77 kg/m(2)) treated by PD (72%) or HD (28%) underwent measurements of BMD (measured at the calcaneus by quantitative ultrasound; expressed as T- and Z-scores) and plasma total calcium (tCa), intact parathyroid hormone 1-84 (iPTH), phosphorus, albumin, glucose, osteoprotegerin (OPG), fetuin-A, intact osteocalcin-49 and N-MID fragment 1-43 aa (N-MID osteocalcin) N-terminal propeptide of type 1 procollagen (PINP) and C-terminal telopeptide-beta aspartic acid (BCL). DNA was extracted from peripheral blood. PCR products were digested with Bsm1 to analyse VDR polymorphism. RESULTS The Z-score of BMD was -1.1 +/- 1.03. According to the values of osteopenia (T-score = -1.0), patients with higher BMD were younger, had lower frequency of amenorrhoea and diabetes and had higher serum creatinine and fetuin levels as well as lower levels of PINP. In a stepwise multivariate logistics analysis, osteopenia was associated with presence of genotype BB+Bb (OR = 3.26, P < or = 0.003) and age (OR = 0.95, P = 0.050). According to the B allele, bb: n = 126 (64%) and BB+Bb: n = 71(36%), group bb had significantly higher mean Z-scores (-0.97 +/- 1.0 vs -1.3+/-0.92; P < or = 0.021). CONCLUSIONS The high frequency of osteopenia observed in female CKD patients on dialysis is associated with age and genetic predisposition as revealed by its association to the Bsm1 VDR polymorphism.
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Affiliation(s)
- Marcela Avila
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN SXXI, Instituto Mexicano del Seguro Social, México City, México.
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Codesal J, Nistal M, Queizan A, Carretero JL, de Vega RM, Perez A, Paniagua R. Number and DNA Content of Hypertrophic Spermatogonia in Normal and Cryptorchid Human Testes. ACTA ACUST UNITED AC 2009; 29:157-62. [PMID: 1360789 DOI: 10.3109/01485019208987720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The number and the DNA content of hypertrophic spermatogonia were studied in normal and cryptorchid testes. The number of hypertrophic spermatogonia in cryptorchid testes is higher than in control testes at the same age. This finding suggests alterations in the spermatogonia of cryptorchid males. The results show a polyploid DNA content in more than 80% of hypertrophic spermatogonia in both normal and cryptorchid testes. There were hypertrophic spermatogonia with a DNA content between 2c and 4c (0.5%) and between 4c and 8c (9%). These spermatogonia might be cells in the S phase of the cell cycle.
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Affiliation(s)
- J Codesal
- Department of Morphology, School of Medicine, Autonomous University of Madrid, Spain
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Picazo ML, De Miguel MP, Gonzalez MJ, Royuela M, Fraile B, Paniagua R, Bardasano JL. Interactions of ELF Magnetic Fields with Mouse Skeletal Muscle. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/15368379509030727] [Citation(s) in RCA: 6] [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] [Indexed: 11/13/2022]
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Picazo ML, De Miguel MP, Leyton V, Franco P, Varela L, Paniagua R, Bardasano JL. Long-Term Effects of ELF Magnetic Fields on the Mouse Testis and Serum Testosterone Levels. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/15368379509022552] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paniagua R, Ventura MDJ, Ávila-Díaz M, Cisneros A, Vicenté–Martínez M, Furlong MDC, García-González Z, Villanueva D, Orihuela O, Prado-Uribe MDC, Alcántara G, Amato D. Icodextrin Improves Metabolic and Fluid Management in High and High-Average Transport Diabetic Patients. Perit Dial Int 2009. [DOI: 10.1177/089686080902900409] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Icodextrin-based solutions (ICO) have clinical and theoretical advantages over glucose-based solutions (GLU) in fluid and metabolic management of diabetic peritoneal dialysis (PD) patients; however, these advantages have not yet been tested in a randomized fashion. Objective To analyze the effects of ICO on metabolic and fluid control in high and high-average transport diabetic patients on continuous ambulatory PD (CAPD). Patients and Methods A 12-month, multicenter, open-label, randomized controlled trial was conducted to compare ICO ( n = 30) versus GLU ( n = 29) in diabetic CAPD patients with high-average and high peritoneal transport characteristics. The basic daily schedule was 3 × 2 L GLU (1.5%) and either 1 × 2 L ICO (7.5%) or 1 × 2 L GLU (2.5%) for the long-dwell exchange, with substitution of 2.5% or 4.25% for 1.5% GLU being allowed when clinically necessary. Variables related to metabolic and fluid control were measured each month. Results Groups were similar at baseline in all measured variables. More than 66% of the patients using GLU, but only 9% using ICO, needed prescriptions of higher glucose concentration solutions. Ultrafiltration (UF) was higher (198 ± 101 mL/day, p < 0.05) in the ICO group than in the GLU group over time. Changes from baseline were more pronounced in the ICO group than in the GLU group for extracellular fluid volume (0.23 ± 1.38 vs –1.0 ± 1.48 L, p < 0.01) and blood pressure (systolic 1.5 ± 24.0 vs –10.4 ± 30.0 mmHg, p < 0.01; diastolic 1.5 ± 13.5 vs –6.2 ± 14.2 mmHg, p < 0.01). Compared to baseline, patients in the ICO group had better metabolic control than those in the GLU group: glucose absorption was more reduced (–17 ± 44 vs –64 ± 35 g/day) as were insulin needs (3.6 ± 3.4 vs – 9.1 ± 4.7 U/day, p < 0.01), fasting serum glucose (8.3 ± 36.5 vs –37 ± 25.8 mg/dL, p < 0.01), triglycerides (54.5 ± 31.9 vs –54.7 ± 39.9 mg/dL, p < 0.01), and glycated hemoglobin (0.79% ± 0.79% vs –0.98% ± 0.51%, p < 0.01). Patients in the ICO group had fewer adverse events related to fluid and glucose control than patients in the GLU group. Conclusion Icodextrin represents a significant advantage in the management of high transport diabetic patients on PD, improving peritoneal UF and fluid control and reducing the burden of glucose overexposure, thereby facilitating metabolic control.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigatión Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - María-de-Jesús Ventura
- Unidad de Investigatión Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Marcela Ávila-Díaz
- Unidad de Investigatión Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Alejandra Cisneros
- Hospital General de Zona 27, Instituto Mexicano del Seguro Social, México City, México
| | | | | | - Zuzel García-González
- Hospital General de Zona 25, Instituto Mexicano del Seguro Social, México City, México
| | - Diana Villanueva
- Hospital General de Zona 25, Instituto Mexicano del Seguro Social, México City, México
| | - Oscar Orihuela
- Unidad de Investigatión Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - María-del-Carmen Prado-Uribe
- Unidad de Investigatión Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Guadalupe Alcántara
- Unidad de Investigatión Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
| | - Dante Amato
- Unidad de Investigatión Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI
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Paniagua R, Ventura MDJ, Avila-Díaz M, Cisneros A, Vicenté-Martínez M, Furlong MDC, García-González Z, Villanueva D, Orihuela O, Prado-Uribe MDC, Alcántara G, Amato D. Icodextrin improves metabolic and fluid management in high and high-average transport diabetic patients. Perit Dial Int 2009; 29:422-432. [PMID: 19602608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Icodextrin-based solutions (ICO) have clinical and theoretical advantages over glucose-based solutions (GLU) in fluid and metabolic management of diabetic peritoneal dialysis (PD) patients; however, these advantages have not yet been tested in a randomized fashion. OBJECTIVE To analyze the effects of ICO on metabolic and fluid control in high and high-average transport diabetic patients on continuous ambulatory PD (CAPD). PATIENTS AND METHODS A 12-month, multicenter, open-label, randomized controlled trial was conducted to compare ICO (n = 30) versus GLU (n = 29) in diabetic CAPD patients with high-average and high peritoneal transport characteristics. The basic daily schedule was 3 x 2 L GLU (1.5%) and either 1 x 2 L ICO (7.5%) or 1 x 2 L GLU (2.5%) for the long-dwell exchange, with substitution of 2.5% or 4.25% for 1.5% GLU being allowed when clinically necessary. Variables related to metabolic and fluid control were measured each month. RESULTS Groups were similar at baseline in all measured variables. More than 66% of the patients using GLU, but only 9% using ICO, needed prescriptions of higher glucose concentration solutions. Ultrafiltration (UF) was higher (198 +/- 101 mL/day, p < 0.05) in the ICO group than in the GLU group over time. Changes from baseline were more pronounced in the ICO group than in the GLU group for extracellular fluid volume (0.23 +/- 1.38 vs -1.0 +/- 1.48 L, p < 0.01) and blood pressure (systolic 1.5 +/- 24.0 vs -10.4 +/- 30.0 mmHg, p < 0.01; diastolic 1.5 +/- 13.5 vs -6.2 +/- 14.2 mmHg, p < 0.01). Compared to baseline, patients in the ICO group had better metabolic control than those in the GLU group: glucose absorption was more reduced (-17 +/- 44 vs -64 +/- 35 g/day) as were insulin needs (3.6 +/- 3.4 vs - 9.1 +/- 4.7 U/day, p < 0.01), fasting serum glucose (8.3 +/- 36.5 vs -37 +/- 25.8 mg/dL, p < 0.01), triglycerides (54.5 +/- 31.9 vs -54.7 +/- 39.9 mg/dL, p < 0.01), and glycated hemoglobin (0.79% +/- 0.79% vs -0.98% +/- 0.51%, p < 0.01). Patients in the ICO group had fewer adverse events related to fluid and glucose control than patients in the GLU group. CONCLUSION Icodextrin represents a significant advantage in the management of high transport diabetic patients on PD, improving peritoneal UF and fluid control and reducing the burden of glucose overexposure, thereby facilitating metabolic control.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México City, México.
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García-Tuñón I, Ricote M, Ruiz A, Fraile B, Paniagua R, Royuela M. Cell Cycle Control Related Proteins (p53,p21, and Rb) and Transforming Growth Factorβ(TGFβ) in Benign and Carcinomatous (In Situ and Infiltrating) Human Breast: Implications in Malignant Transformations. Cancer Invest 2009; 24:119-25. [PMID: 16537179 DOI: 10.1080/07357900500524314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A comparative study of the products of the cell cycle control genes p53 (mutated form), p21, Rb (nonphosphorylated and phosphorylated form) and TGFbeta was performed by immunohistochemistry and Western blot, in benign breast disorders and breast cancer (in situ and infiltrating tumors). For the five proteins studied, the relative numbers of positively stained cells were higher in in situ carcinoma than in benign breast diseases. In infiltrating breast tumors, the relative numbers of positively stained cells were even higher than in in situ tumors except for the percentage of pRb immunostained cells, which decreased slightly in infiltrative tumors. For the other four proteins, the percentages of positively stained cases were similar to those found in in situ tumors. In the three groups of patients, TGFbeta immunoreaction appeared in the cytoplasm while immunoreactions to p53, p21, Rb, and pRb were found always in the nucleus except for p21 in in situ tumors, which showed cytoplasmic immunoreaction. Present results suggest that accumulation of mutated p53, cytoplasmic p21, and pRb in breast gland epithelium might be a crucial point in the development of in situ adenocarcinoma. In the infiltrating tumors, the expression of p21 in the nuclei and the decrease in pRb expression suggest an insufficient attempt to hinder cell proliferation.
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MESH Headings
- Adult
- Aged
- Blotting, Western
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/physiopathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/physiopathology
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/physiopathology
- Cell Cycle Proteins/biosynthesis
- Cell Transformation, Neoplastic/metabolism
- Cell Transformation, Neoplastic/pathology
- Cyclin-Dependent Kinase Inhibitor p21/biosynthesis
- Female
- Humans
- Immunohistochemistry
- Middle Aged
- Retinoblastoma Protein/biosynthesis
- Transforming Growth Factor beta/biosynthesis
- Tumor Suppressor Protein p53/biosynthesis
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Affiliation(s)
- I García-Tuñón
- Department of Cell Biology and Genetics, University of Alcalá, Madrid, Spain
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Rodriguez H, Tamayo C, Inostroza J, Soto C, Bustos-Obregón E, Paniagua R. Cypermethrin effects on the adult mice seminal glands. Ecotoxicol Environ Saf 2009; 72:658-662. [PMID: 18490057 DOI: 10.1016/j.ecoenv.2008.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 01/30/2008] [Accepted: 03/23/2008] [Indexed: 05/26/2023]
Abstract
The insecticide cypermethrin acts upon the sodium channels. Their effects over animal health are not understood. Here, the effects of cypermethrin on the seminal glands (SGs) are studied (1/5 DL50 i.p.). Forty-five adult mice (CF1) were distributed in three groups: (1) untreated, (2) vehicle (oil), and (3) experimental (cypermethrin in oil). The animals were sacrificed at 1 and each 8.6 days. The SGs were processed for histology: Haematoxylin/P.A.S, Thyonin (0.6%) and Immunohistochemistry (Ki-67). In the SGs was quantified: the epithelium height, mastocytes, and cell proliferation. In the results, cypermethrin exerts an intense effect on epithelium height and cell proliferation. A net increase of both parameters was observed at 24 h (p0.05). However, the mastocytes increased drastically and progressively during the experimental period (p0.05). Then, the effects have acute manifestations, which would be responsible for the potential changes in the male's reproductive potentiality.
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Affiliation(s)
- H Rodriguez
- Laboratory of Reproduction, Faculty of Medicine, Medical School, University of Chile, Avenida Independencia 1027, Santiago. Chile.
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Royuela M, Rodríguez-Berriguete G, Fraile B, Paniagua R. TNF-alpha/IL-1/NF-kappaB transduction pathway in human cancer prostate. Histol Histopathol 2008; 23:1279-90. [PMID: 18712680 DOI: 10.14670/hh-23.1279] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
TNFalpha exerts apoptosis throughout an intracellular transduction pathway that involves the kinase proteins TRAF-2 (integration point of apoptotic and survival signals), ASK1 (pro-apoptotic protein), MEK-4 (p38 activator and metastasis suppressor gene), JNK (stress mitogen activated protein kinase) and the transcription factor AP-1. TNFalpha also exerts proliferation by p38 activation, or when TRAF-2 simultaneously induces the transcription factor NF-kappaB by NIK. NIK and p38 may also be activated by IL-1. P38 activated several transcription factors such as Elk-1, ATF-2 and NF-kappaB. NIK also may activate NF-kappaB. The aim of the present article was to evaluate the different components of this TNFalpha/IL-1 transduction pathway in human prostate carcinoma (PC) in comparison with normal human prostate. In prostate cancer, pro-apoptotic TNFalpha/AP-1 pathway is probably inactivated by different factors such as p21 (at ASK-1 level) and bcl-2 (at JNK level), or diverted towards p38 or NIK activation. IL-1alpha enhances proliferation through IL-1RI that activates either NIK or p38 transduction pathway. P38 and NIK activate different transcription factors related with cell proliferation and survival such as ATF-2, Elk-1 or NF-kappaB. In order to search a possible target to cancer prostate treatment we proposed that inhibition of several proinflamatory cytokines such as IL-1 and TNFalpha might be a possible target for PC treatment, because decrease the activity of all transduction pathway members that activate transcription factors as NF-kappaB, Elk-1 or ATF-2.
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Affiliation(s)
- M Royuela
- Department of Cell Biology and Genetics, University of Alcalá, Alcalá de Henares, Madrid, Spain.
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Nuñez C, Cansino JR, Bethencourt F, Pérez-Utrilla M, Fraile B, Martínez-Onsurbe P, Olmedilla G, Paniagua R, Royuela M. TNF/IL-1/NIK/NF-kappa B transduction pathway: a comparative study in normal and pathological human prostate (benign hyperplasia and carcinoma). Histopathology 2008; 53:166-76. [PMID: 18752500 DOI: 10.1111/j.1365-2559.2008.03092.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Tumour necrosis factor (TNF)-alpha induces death or cell proliferation by activation of nuclear factor (NF)-kappaB, also activated by interleukin (IL)-1 alpha. The aim was to investigate upstream and downstream components of NIK transduction pathway in normal (NP), benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia (PIN) and prostatic carcinoma (PC). METHODS AND RESULTS Immunohistochemistry and Western blotting were performed. In NP, the cytoplasm of epithelial cells was intensely immunoreactive to IL-1 receptor-associated kinase (IRAK), TNF receptor-associated factor (TRAF)-6, NF-kappaB inducing kinase (NIK), I kappa kappa alpha/beta, I kappaB alpha and p-I kappaB; weakly to NF-kappaB-p50; and negative to NF-kappaB-p65. BPH samples were intensely immunoreactive to IRAK, TRAF-6, NIK, I kappa kappa alpha/beta, I kappaB alpha, p-I kappaB; weakly to NF-kappaB-p50 and NF-kappaB-p65. Whereas low-grade PIN showed intermediate results between NP and BPH, results in high-grade PIN were similar to those found in PC (low Gleason). In PC, immunoreactivity was intense for IRAK, TRAF-6, NIK, I kappa kappa alpha/beta (increasing with Gleason), I kappaB alpha, p-I kappaB (decreasing with Gleason); weak for NF-kappaB-p50 and NF-kappaB-p65 (decreasing with Gleason). Nuclear NF-kappaB was observed in PC. CONCLUSIONS NF-kappaB enhances cell proliferation, but also ATF-2 or Elk-1. Since IL-1 and TNF-alpha are related to inflammation and their immunoexpression increases in PC, inhibition of these cytokines might be a possible target for PC treatment, because they decrease the activity of all transduction pathway members that activate transcription factors such as NF-kappaB, Elk-1 or ATF-2.
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Affiliation(s)
- C Nuñez
- Department of Cell Biology and Genetics, University of Alcalá, Madrid, Spain
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Miranda-Novales G, Aburto y-Huesca R, Leaños-Miranda B, Mendoza-Guevara L, Paniagua R, Amato D. [Staphylococcus aureus colonization and risk of developing a subsequent peritonitis episode caused by an identical strain, among pediatric patients admitted for continuous ambulatory peritoneal dialysis]. GAC MED MEX 2008; 144:297-302. [PMID: 18942263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To determine the risk of pediatric end stage renal disease patients undergoing continuous ambulatory peritoneal dialysis to develop a subsecuent peritonitis episode caused by an identical Staphylococcus aureus (SA) strain. METHODS Longitudinal survey carried out in a CAPD center at the nephrology department of a tertiary care (reference) pediatric hospital. At recruitment, swabs were collected from the nares, exit site, and hands, respectively from 29 patients who were followed-up for a mean period of 369 +/- 80 days (range 224-516 days), and from the nares and hands of their mothers. Isolated SA strains were kept in BHI glycerol at -20 degrees C for subsequent analysis. Peritonitis episodes were monitored and registered. When a SA strain was isolated from the dialysate effluent it was compared with the preexisting strain by PFGE. RESULTS We report 7 SA-mediated peritonitis episodes among 6 patients. Only one of these patients was a previous nasal carrier, and 2 were previous exit site carriers of the same SA strain. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the exit site was 0.948. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the nares was 0.525. CONCLUSIONS SA carriers do not appear to be at higher risk of developing peritonitis by an SA related strain than non-carriers. Our results do not lend support to the recommendation of monitoring nasal or exit site carrier status in CAPD patients. The need of attempting to eradicate SA from nose or exit site is also questioned.
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Affiliation(s)
- Guadalupe Miranda-Novales
- Unidad de Investigación Médica en Epidemiología Hospitalaria, Hospital de Pediatría, México DF, México
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Ricote M, García-Tuñón I, Fraile B, Fernández C, Aller P, Paniagua R, Royuela M. P38 MAPK protects against TNF-alpha-provoked apoptosis in LNCaP prostatic cancer cells. Apoptosis 2007; 11:1969-75. [PMID: 17031491 DOI: 10.1007/s10495-006-0086-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE One of the most relevant aspects in cell death regulation is the signalling of apoptosis by the serine/threonine kinases MAPKs. The aim of this study was to investigate the effects of TNF-alpha stimulation on MAPK activation, and the pro- or anti-apoptotic role of these kinases in LNCaP and PC3 cells. MATERIAL AND METHODS Treatments were carried out using several TNF-alpha concentrations, as well as specific pharmacological inhibitors of MAPKs. Apoptosis rates were evaluated by DAPI staining and flow cytometry. MAPK phosphorylation/activation was measured by Western blot. RESULTS TNF-alpha induced apoptosis in a dose-dependent manner in LNCaP but not in PC3 cells. The MAPK inhibitors revealed that the apoptotic rate in LNCaP cells increased significantly following p38 inhibition. The kinase inhibitors failed to cause changes in apoptosis in PC3 cells. CONCLUSIONS The potentiation of apoptosis by p38 inhibition points to this kinase as a possible target for the treatment of androgen-dependent prostatic cancer.
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Affiliation(s)
- M Ricote
- Departmento de Biología Celular y Genética, Universidad de Alcalá, E-28871, Alcalá de Henares, Madrid, Spain
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Paniagua R, Ramos A, Fabian R, Lagunas J, Amato D. Chronic kidney disease and dialysis in Mexico. Perit Dial Int 2007; 27:405-9. [PMID: 17602147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The increasing rates in incidence and prevalence of chronic kidney disease (CKD) are important challenges for health systems around the world, and are even more significant for undeveloped countries. In Mexico the prevalence of CKD seems to be similar to that in highly developed nations, with diabetes as the leading cause of CKD; however, human and economic resources seem to be insufficient for treatment needs. This is reflected in the unacceptably high mortality rates and in noncompliance with established standards and guidelines. Several measures need to be taken to improve this picture, such as more efficient programs for the prevention of obesity, diabetes, and hypertension. Organizing a national registry of patients with CKD is now a pressing need, as is a continuous search for additional funding and budgets to increase the number of qualified nephrologists and specialized nurses and to continue the much-needed research on CKD.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México.
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Gallardo JM, de Carmen Prado-Uribe M, Amato D, Paniagua R. Inflammation and Oxidative Stress Markers by Pentoxifylline Treatment in Rats with Chronic Renal Failure and High Sodium Intake. Arch Med Res 2007; 38:34-8. [PMID: 17174720 DOI: 10.1016/j.arcmed.2006.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 08/16/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inflammation is a risk factor for mortality in patients with chronic renal failure (CRF). Prevention of extracellular fluid volume expansion and the use of certain drugs such as pentoxifylline (PF) may reduce inflammation and oxidative stress. The aim of this study is to analyze the effect of dietary sodium and PF treatment on the levels of inflammation and oxidative stress markers in rats with CRF. METHODS CRF was induced in rats by 5/6 nephrectomy. Different groups of rats with CRF received low sodium (LNa, 0.01% sodium chloride [NaCl] in the diet), normal sodium (NNa, 0.05% NaCl in the diet), or high sodium diet (HNa, as in NNa plus 0.015% NaCl in the drinking water). An additional group received HNa plus PF treatment (25 mg/kg in the drinking water) for 60 days. Circulating creatinine, tumor necrosis factor alpha (TNF-alpha), nitrites, thiols, malondialdehyde (MDA), and advanced oxidation protein products (AOPP) were measured. RESULTS Higher sodium intake was associated with higher serum creatinine levels (median; interquartile range), LNa, 1.255; 0.715, NNa, 1.305; 0.495, HNa, 2.015; 1.115 mg/dL (p < 0.05), TNF-alpha levels, LNa, 2.7; 23.6, NNa, 36.7; 47.7, HNa, 263.7; 126.5 pg/mL, and AOPP, LNa, 31.72; 7.55, NNa, 45.89; 9.38, HNa, 60.41; 37.42 microg/mL. MDA was not modified by sodium intake. PF treatment decreased serum TNF-alpha (151.7 pg/mL, p < 0.5) and AOPP (49.83 micromol/L, p < 0.03), and increased nitrites and thiols levels when compared with HNa rats. CONCLUSIONS High sodium intake increases the serum concentration of inflammation and oxidative stress markers; these changes are prevented by PF treatment.
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Affiliation(s)
- Juan M Gallardo
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, DF, México. jmgallardo2salud.gob.mx
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Avila-Díaz M, Ventura MDJ, Valle D, Vicenté-Martínez M, García-González Z, Cisneros A, Furlong MDC, Gómez AM, Prado-Uribe MDC, Amato D, Paniagua R. Inflammation and extracellular volume expansion are related to sodium and water removal in patients on peritoneal dialysis. Perit Dial Int 2006; 26:574-80. [PMID: 16973513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Inflammation is an important risk for mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a condition commonly seen in peritoneal dialysis (PD) patients, may be associated with inflammation. However, published support for this relationship is scarce. OBJECTIVES To quantify the proportion of patients on PD with inflammation and to analyze the role of ECFv expansion and the factors related to these conditions. DESIGN A prospective, multicenter cross-sectional study in six hospitals with a PD program. PATIENTS AND METHODS Adult patients on PD were studied. Clinical data, body composition, and sodium and fluid intake were recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and urinary fluid and sodium removal were also measured. RESULTS CRP values positive (>or=3.0 mg/L) for inflammation were found in 147 (80.3%) and negative in 36 patients. Patients with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69 +/- 0.69 vs 47.36 +/- 0.65, men 43.15 +/- 1.14 vs 42.84 +/- 0.65; p < 0.05), higher serum glucose (125.09 +/- 81.90 vs 103.28 +/- 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86 +/- 0.54 vs 3.17 +/- 0.38 g/dL, p < 0.001) levels. They also had lower ultrafiltration (1003 +/- 645 vs 1323 +/- 413 mL/day, p < 0.005) and total fluid removal (1260 +/- 648 vs 1648 +/- 496 mL/day, p < 0.001), and less peritoneal (15.59 +/- 162.14 vs 78.11 +/- 110.70 mEq/day, p < 0.01) and total sodium removal (42.06 +/- 142.49 vs 118.60 +/- 69.73 mEq/day, p < 0.001). In the multivariate analysis, only ECFv/TBW was significantly (p < 0.04) and independently associated with inflammation. ECFv/TBW was correlated with fluid removal (r = 0.16, p < 0.03) and renal sodium removal (r = 0.2, p < 0.01). CONCLUSION The data suggest that ECFv expansion may have a significant role as an inflammatory stimulus. The results disclose a relationship between the two variables, ECFv expansion and inflammation, identified as independent risk factors for mortality in PD patients.
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Affiliation(s)
- Marcela Avila-Díaz
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México.
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Rodríguez-Ayala E, Avila-Díaz M, Foyo-Niembro E, Amato D, Ramirez-San-Juan E, Paniagua R. Effect of parathyroidectomy on cardiac fibrosis and apoptosis: possible role of aldosterone. Nephron Clin Pract 2006; 103:p112-8. [PMID: 16557029 DOI: 10.1159/000092244] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Accepted: 10/16/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM It has been demonstrated that parathyroidectomy prevents left ventricular hypertrophy in uremic animals. Although this effect may be mediated by direct actions of parathormone (PTH), it may also be exerted through regulation of profibrotic factors such as aldosterone. In adrenal cortex cell cultures, PTH increases aldosterone release. The objective of this work is to assess the effect of parathyroidectomy on aldosterone levels and on cardiac fibrosis and apoptosis in uremic rats. METHODS Four groups of rats were studied: C, control; 5/6Nx, 5/6 nephrectomy; PTx, parathyroidectomy, and 5/6NxPTx, 5/6 nephrectomy plus parathyroidectomy. Thirty days after the last surgical procedure the animals were sacrificed. Serum creatinine, ionized calcium, aldosterone, PTH, cardiac weight, fibrosis and apoptosis were measured. RESULTS Serum creatinine levels were significantly higher in 5/6Nx and 5/6NxPTx groups (1.62 +/- 0.21 and 1.38 +/- 0.15 mg/dl) than in C and PTx groups (0.66 +/- 0.02 and 0.47 +/- 0.01 mg/dl, p < 0.001). Potassium levels were significantly higher in the 5/6Nx and 5/6NxPTx groups (5.2 +/- 0.3 and 5.4 +/- 0.3 mg/dl) than in the C group (4.3 +/- 0.06 mg/dl, p < 0.05). Values in 5/6Nx and 5/6NxPTx groups were not significantly different from each other. PTH levels were significantly higher in the 5/6Nx group (470.5 +/- 156.3 microg/ml) than in the controls (102.3 +/- 14.3 microg/ml). PTH levels in the PTx group (1.78 +/- 0.52 microg/ml) and in the 5/6NxPTx group (81.64 +/- 32.15 microg/ml) were similar to control values. Ionized calcium was lower in PTx and 5/6NxPTx groups (0.80 +/- 0.07 and 0.89 +/- 0.07 mmol/l) as compared with C and 5/6Nx groups (1.14 +/- 0.01 and 0.96 +/- 0.01 mmol/ l, p < 0.01). The heart weight as percentage of the body weight increased significantly in 5/6Nx animals (4.20 +/- 0.15%) compared to the C group (3.41 +/- 0.27%, p < 0.05); parathyroidectomy reversed the heart weight increment in the 5/6NxPTx animals (3.58 +/- 0.16%). Myocardial fibrosis was significantly higher in the 5/6Nx group (12.5 +/- 1.1%) than in the C group (7.3 +/- 1.5%, p < 0.001); in the 5/6NxPTx animals fibrosis returned towards control values (8.9 +/- 0.2%). Myocardial apoptosis rose significantly in 5/6Nx animals (24.3 +/- 1.2%) compared to the C group (6.7 +/- 0.83%, p < 0.001); parathyroidectomy reversed the apoptosis in the 5/6NxPTx animals (10.4 +/- 0.49%). Aldosterone levels increased significantly in the 5/6Nx group (2,461 +/- 257 pg/ml) compared to the C group (703 +/- 81 pg/ml, p < 0.001); in the 5/6NxPTx animals aldosterone levels were below control values (509 +/- 99 pg/ml). CONCLUSIONS Uremia was associated to myocardial hypertrophy, fibrosis and apoptosis. Surgically induced hypoparathyroidism prevented the development of these disorders. Our results suggest that in the remnant kidney rat model myocardial hypertrophy, fibrosis, and apoptosis are mediated by high circulating aldosterone levels. Aldosterone, in turn, may be regulated by PTH.
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Affiliation(s)
- Ernesto Rodríguez-Ayala
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México, DF.
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