Category Archives: Markers & Measurements
Current Status and Practical Use of Effluent Biomarkers in Peritoneal Dialysis Patients
Hemodialysis.com eInterview with
Raymond T Krediet, MD,PhD
Professor of Nephrology
Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Hemodialysis.com: What are the main findings of the study?
Dr. Krediet: The review summarizes the current knowledge and potential use of substances, that are present in drained peritoneal dialysate due to local production or release, also called effluent biomarkers. Some of these may give a mirror image of certain morphological changes in the peritoneum. Examples are cancer antigen 125 (CA125), that reflects the mesothelial cell mass, interleukin-6, (Il-6) which indicates peritoneal micro-inflammation in the absence of peritonitis, and plasminogen activator inhibitor-1. An example is given of a patient, in whom an earlier diagnosis of encapsulating peritoneal sclerosis (EPS) would have been possible with the use of biomarkers during his follow-up.
Marie Benz, MD on Google+Linking injury to outcome in acute kidney injury: a matter of sensitivity
Hemodialysis.com eInterview with Dr. John Pickering
Senior Research Fellow
Christchurch Kidney Research Group
Department of Medicine
University of Otago Christchurch
john.pickering@otago.ac.nz
Hemodialysis.com: What are the main findings of the study?
Dr. Pickering: The novel injury biomarker thresholds for diagnosis of Acute Kidney Injury (AKI) can be linked to the established serum creatinine thresholds via both their sensitivity for death or dialysis. We used urinary NGAL as an example and presented the results also for Cystatin C, IL18, KIM1, alpha and pi GST, GGT and ALP.
RAGE Polymorphism Is Associated with Chronic Kidney Disease Progression in Subjects Affected by Nephrocardiovascular Disease
Hemodialysis.com eInterview with Drs. Ivano Baragetti and Giuseppe Danilo Norata
Affiliations: Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy, Center for the Study of Atherosclerosis, Italian Society for the Study of Atherosclerosis (SISA) Lombardia Chapter, Bassini Hospital, Cinisello Balsamo, Milan, Italy, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen’s Mary University, London, United Kingdom
Nephrology and Dialysis Unit, Bassini Hospital, Cinisello Balsamo, Milan, Italy
Written Interview conducted with author by Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Answer: The main finding of the present study is the observation of the association of a single nucleotide polymorphism of the Receptor for Advanced Glycation End Products (-374 T/A RAGE) with the progression of chronic kidney disease (CKD). In particular, CKD patients carrying the A allele show a faster decline of renal function (doubled creatinine plasma concentrations and dialysis) than T carriers. This polymorphism induces an enhanced transcription of RAGE mRNA and a potential major expression of membrane RAGE at renal level, thus enhancing the binding of circulating AGEs with RAGE, especially at mesangial level. This effect could in turn sustain local inflammation. Indeed inflammation typical of CKD increases production and accumulation of RAGE ligands: AGEs [1], AOPPs (advanced oxidation protein products), HMGB1, S100 proteins, β2-integrin Mac/CD11b, amyloid β peptide, β sheet-fibrils, complement C3a, lipopolysaccharides and phosphatidylserine on the surface of apoptotic cells [2]. All these molecules are pro-inflammatory [3]. RAGE is expressed at low levels in normal tissues and vessels, but it is upregulated under pathological conditions in sites where the pro-inflammatory ligands accumulate [4] and following activation gives rise to NF-kB mediated cellular responses [5].
Outcomes Associated With Microalbuminuria: Effect Modification By Chronic Kidney Disease
Hemodialysis.com Author Interview:
Csaba P. Kovesdy MD FASN.
The Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program in Nephrology
University of Tennessee Health Science Center
Chief of Nephrology
Division of Nephrology, Memphis VA Medical Center
Hemodialysis.com: What are the main findings of the study?
Dr. Kovesdy: We described an association of urine microalbumin-creatinine ratio (UACR) with mortality and with progression of CKD in close to 300,000 mostly male patients with non-dialysis dependent CKD. We detected a linear association between lower amounts of UACR and better outcomes, down to levels as low as 5 mcg/mg. When we examined these associations in subgroups of patients categorized according to various key characteristics such as level of blood pressure and kidney function, and presence/absence of various comorbid conditions, the same linear associations were present in all except patients with advanced CKD (eGFR<45 ml/min/1.73m2), in whom there was a U-shaped association, and in whom a UACR of 10-20 mcg/mg was associated with the best outcomes.
Effect of serum FGF-23, MGP and fetuin-A on calcium-phosphate metabolism in maintenance hemodialysis patients
Hemodialysis.com Interview with Jian-Ying Niu
Division of Nephrology
the Fifth People’s Hospital of Shanghai 200240 China
Hemodialysis.com: What are the main findings of the study?
Answer: In this study, we enrolled 64 patients (30 males,34 females, 60.6+-11.3 years of age) who received an average dialysis vintage of 6.88+-2.94 years, and evaluated the serum level of FGF-23, MGP and fetuin-A, as well as the coronary artery calcification score (CACS) with coronary artery computed tomography scan.
There were 13 (20.31%), 16 (25%), and 35 (54.69%) patients exhibited a CACS of 0–100, 100–400, and >400, respectively. The dialysis vintage, serum FGF-23, fetuin-A, phosphorus and high-density lipoprotein-C levels were identified as independent variables of CACS by stepwise multiple regression analysis. The area under receiver operating characteristic curve indicated that serum FGF-23 and fetuin-A were useful for identifying CAC in MHD patients. The cut-off value corresponding to the highest Youden’s index was serum FGF-23 ≥ 256 pg/mL and fetuin-A ≤ 85mg/mL, which was defined as the optimal predictors of CAC.
Estimated GFR reporting is associated with decreased NSAID drug prescribing and increased renal function
Hemodialysis.com Author Interview: Dr Li Wei
Senior Lecturer Department of Practice and Policy
UCL School of Pharmacy Tavistock Square London WC1H 9JP
Hemodialysis.com: What are the main findings of the study?
Dr. Li: The study was a population-based longitudinal analysis using a record-linkage database in Tayside, Scotland, UK. The aim of the study was to determine NSAID prescribing before and after the implementation of estimated eGFR reporting and to evaluate renal function in patients who used NSAIDs but stopped these after the first eGFR report. The study found that prescriptions for NSAIDs significantly decreased after the implementation of eGFR reporting. eGFR reporting was associated with reduced NSAID prescriptions (adjusted OR, 0.78 95%CI 0.75-0.82). NSAID prescribing rates in the 6 months prior to April 2006 were 18.8%, 15.4% and 7.0% in patients with CKD stages 3, 4, and 5 and 15.5%, 10.7% and 6.3% respectively, after eGFR reporting commenced. In patients who stopped NSAID treatment, eGFR significantly increased from 45.9 to 46.9, 23.9 to 27.1, and 12.4 to 26.4 ml/min per 1.73m2 in 1340 stage 3 patients, 162 stage 4 patients, and 9 stage 5 patients, respectively.
Semaphorin 3A Is a New Early Diagnostic Biomarker of Experimental and Pediatric Acute Kidney Injury
Hemodialysis.com Interview with Dr. Ganesan Ramesh, Ph.D.
Associate Professor
Department of Medicine/Vascular Biology Center, CB-3702
Georgia Regents University
Augusta, GA 30912
Dr. Ramesh, would you please explain the background and potential usefulness of Semaphorin 3A in Acute Kidney Injury?
Acute kidney injury is a serious and frequent complication in hospitalized and ICU patients.
Currently used diagnostic test, serum creatinine is neither sensitive nor specific to detecting AKI early. This poses a problem for clinicians to intervene early to prevent the kidney damage further. Our aim is to identify a sensitive biomarker that can be used to diagnose kidney injury early and accurately, in a non-invasive manner.
In search for one such biomarker, we identified a protein called semaphorin 3A. Semaphorin 3A.
The GFR and GFR decline cannot be accurately estimated in type 2 diabetics
Hemodialysis.com Authors’ Interview
- Piero Ruggenenti MDPiero Ruggenenti, Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori, Science and TechnologyPark Kilometro Rosso, Via Stezzano, 87, 24126 Bergamo, Italy
- Flavio Gaspari ChemDClinical ResearchCenter for Rare Diseases ‘Aldo & Cele Daccò’,
Mario Negri Institute for Pharmacological Research, Bergamo, Italy - Esteban PorriniNephrology Section and Research Unit, Hospital Universitario de Canarias,
University of La Laguna, Tenerife, Canary Islands, Spain - Giuseppe Remuzzi MDClinical ResearchCenter for Rare Diseases ‘Aldo & Cele Daccò’,
Mario Negri Institute for Pharmacological Research, Bergamo, Italy
Unit of Nephrology, Azienda Ospedaliera ‘Ospedali Riuniti di Bergamo’, Bergamo, Italy
Hemodialysis.com: What are the main findings of the study?
Response: The main finding of our study was that in hypertensive type 2 diabetes, subjects with normo- or micro-albuminuria, estimation formulas fail to detect glomerular hyperfiltration and to reliably describe GFR changes over time.
Baseline GFR was significantly underestimated by all formulas and a six-month GFR reduction was fully missed, in particular in hyperfiltering patients.
Long-term GFR decline was also underestimated by all formulas in the whole study group, as well as in hyper-, normo- and hypofiltering patients considered separately.
